Publications by authors named "Ka-Wai Tam"

124 Publications

Effects of intranasal oxytocin in food intake and craving: A meta-analysis of clinical trials.

Clin Nutr 2021 Oct 24;40(10):5407-5416. Epub 2021 Aug 24.

Center for Evidence-Based Health Care, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Dentistry, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan. Electronic address:

Objective: A rise of endogenous oxytocin (OT) is associated with anxiety and meal size reduction, and the effects of intranasal OT (INOT) have been examined in the management of food intake and craving. However, the discrepancy INOT effects in different disease populations are not entirely clear.

Research Design And Methods: Updated systematic review and meta-analysis. By systematically searching the PubMed, Embase and Cochrane Library, we obtained 12 controlled trials. We performed meta-analyses to examine food intake, craving, anxiety or stress reduction on INOT administration, using standard mean difference (SMD) with a 95% confidence interval (CI) and a random-effects model.

Results: This study examined 12 trials with 266 non-psychiatric and 157 psychiatric participants. The pooled results showed that single-dose INOT induced a significant lesser food intake in non-psychiatric subjects (SMD: -0.66 [95% CI: -1.18, -0.14]), but no effects was found in anorexia nervosa (AN) (SMD: 0.17 [95% CI: -0.32, 0.66]), bulimia nervosa (BN) and binge eating disorder (BED) (SMD: -0.41 [95% CI: -0.94, 0.11]), and schizophrenia (SMD: 0.04 [95% CI: -0.94, 1.02] subjects. Further analysis on leisure food also indicated an inhibition of consumption of chocolate biscuits in non-psychiatric subjects. Neither the non-psychiatric (SMD: -0.08 [95% CI: -0.50, 0.33]) nor the BN and BED (SMD: -0.08 [95% CI: -0.72, 0.88]) and schizophrenia subjects (SMD: -0.07 [95% CI: -1.05, 0.91]) demonstrated a difference in food craving or hunger compared with placebo. Anxiety or stress level was not influenced by INOT in any subgroup (non-psychiatric, SMD: 0.19 [95% CI: -0.22, 0.60]; AN, SMD: -0.01 [95% CI: -0.28, 0.88]; BN and BED: SMD: 0.00 [95% CI: -0.80, 0.80]).

Conclusions: Single-dose INOT significantly reduces food intake in nonpsychiatric subjects, and further studies are necessary to assess the long-term effects and safety in obese patients. Whether INOT could be a treatment option for patients with eating disorders remains to be investigated.
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http://dx.doi.org/10.1016/j.clnu.2021.08.011DOI Listing
October 2021

Early versus delayed feeding after therapeutic endoscopic procedures: Meta-analysis of randomized controlled trials.

Dig Endosc 2021 Sep 18. Epub 2021 Sep 18.

Division of Emergency Medicine, Department of Emergency and Critical Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.

Introduction: Early feeding was previously considered to increase the risk of postprocedural bleeding. However, many trials have demonstrated the benefits of early feeding after therapeutic endoscopic procedures. We conducted a meta-analysis of randomized controlled trials to evaluate the safety and outcomes between early feeding and delayed feeding after therapeutic endoscopic procedures.

Methods: Medline (PubMed), Embase, Google Scholar, the Cochrane Library, and clinicaltrials.gov were searched to identify randomized controlled trials that met our inclusion criteria. The pooled data for the mortality rate, postprocedural bleeding rate, and length of hospital stay were analyzed.

Results: A total of seven trials consisting of 717 patients were reviewed. These seven trials examined various therapeutic endoscopic procedures. Three trials included patients undergoing endoscopic hemostasis for upper gastrointestinal bleeding, two included patients undergoing esophageal variceal ligation, and two included patients with gastric neoplasm treated with endoscopic submucosal dissection. Although no significant differences were observed in the postprocedural bleeding rate or the mortality rate between patients who received early feeding and those who received delayed feeding, early feeding resulted in shorter hospital stays (weighted mean difference -1.04, 95% confidence interval -1.45 to 0.63).

Conclusion: Early feeding appears to be a safe management method for patients undergoing therapeutic endoscopic procedures. Therefore, we recommend early feeding for these patients.
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http://dx.doi.org/10.1111/den.14140DOI Listing
September 2021

Effect of Urea Cream on Hand-Foot Syndrome in Patients Receiving Chemotherapy: A Meta-analysis.

Cancer Nurs 2021 Aug 31. Epub 2021 Aug 31.

