三军总医院

Gastric cancer (GC) remains a global health burden. While international guidelines share consensus, variations exist in disputed issues. The 2025 Taiwan Consensus and Management Guidelines for Gastric Cancer had just been released. We compared the key recommendations with established international guidelines. A multidisciplinary taskforce addressed key questions and recommendations using modified Delphi method and evidence-based approaches. The comparative review aimed to elucidate similarities and differences among guidelines from Taiwan, Japan, South Korea, China, Europe, and the US. Guidelines converge on absolute endoscopic resection criteria for early GC but differ in extended indications and perioperative approaches for locally advanced disease. Heterogeneity exists in biomarker assessment protocols, cutoff thresholds, and companion diagnostics. For metastatic disease, consensus exists on anti-HER2, anti-VEGF, immunotherapy, and biomarker-driven strategies, though oligo-metastatic definitions and intraperitoneal chemotherapy indications remain controversial. Optimal GC management requires integrating global evidence with regional contexts. The comparative review addresses heterogeneity among international guidelines, which helps harmonize management strategies as therapeutic standards evolve.

Although pulmonary hypertension (PH) and interstitial lung disease (ILD) are major contributors to mortality in patients with connective tissue disease (CTD), data on concomitant PH specifically in those with CTD-associated ILD (CTD-ILD) remain limited. We aimed to identify predictors for PH development in CTD-ILD patients, and assess their impact on survival in this population. This retrospective observational study included 224 patients with CTD-ILD, confirmed through multidisciplinary discussion, including patients with inflammatory myopathy-associated ILD (IIM-ILD, n = 88), systemic sclerosis-associated ILD (SSc-ILD, n = 57), rheumatoid arthritis-associated ILD (RA-ILD, n = 55), and primary Sjögren’s syndrome-associated ILD (pSS-ILD, n = 24). PH was diagnosed using right heart catheterization (RHC) or, in patients unable to undergo RHC, by transthoracic echocardiography. Autoantibodies related to IIM and SSc were assessed using Euroimmun immunoblot assays. Among CTD-ILD patients, 28 (12.5

Radiation-induced oral mucositis requires predictive biomarkers for personalized therapy. We evaluated salivary IL-6 for predicting severe mucositis and response to food-grade bee products. Secondary analysis of 51 head/neck cancer patients randomized to honey (n = 15), Taiwanese green propolis (TGP, n = 17), or usual-care (n = 19). Both interventions used standardized preparations (10 g in 20 mL water, 10 mL TID). Salivary cytokines were analyzed using ELISA at baseline and during early radiotherapy. Salivary IL-6 at week 3 of radiotherapy demonstrated superior predictive performance (AUC = 0.780, 95

BACKGROUND:Nurses working in acute and critical care settings, including general wards, intensive care units and emergency departments, are exposed to high job demands that increase the risk of stress and burnout. Self-efficacy has been identified as an important psychological resource that may buffer these effects; yet limited evidence has explored its mediating role in clinical nursing practice. AIM:To examine the association relationships between perceived stress, self-efficacy, and burnout among hospital nurses and to test the mediating role of self-efficacy, with subgroup analysis across demographic and work-related factors. STUDY DESIGN:A cross-sectional design was conducted through quota sampling to recruit registered nurses from a medical centre in Taiwan between July and October 2020. Data were collected using a self-report questionnaire including demographic and work-related characteristics, the Perceived Stress Scale, the General Self-Efficacy Scale and the Burnout Scale. Descriptive analyses and mediation with bootstrapping were used to test the indirect effect of self-efficacy, with stratified analyses for subgroups. RESULTS:Of the 395 nurses invited, 380 completed the survey, yielding a response rate of 96.2%. Higher perceived stress was significantly associated with lower self-efficacy, which in turn increased burnout. Mediation analysis confirmed that self-efficacy played a significant indirect role in the stress-burnout pathway. The mediating effect was particularly evident among nurses aged over 40 years and those working day shifts, groups often holding leadership or supervisory responsibilities in acute and critical care environments. CONCLUSIONS:Self-efficacy is a key psychological mechanism linking stress to burnout among nurses in acute and critical care settings. This study adds evidence that reinforcing self-efficacy may reduce vulnerability to burnout, particularly among senior and supervisory nurses. RELEVANCE TO CLINICAL PRACTICE:Interventions designed to reduce perceived stress while enhancing self-efficacy, such as resilience training, simulation-based education and mentorship programmes may help mitigate burnout, improve nurse retention and support well-being in high-intensity clinical settings.

BACKGROUND:Patients treated with glucagon-like peptide-1 (GLP-1) receptor agonists and sodium glucose co-transporter 2 (SGLT2) inhibitors often have underlying conditions that predispose them to infection. While these agents offer cardiometabolic benefits, concerns persist regarding their impact on infectious risk. Existing literature has not comprehensively assessed their dose-dependent influence on severe infections such as sepsis. OBJECTIVES:To investigate the effect of GLP-1 receptor agonists and SGLT2 inhibitors on infection risk. DATA SOURCES:PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov up to December 18, 2024. STUDY ELIGIBILITY CRITERIA:Randomized controlled trials reporting target infection outcomes related to GLP-1 receptor agonists or SGLT2 inhibitor prescription. PARTICIPANTS:Individuals without evidence of ongoing infection at study initiation. INTERVENTIONS:GLP-1 receptor agonists or SGLT2 inhibitors. ASSESSMENT OF RISK OF BIAS:Cochrane risk of bias tool version 2.0. METHODS OF DATA SYNTHESIS:A frequentist random-effects model was used to assess the comparative incidence of infectious complications-classified as sepsis, abscess/gangrene, or other infections (e.g., pneumonia and urinary tract infection). Drop-out rates served to reflect acceptability. Sensitivity analyses included Bayesian modelling and subgroup analyses of diabetic status and treatment duration. RESULTS:Based on 105 randomized controlled trials with 219 283 participants, no significant association was found between GLP-1 receptor agonists or SGLT2 inhibitors and controls, except for high-dose canagliflozin (300 mg/day), which was the only intervention significantly associated with reduced sepsis risk versus control. This effect persisted in participants with diabetes. No significant associations were found between any other GLP-1 receptor agonist or SGLT2 inhibitor and risk of sepsis, abscess, gangrene, or other infections. Subgroup and meta-regression analyses confirmed robustness. Bayesian modelling yielded comparable results. Treatment duration had minimal influence on primary outcomes. CONCLUSIONS:This analysis identifies no significant evidence of infection-related adverse events related to GLP-1 receptor agonist or SGLT2 inhibitor prescription.