A BSTRACT Objectives: Higher adherence to enhanced recovery after surgery (ERAS) protocols improves outcomes, but real-world anesthetic ERAS data remain limited. This study examines anesthesia-influenced ERAS for colorectal surgery. Materials and Methods: Data from 131 patients receiving colorectal minimally invasive surgery (January 2020–November 2021) at Taipei Tzu Chi Hospital were analyzed. Patients were categorized as non-ERAS, pre-ERAS, or ERAS based on adherence to 25 ERAS components. Primary and secondary outcomes included hospital length of stay (LOS), pain, PONV, bowel recovery, and morphine use. Results: ERAS adherence rates were 91.8% (ERAS), 58.4% (pre-ERAS), and 40.0% (non-ERAS) ( P < 0.0001). The ERAS group had the shortest LOS (4.09 days, P < 0.0001), lowest pain and morphine use, reduced PONV (0%, P = 0.001), and fastest bowel recovery. Conclusion: Surgical ERAS care facilitates functional recovery, whereas anesthetic ERAS care further improves ERAS adherence and postoperative recovery by reducing pain, lowering PONV incidence, and accelerating the return of bowel function.
A BSTRACT Objectives: This study had two main objectives. First, it aimed to identify clusters of health risk behaviors (HRBs) among Taiwanese adolescents and then to examine the associations between these behavior clusters and sociodemographic factors, including grade level, sex, and food insecurity, to validate the identified clusters using known-group methods. Second, it explored the relationships between the clusters and health outcomes, including anxiety and obesity. Materials and Methods: This study used data from the 2012, 2014, and 2016 Taiwan Global School-Based Student Health Survey. Latent class analysis (LCA) identified clusters of HRBs: smoking, alcohol use, unhealthy diet, physical inactivity, and sedentary behavior. Latent class regression assessed the associations between cluster membership and sex, grade, and food insecurity to validate the clusters using the known-group method. The associations between clusters and health outcomes (anxiety and obesity) were examined using posterior weighted-probability logistic regression. Results: After excluding invalid responses, 14,757 junior high school students (grades 7–9) were analyzed. LCA identified three clusters: “low-risk” (55.04%), “dietary deficiency” (33.68%), and “high-risk” (11.28%). Females had higher odds of being in the “dietary deficiency” cluster (adjusted odds ratio [AOR] = 1.43) and lower odds in the “high-risk” cluster (AOR = 0.38). A higher grade level was linked to increased odds of “dietary deficiency” (AOR = 1.67 & AOR = 2.67) and “high risk” (AOR = 1.66 & AOR = 2.35). High food insecurity was strongly associated with both “dietary deficiency” (AOR = 2.97) and “high-risk” (AOR = 9.93). Compared with the low-risk cluster, only high-risk cluster was associated with higher odds of anxiety (AOR = 2.4), while no significant association was observed with obesity after adjustment for covariates. Conclusion: This study demonstrates that HRBs among adolescents co-occur, forming three distinct clusters. Because only the “high-risk” group showed a significant association with adverse health outcomes such as anxiety, health programs should focus on high-risk adolescents.
A BSTRACT Objectives: This study aimed to compare irregular antibody detection and transfusion reaction rates between the manual polybrene (MP) method and an automated column agglutination technology (CAT) system in an eastern Taiwan medical center and to assess whether automation refines the detection profile without compromising transfusion safety. Materials and Methods: This retrospective study analyzed pretransfusion testing data and transfusion reaction reports from 2018 to 2020 (MP period) and 2022–2024 (CAT period). Irregular antibody screening was performed using the MP method in the MP period and an automated Ortho BioVue CAT system in the CAT period. Irregular antibody-positive rates, antibody specificities by blood group system, and transfusion reaction rates stratified by severity were compared between periods using Pearson’s Chi-square test or Fisher’s exact test, with P < 0.05 considered statistically significant. Results: Among 74,391 pretransfusion requests, the overall irregular antibody-positive rate decreased from 4.40% to 3.44% ( P < 0.001). Single-antibody detection declined from 76.95% to 73.46% ( P < 0.001), whereas multiple-antibody detection showed a modest, nonsignificant increase from 23.05% to 26.54% ( P = 0.158). Anti-Mi a remained the most frequent antibody, whereas several cold-reactive antibodies were detected less frequently with CAT. The overall transfusion reaction rate decreased from 0.97% to 0.74% ( P < 0.001), largely because of the fewer moderate reactions. Conclusion: The transition from MP to automated CAT was associated with a reduction in the overall irregular antibody-positive rate, with less frequent detection of cold-reactive antibodies of limited clinical significance and preserved detection of clinically important alloantibodies. The concurrent decline in transfusion reaction rates is consistent with the established benefit of prestorage leukoreduction, although the individual contributions of CAT adoption and leukoreduction cannot be determined from the present dataset. This study provides real-world evidence to support automation implementation and blood bank workflow optimization, with a sustained focus on clinically significant antibodies and transfusion safety surveillance.