Author Affiliations: School of Medicine, College of Medicine, Taipei Medical University (Drs Lan and Tsou); Center for Evidence-Based Health Care and Department of Medical Research, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, and Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City (Dr Tam); and Cochrane Taiwan (Drs Tam and Huang) and School of Nursing, College of Nursing, Taipei Medical University, Taipei, and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei (Dr Huang).

Background: Hand-foot syndrome (HFS) is a specific adverse effect of certain chemotherapy that may lead to dosage reduction or chemotherapy discontinuation in patients with cancer. Topical urea cream may reduce symptom severity in patients with HFS. However, these studies have not provided consonant results.

Objective: To determine the effectiveness of urea cream, we conducted a meta-analysis of clinical trials to evaluate the prevention and treatment of HFS.

Methods: PubMed, EMBASE, and Cochrane Library databases were searched for studies published before September 2020. The study registered at PROSPERO (CRD 42020203164). Incidence of HFS reported in studies at any grade and at second grade or greater was assessed within 3 to 12 weeks. Secondary outcomes were time to HFS, incidence of skin-related adverse events, chemotherapy dose reduction, and quality of life.

Results: Seven trials involving 1387 patients were reviewed. In the prophylactic subgroup, patients with urea cream intervention showed a significantly lower incidence of HFS at second grade or greater (risk ratio, 0.72; 95% confidence interval, 0.58-0.90) and a nonsignificant lower incidence of any-grade HFS (risk ratio, 0.79; 95% confidence interval, 0.58-1.08) than those not receiving urea cream intervention.

Conclusions: Urea cream has advantages to reduce the incidence of severe HFS.

Implications For Practice: Urea cream is a safe and viable topical prevention strategy that can reduce the incidence of high-grade HFS in patients undergoing chemotherapy. We recommend a routine treatment option before chemotherapy for the patients.
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http://dx.doi.org/10.1097/NCC.0000000000001008DOI Listing
August 2021

Author's Reply.

J Minim Invasive Gynecol 2021 Aug 28. Epub 2021 Aug 28.

New Taipei City, Taiwan.

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http://dx.doi.org/10.1016/j.jmig.2021.08.017DOI Listing
August 2021

Influence of Shared Decision Making on Decisional Conflict and Regret in Postpartum Mother-Infant Care: A Randomized Controlled Trial.

Value Health 2021 Sep 3;24(9):1335-1342. Epub 2021 May 3.

Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital and Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Objectives: Although postpartum rooming-in is encouraged by the World Health Organization, independent separated nursery care is still widely adopted in Eastern countries. Our aim is to evaluate the effect of shared decision making (SDM) assisted by patient decision aids on subjective decisional conflict and regret among women who are required to make choices regarding postpartum infant care.

Methods: A total of 196 pregnant women who came for routine checkups 1 month before delivery were randomly assigned to the SDM group or the classic group. Before the mothers were discharged after delivery, their decision-making difficulties were evaluated. The primary outcome was the decisional conflict, which was assessed using the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) scale. The secondary outcome was the decisional regret, which was measured using the Decision Regret scale.

Results: Compared with the classic group, SDM group had surer feelings about the choice (P<.001), felt more confident about knowing the benefits and risks of each option (P<.001), had a clearer understanding of the benefits and risks (P<.001), and felt sufficiently supported with enough advice to make a suitable choice (P<.001). No significant difference was noted in the Decision Regret scores between groups. The choice of 24-hour rooming-in, 12-hour rooming-in, and separated nursery care was not significantly different between groups.

Conclusions: SDM reduced the decisional conflict and uncertainty of the mothers. Available choices of postpartum mother-infant care should be provided to mothers through SDM that includes individual values, health goals, and clear knowledge and transparency.
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http://dx.doi.org/10.1016/j.jval.2021.03.011DOI Listing
September 2021

Efficacy and safety of botulinum toxin for treating sialorrhea: A systematic review and meta-analysis.

Eur J Neurol 2021 Aug 27. Epub 2021 Aug 27.

Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.

Background And Purpose: Sialorrhea often happens in patients with neurologic disorders, and botulinum toxin (BoNT), which inhibits acetylcholine activation, may be an effective treatment for drooling. This systematic review and meta-analysis of randomized control trials aims to evaluate the efficacy and safety of BoNT in adults and children with sialorrhea due to neurological disorders.