Neurogenic lower urinary tract dysfunction (NLUTD) is frequently characterized by coexisting storage and voiding abnormalities, particularly in patients with spinal cord injury (SCI) and concomitant detrusor overactivity (DO) and detrusor sphincter dyssynergia (DSD). Conventional therapies often improve either storage or voiding function at the expense of the other, creating a significant therapeutic challenge. Combined intradetrusor and urethral botulinum neurotoxin type A (BoNT-A) injection has emerged as a potential dual-target strategy aimed at simultaneously improving bladder storage and facilitating bladder emptying. This review summarizes the current evidence regarding concomitant detrusor and urethral BoNT-A injection in patients with NLUTD. Available clinical data are limited and are derived predominantly from male patients with SCI, DO, and DSD. Preliminary studies have demonstrated improvements in urodynamic parameters, urinary continence, spontaneous voided volume, bladder compliance, and quality of life without significantly increasing clean intermittent catheterization frequency or post-void residual ratio. These findings suggest that combined injection may provide a therapeutic balance between storage and emptying functions while preserving spontaneous voiding. However, current evidence remains limited by small sample sizes, heterogeneous study designs, and the absence of randomized controlled trials. Important questions regarding optimal patient selection, long-term efficacy, and generalizability to other neurogenic conditions remain unanswered. Although future application in selected nonneurogenic patients may be possible, further prospective studies are required to establish the role of combined detrusor and urethral BoNT-A injection in the management of NLUTD.
Objectives: To investigate the functional role of chloride-dependent signaling pathways in urinary bladder smooth muscle (SM) contractility and to evaluate the expression of ClC-3 and CLCA4 in rat bladder tissue. Materials and Methods: Expression of ClC-3 and CLCA4 in rat bladder tissue was examined using Western blotting and immunohistochemistry. Functional studies were conducted using isolated bladder SM strips (2 mm × 2 mm × 10 mm) from adult male Wistar rats mounted in organ bath chambers for isometric tension recording. Potassium chloride (KCl)-induced contractions were assessed under varying extracellular chloride concentrations (138–8 mM) and after substitution with Br− or I− . Norepinephrine (NE)-induced contractions were evaluated with pretreatment of chloride transport inhibitors (bumetanide, HEPES without bicarbonate, and ethacrynic acid) and chloride channel blockers (4,4’-diisothiocyano-2,2’-stilbene-disulfonic acid, anthracene-9-carboxylic acid, and niflumic acid) at different concentrations. Results: ClC-3 and CLCA4 were expressed in both urothelial and SM layers. Reduction of extracellular chloride concentration significantly attenuated KCl-induced contractions in a concentration-dependent manner (P < 0.01) and substitution with bromide or iodide produced similar effects. Chloride transport inhibitors and channel blockers significantly and dose-dependently suppressed NE-induced contractions (all P < 0.01). The inhibitory effects were consistently observed across multiple pharmacological interventions. Conclusion: The present study provides pharmacological and molecular evidence supporting a contributory role of chloride-dependent signaling in bladder SM contractility under ex vivo conditions. Expression of ClC-3 and CLCA4 in urothelial and SM layers further suggests that chloride-dependent regulation may involve multiple bladder compartments. Although the precise molecular mechanisms remain incompletely defined, these findings support further investigation into chloride-dependent signaling pathways in bladder physiology and dysfunction.