Methods: The PubMed, Embase, and Cochrane databases were searched for relevant studies published before August 2021. The pooled estimate of outcomes was calculated using a random effect model.

Results: The review included 17 studies involving 981 patients. Compared with placebo, both BoNT type A (BoNT-A) and BoNT type B (BoNT-B) alleviated drooling frequency and severity (mean difference, 95% CI; BoNT-A: -1.20, -1.89 to -0.51; BoNT-B: -1.62, -2.07 to -1.17), reduced saliva weight (BoNT-A: -1.70, -2.30 to -1.10; BoNT-B: -1.12, -1.97 to -0.27), and improved global impression of change (BoNT-A: -1.30, -1.73 to -0.86; BoNT-B: -1.58, -1.95 to -1.21) in adults 4 weeks postinjection. BoNT-B remained effective at 12 weeks. In children, BoNT-A and BoNT-B alleviated sialorrhea symptoms (BoNT-A: -1.63, -2.42 to -0.85; BoNT-B: -5.20, -6.03 to -4.37) and BoNT-A reduced saliva weight (-0.77, -1.54 to 0.00) at 4 weeks postinjection. After 12 weeks, BoNT-B remained efficacious. Most adverse effects (AEs) were mild to moderate and self-limited.

Conclusions: There is moderate certainty of evidence (COE) that either BoNT-A or BoNT-B could relieve sialorrhea after 4 and 12 weeks of follow-up without significantly more severe AEs in adults. However, the COE is very low to low in children.
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http://dx.doi.org/10.1111/ene.15083DOI Listing
August 2021

Effects of Low-Level Laser Therapy on Muscular Performance and Soreness Recovery in Athletes: A Meta-analysis of Randomized Controlled Trials.

Sports Health 2021 Aug 25:19417381211039766. Epub 2021 Aug 25.

Cochrane Taiwan, Taipei Medical University, Taipei.

Context: Athletes must maintain their peak state of strength. Previous studies have investigated the effect of low-level laser therapy (LLLT) on muscular performance. A previous systematic review and meta-analysis has investigated this issue in healthy participants but not in physically active athletes.

Objective: To investigate whether LLLT can improve muscular performance and soreness recovery in athletes.

Data Sources: PubMed, EMBASE, and Cochrane Library.

Study Selection: Published randomized controlled trials and crossover studies till December 2020.

Study Design: Systematic review and meta-analysis.

Level Of Evidence: Level 3.

Data Extraction: Assessment of study quality was rated using the risk of bias assessment method for randomized trials (Cochrane Handbook for Systematic Reviews of Interventions).

Results: A total of 24 studies were included. LLLT application before exercise significantly improved lower-limb muscle strength in 24-hour, 48-hour, 96-hour, and 8-week follow-up groups. Furthermore, decreased soreness index, serum creatine kinase concentrations, interleukin-6, and thiobarbituric acid reactive substance concentrations and a trend toward the improvement of contract repetition number and VO kinetic outcomes were observed.

Conclusion: Although a definite therapeutic effect of LLLT is yet to be established, the current evidence supports that LLLT use improves muscular performance in physically active athletes. Additional trials with large sample sizes and robust design should be conducted before strong recommendations are made.
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http://dx.doi.org/10.1177/19417381211039766DOI Listing
August 2021

Reply to Letter to Editor concerning "Effects of preoperative oral carbohydrate on postoperative discomfort in patients undergoing elective surgery: a meta-analysis of randomized controlled trials".

Langenbecks Arch Surg 2021 Jul 18. Epub 2021 Jul 18.

Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

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http://dx.doi.org/10.1007/s00423-021-02278-7DOI Listing
July 2021

The optimal strategy for pertussis vaccination: a systematic review and meta-analysis of randomized control trials and real-world data.

Am J Obstet Gynecol 2021 Jul 2. Epub 2021 Jul 2.

Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan. Electronic address:

Objective: Severe pertussis infection has been reported in infants before receiving routine immunization series. This problem could be solved by vaccinating mothers during pregnancy or children at birth. This study aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) and real-world evidence to evaluate the optimal strategy for pertussis vaccination.

Data Sources: PubMed, Embase, and the Cochrane Library databases were searched until December 2020.

Study Eligibility Criteria: RCTs, cohort studies, case-control studies, and case series were included if they investigated the efficacy, immunogenicity, and safety of acellular pertussis vaccine during pregnancy and at birth.

Methods: Number of pertussis cases, severe adverse events (SAEs), and pertussis antibody concentration in infants before and after they receive routine vaccination series were extracted and random-effect model was used to pool the analyses.

Results: Overall, 29 studies were included. Our meta-analysis revealed that pertussis immunization during pregnancy significantly increased the concentrations of 3 pertussis antibodies and reduced the incidence rates of infected infants below 3 months of age (odds ratio, 0.22; 95% confidence interval, 0.14-0.33). Similarly, infants vaccinated at birth had higher levels of pertussis antibody than those who were not. No significant difference in rates of severe adverse events was seen in all vaccination groups (during pregnancy [risk ratio, 1.18; 95% confidence interval, 0.76-1.82] and at birth [risk ratio, 0.72; 95% confidence interval, 0.34-1.54]).

Conclusion: Pertussis vaccination during pregnancy could protect infants against pertussis disease before the routine vaccination. Pertussis immunization at birth would be an alternative for infants whose mothers did not receive pertussis vaccines during pregnancy.
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http://dx.doi.org/10.1016/j.ajog.2021.06.096DOI Listing
July 2021

Recruitment maneuvers in patients undergoing thoracic surgery: a meta-analysis.

Gen Thorac Cardiovasc Surg 2021 Jun 21. Epub 2021 Jun 21.

Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.

Objective: Pulmonary atelectasis is a common postoperative complication that may lead to intrapulmonary shunt, refractory hypoxemia, and respiratory distress. Recruitment maneuvers may relieve pulmonary atelectasis in patients undergoing thoracic surgery. This meta-analysis of randomized controlled trials (RCTs) is to evaluate the effectiveness and safety of recruitment maneuvers in patients undergoing thoracic surgery.

Methods: We performed a literature search on the PubMed, Embase, and Cochrane Library databases and the ClinicalTrials.gov registry for trials published before April 2021. We investigated postoperative pulmonary atelectasis incidence, intrapulmonary shunt fraction, static lung compliance, and mean arterial pressure.

Results: Six RCTs involving 526 patients were reviewed. Patients receiving a recruitment maneuver exhibited a significant decrease in intrapulmonary shunt fraction [weighted mean difference (WMD) - 0.02, 95% CI - 0.03 to - 0.01], improved static lung compliance (WMD 2.16; 95% CI 1.14-3.18), and PaO/FIO ratio (WMD 31.31; 95% CI 12.11-50.52) without a significant difference in mean arterial pressure (WMD - 0.64; 95% CI - 4.92 to 3.64). The incidence pulmonary atelectasis favored recruitment maneuver group, but was not statistically significant (RR 0.55; 95% CI 0.27-1.12).

Conclusions: Recruitment maneuvers may be a viable treatment for reducing intra-pulmonary shunt and improving static lung compliance and PaO/FIO ratio without the disturbance of hemodynamics in patients undergoing thoracic surgery.
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http://dx.doi.org/10.1007/s11748-021-01673-7DOI Listing
June 2021

Comparison of High-Intensity Focused Ultrasound and Conventional Surgery for Patients with Uterine Myomas: A Systematic Review and Meta-Analysis.

J Minim Invasive Gynecol 2021 Oct 11;28(10):1712-1724. Epub 2021 Jun 11.

Division of General Surgery, Department of Surgery (Dr. Tam), Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, (Dr. Tam), Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery (Dr. Tam), Taipei Medical University, Taipei, Taiwan; Shuang Ho Hospital, and Cochrane Taiwan (Dr. Tam), Taipei Medical University, Taipei, Taiwan. Electronic address:

Objective: Uterine myomas are one of the most common gynecologic tumors in premenopausal women. The conventional surgical treatments are myomectomy and hysterectomy, but high-intensity focused ultrasound (HIFU) is a new noninvasive treatment creating no surgical wound. The aim of this study was to evaluate the effectiveness and safety of HIFU treatment compared with conventional surgery for patients with uterine myomas.

Data Sources: PubMed, Embase, and the Cochrane Library were searched for studies published before January 2021.

Methods Of Study Selection: Studies comparing the outcome of HIFU and conventional surgery-myomectomy and hysterectomy-for patients with uterine myomas were included. We conducted meta-analyses by using a random effects model. Uterine myoma symptom score and quality-of-life score were analyzed using the mean difference (MD). The recovery time and frequency of major adverse events were also evaluated.

Tabulation, Integration, And Results: Ten studies were included. HIFU relieved uterine myoma symptoms significantly when compared with conventional surgery at 6 (MD -1.61; 95% confidence interval [CI], -2.88 to -0.33) and 12 (MD -2.44; 95% CI, -3.68 to -1.20) months after treatment. Similarly, HIFU group improve the quality-of-life score significantly at 6 (MD 2.14; 95% CI, 0.86-3.42) and 12 (MD 2.34; 95% CI, 0.82-3.86) months after treatment when compared with the surgery group.

Conclusion: HIFU could be an effective and safe treatment option for patients with uterine myomas. However, one of its side effects, skin burns, requires further research and discussion. Additional studies involving more randomized controlled trials are warranted.
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http://dx.doi.org/10.1016/j.jmig.2021.06.002DOI Listing
October 2021

Effectiveness of palonosetron versus granisetron in preventing chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis.

Eur J Clin Pharmacol 2021 May 15. Epub 2021 May 15.

Department of Pharmacy, En Chu Kong Hospital, 399 Fuxing Road Sanxis District, New Taipei City, 23741, Taiwan.

Purpose: Chemotherapy-induced nausea and vomiting (CINV) commonly occurs after chemotherapy, adversely affecting patients' quality of life. Recently, studies have shown inconsistent antiemetic effects of two common 5-hydroxytryptamine 3 receptor antagonists, namely, palonosetron and granisetron. Therefore, we conducted a meta-analysis to evaluate the effectiveness of palonosetron versus granisetron in preventing CINV.

Methods: Relevant studies were obtained from PubMed, Embase, and Cochrane databases. The primary outcome was the complete response (CR) rate. Secondary outcomes were headache and constipation events.

Results: In total, 12 randomized controlled trials and five retrospective studies were reviewed. Palonosetron was consistently statistically superior to granisetron in all phases in terms of the CR rate (acute phases: odds ratio [OR] = 1.28, 95% confidence interval [CI] = 1.06-1.54; delayed phases: OR = 1.38, 95% CI = 1.13-1.69; and overall phases: OR = 1.37, 95% CI = 1.17-1.60). Moreover, a non-significant difference was found between the two groups in terms of the headache event, but the occurrence of the constipation event was lower in the granisetron group than in the palonosetron group.

Conclusion: Palonosetron showed a higher protective efficacy in all phases of CINV prevention, especially in delayed phases, and no relatively severe adverse effects were observed.
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http://dx.doi.org/10.1007/s00228-021-03157-2DOI Listing
May 2021

Efficacy and safety of adjuvant therapy after curative surgery for ampullary carcinoma: A systematic review and meta-analysis.

Surgery 2021 Oct 24;170(4):1205-1214. Epub 2021 Apr 24.

Center for Evidence-based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taiwan. Electronic address:

Background: Ampullary carcinoma patients require radical resection for optimal survival; however, the outcomes are often unsatisfactory. The utility of adjuvant therapy among such patients is unclear, probably owing to its potential side effects. Therefore, this study investigated the benefits and safety of adjuvant therapy in resected ampullary carcinoma.

Methods: Cochrane, Embase, Medline, and PubMed databases were systematically searched for eligible studies, and those comparing adjuvant therapy and surgical treatment alone were included. Hazard ratios for survival outcomes and the number of adverse events for safety endpoints were extracted and subjected to pooled analyses through a random-effects model.

Results: In total, 27 studies involving 3,538 patients were included. Adjuvant therapy was significantly associated with decreased mortality risk (hazard ratio, 0.58; 95% confidence interval 0.40-0.84), especially for chemoradiotherapy (hazard ratio, 0.42; 95% confidence interval 0.28-0.62). Furthermore, adjuvant therapy was significantly associated with increased overall survival among high-risk patients (hazard ratio, 0.63; 95% confidence interval 0.48-0.82) or those with the pancreaticobiliary subtype (hazard ratio, 0.53; 95% confidence interval 0.32-0.85). By contrast, adjuvant therapy was not associated with improved overall survival among low-risk patients (hazard ratio, 0.93; 95% confidence interval 0.52-1.68) or those with the intestinal subtype (hazard ratio, 1.06; 95% confidence interval 0.57-1.95). Regarding the safety of adjuvant therapy, no intervention-related mortality occurred, and severe adverse events were within the acceptable range (risk difference, 0.04; 95% confidence interval 0.01-0.08).

Conclusion: The present results suggest that adjuvant therapy is safe and extends survival in high-risk patients or those with the pancreaticobiliary subtype of ampullary carcinoma.
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http://dx.doi.org/10.1016/j.surg.2021.03.046DOI Listing
October 2021

Effectiveness of N-acetylcysteine in Treating Clinical Symptoms of Substance Abuse and Dependence: A Meta-analysis of Randomized Controlled Trials.

Clin Psychopharmacol Neurosci 2021 May;19(2):282-293

Center for Evidence-Based Health Care and Shared Decision Making Resource Center, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.

Objective: Treatment with N-acetylcysteine (NAC) is believed to reduce the clinical symptoms among individuals with substance abuse or dependence. We conducted a meta-analysis of randomized controlled trials to evaluate the effectiveness of NAC in treating substance abuse and dependence.

Methods: PubMed, EMBASE, ClinicalTrials.gov registry, and the Cochrane Library were searched for trials published before June 2020.

Results: A total of 16 trials were analyzed. The treatment effectiveness domains assessed in this study were craving and depressive symptoms, withdrawal syndrome, adverse events, and smoking frequency. Standardized mean difference (SMD), weighted mean difference (WMD), and odds ratio (OR) were used for evaluation where appropriate. A significant decrease in craving symptoms was observed in the NAC treatment group compared with the control group (SMD, -0.67; 95% confidence interval [CI], -1.21 to 0.21). When withdrawal and depressive symptoms were considered as a single domain, the NAC treatment group demonstrated a significantly higher overall improvement than the control group (SMD, -0.35; 95% CI, -0.64 to -0.06). No between-group differences in term of the OR of adverse events (OR, 1.18; 95% CI, 0.68 to 2.06) and a non-significant trend toward reduction in smoking frequency was observed in the NAC treatment group compared with the control group (WMD, -3.09; 95% CI, -6.50 to 0.32).

Conclusion: NAC provides certain noticeable benefits in attenuating substance craving and might help alleviate depressive symptoms and withdrawal syndrome. Precautious measures should be considered when using NAC although no difference in adverse effects was found between NAC treatment and control group.
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http://dx.doi.org/10.9758/cpn.2021.19.2.282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077050PMC
May 2021

Effects of pulmonary rehabilitation program on amyotrophic lateral sclerosis: A meta-analysis of randomized controlled trials.

NeuroRehabilitation 2021 ;48(3):255-265

Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.

Background: Patients with amyotrophic lateral sclerosis (ALS) develop respiratory failure and progressive muscle weakness. The effects of pulmonary rehabilitation on the lung function of patients with ALS are unclear.

Objective: Through this meta-analysis of randomized controlled trials (RCTs), we evaluated the effects of pulmonary rehabilitation, such as type of treatment, on patients with ALS and compared the effectiveness of this treatment.

Methods: PubMed, EMBASE, Web of Science, and Cochrane databases were searched until December 2020. The methodological quality of each study was assessed using the updated Cochrane Risk of Bias tool (RoB 2.0). Data were analyzed using Review Manager version 5.4 (Cochrane Collaboration, Oxford, England), and the meta-analysis was performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines.

Results: Of 2168 articles, 10 trials were reviewed; among these trials, two focused on respiratory training and eight on physical exercise, three of which involved a combination of aerobic and resistance training. Our meta-analysis demonstrated no difference in the ALSFRS-R score and % FVC among patients with ALS.

Conclusions: Respiratory training or physical exercise did not significantly affect the ALSFRS-R score and % FVC of patients with ALS. At 12 months after intervention, the ALSFRS-R score in the physical exercise group was higher than that in the usual care group. Further clinical trials are warranted to develop approaches for improving the lung function of patients with ALS.
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http://dx.doi.org/10.3233/NRE-210052DOI Listing
June 2021

Effects of preoperative oral carbohydrate on postoperative discomfort in patients undergoing elective surgery: a meta-analysis of randomized controlled trials.

Langenbecks Arch Surg 2021 Jun 25;406(4):993-1005. Epub 2021 Feb 25.

Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.

Purpose: Fasting is a standard preoperative procedure performed to prevent vomiting and pulmonary aspiration during anaesthesia and surgery. However, fasting can cause postoperative physical and psychological discomfort. Intake of oral carbohydrate (CHO) may mimic the intake of food, which prevents postoperative discomfort. We conducted a meta-analysis to evaluate the effect and safety of preoperative oral CHO in adult surgical patients.

Methods: Randomized controlled trials (RCTs) were searched for in the PubMed, EMBASE, and Cochrane Library databases. A meta-analysis was performed to calculate a pooled effect size by using random-effects models. The satisfaction outcomes were mouth dryness, hunger, thirst, pain severity, duration of hospitalization, homeostatic model assessment for insulin resistance (HOMA-IR), and the incidence of postoperative nausea and vomiting. The safety outcomes were the incidence of aspiration and infection.

Results: In total, 57 RCTs involving 5606 patients were included. The outcomes of mouth dryness, thirst, hunger, and pain were assessed by a 10-point visual analogue scale (0 = best, 10 = worst). The severity of mouth dryness (weighted mean difference [WMD]: -1.26, 95% CI: -2.36 to -0.15), thirst (WMD: -1.36, 95% CI: -2.05 to -0.67), hunger (WMD: -1.66, 95% CI: -2.53 to -0.80), pain (WMD: -0.68, 95% CI: -1.01 to -0.35), duration of hospitalization (WMD: -0.39 day, 95% CI: -0.66 to -0.12), and HOMA-IR (WMD: -1.80, 95% CI: -2.84 to -0.76) were significantly lower in the CHO group than in the control group. The incidence of postoperative nausea and vomiting did not differ between the CHO and control groups. No aspiration was recorded in any of the groups.

Conclusions: Preoperative CHO can alleviate patient's discomfort without safety concerns. Surgeons and anaesthesiologists should strongly promote preoperative CHO as a strategy to enhance recovery after surgery protocols.
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http://dx.doi.org/10.1007/s00423-021-02110-2DOI Listing
June 2021

Effect and safety of peritoneal lavage for appendectomy: A meta-analysis.

Surgeon 2021 Feb 12. Epub 2021 Feb 12.

Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background: Whether peritoneal lavage is beneficial for the postoperative outcomes of appendectomy is debatable. This study is a meta-analysis of randomized controlled trials (RCTs) that aimed to determine whether peritoneal lavage leads to improved appendectomy outcomes.

Methods: PubMed, Embase, and Cochrane Library databases were searched for articles published before September 2020. The meta-analysis calculated the pooled effect size by using a random effects model. The primary outcome was the incidence of intra-abdominal abscess. Secondary outcomes were the incidence of surgical-site infection, hospital stay duration, operation time, and readmission incidence.

Results: Eight RCTs involving 1487 patients were reviewed. The lavage group had a nonsignificantly lower incidence of intra-abdominal abscess (risk ratio [RR]: 0.81; 95% confidence interval [CI]: 0.55-1.18) and surgical-site infection (RR: 0.73; 95% CI: 0.31-1.72) than did the nonirrigation group. Furthermore, the lavage group showed a nonsignificantly shorter hospital stay duration and lower readmission incidence than did the nonirrigation group. However, the lavage group required significantly more operation time than did the nonirrigation group (mean difference: 7.59 min; 95% CI: 4.67-10.50).

Conclusion: Our study revealed that performing peritoneal lavage has no advantage over suction or drainage only in appendectomy. Moreover, peritoneal lavage significantly increased operation time. Consequently, for improving efficiency and reducing operation time, we suggest skipping peritoneal irrigation during appendectomy. However, the available evidence is of variable quality; therefore, high-quality prospective RCTs are required in the future.
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http://dx.doi.org/10.1016/j.surge.2021.01.001DOI Listing
February 2021

Effects of yoga on improving quality of life in patients with breast cancer: a meta-analysis of randomized controlled trials.

Breast Cancer 2021 Mar 15;28(2):264-276. Epub 2021 Jan 15.

Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.

Background: Complications of breast cancer treatment can cause physical and psychosocial distress in patients. Yoga demonstrates substantial potential as a supportive therapy for patients with breast cancer. Our aim is to conduct a meta-analysis of randomized controlled trials to evaluate the effectiveness of yoga in enhancing the quality of life (QoL) of patients with breast cancer.

Methods: We searched for studies published before March 2020 in the PubMed, Embase, and Cochrane Library databases. Individual effect sizes were standardized, and the pooled effect size was calculated using a random effect model. Measured outcomes included QoL, anxiety and depression, stress, fatigue, pain severity, and sleep quality.

Results: In total, 26 trials involving 2069 patients were reviewed. Significant enhancement in QoL was observed immediately after the yoga intervention. The pooled mean differences in social (weighted mean difference [WMD]: 1.36, 95% confidence interval [CI] 0.12-2.61), emotional (WMD: 1.46, 95% CI 0.26-2.66), and functional well-being (WMD: 2.04, 95% CI 0.21-3.87) were significantly higher in the yoga group than in the control group. Patients practicing yoga exhibited significant improvements in physical well-being, mental well-being, and sleep quality as well as reductions in anxiety, depression, stress, fatigue, and pain severity after the intervention.

Conclusions: Yoga may enhance QoL in patients with breast cancer experiencing post-treatment complications. Therefore, we recommend yoga as a supportive therapy for patients with breast cancer to relieve post-treatment distress.
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http://dx.doi.org/10.1007/s12282-020-01209-6DOI Listing
March 2021

Recruitment maneuvers to reduce pulmonary atelectasis after cardiac surgery: A meta-analysis of randomized trials.

J Thorac Cardiovasc Surg 2020 Nov 26. Epub 2020 Nov 26.

Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background: Pulmonary atelectasis is a common postoperative complication that may lead to intrapulmonary shunt, refractory hypoxemia, and respiratory distress. Recruitment maneuvers may relieve pulmonary atelectasis in patients undergoing cardiac surgery. We conducted a meta-analysis of randomized controlled trials to evaluate the effectiveness of recruitment maneuvers in these patients.

Methods: We conducted a search in PubMed, Embase, Cochrane Library, and the ClinicalTrials.gov registry for trials published before March 2020. Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size by using random-effects models. Pulmonary atelectasis was assessed postoperatively. Secondary outcomes included hypoxic events, arterial oxygen tension (Pao)/inspired oxygen fraction (Fio) ratio, cardiac index, mean arterial pressure, and postoperative complications including pneumothorax and pneumonia.

Results: We reviewed 16 trials involving 1455 patients. Patients receiving recruitment maneuvers had a reduced incidence of pulmonary atelectasis (group with recruited pressure >40 cmHO: risk ratio [RR], 0.20; 95% confidence interval [CI], 0.07-0.57; group with recruited pressure <40 cmHO: RR, 0.54; 95% CI, 0.33-0.89), reduced incidence of hypoxic events (RR, 0.23; 95% CI, 0.14-0.37), reduced incidence of pneumonia (RR, 0.42; 95% CI, 0.18-0.95), and improved Pao/Fio ratio (weighted mean difference [WMD]; 58.87, 95% CI, 31.24-86.50) without disturbing the cardiac index (WMD, 0.22; 95% CI, -0.18 to 0.61) or mean arterial pressure (WMD, -0.30, 95% CI, -3.19 to 2.59) as compared with those who received conventional mechanical ventilation. The incidence of pneumothorax was nonsignificant between the groups.

Conclusions: Recruitment maneuvers may reduce postoperative pulmonary atelectasis, hypoxic events, and pneumonia and improve Pao/Fio ratios without hemodynamic disturbance in patients undergoing cardiac surgery.
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http://dx.doi.org/10.1016/j.jtcvs.2020.10.142DOI Listing
November 2020

Effect of drug interactions between carbapenems and valproate on serum valproate concentration: a systematic review and meta-analysis.

Expert Opin Drug Saf 2021 Feb 28;20(2):215-223. Epub 2020 Dec 28.

Center for Evidence-Based Health Care, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University , New Taipei City, Taiwan.

: Concurrent use of valproate and carbapenem antibiotics may decrease serum valproate concentration (SVC). This study evaluated the effects of carbapenem-valproate drug interactions. : We screened PubMed, EMBASE, and Cochrane databases for eligible prospective or retrospective studies that evaluated the effect of concurrent use of carbapenem and valproate compared with valproate alone on SVC. Primary outcomes were the change in SVC from before the addition of the carbapenem to the SVC during the use of carbapenems and after carbapenem discontinuation, and seizure-related outcomes. Secondary outcomes were the influence of valproate or carbapenem dose on SVC and Drug Interaction Probability Scale scores. : Twelve studies (633 patients) were included. Compared with valproate alone, combination treatment with carbapenem substantially decreased mean SVC (mean difference, -43.98 mg/L; 95% confidence interval, -48.18 to -39.78). The onset of SVC decreases was within 1-3 days following carbapenem initiation. Seizure frequency increased by 26.3% during combination treatment. No difference was found in mean SVC between the different doses of valproate or carbapenem during combination treatment. Mean SVC increased to similar pre-carbapenem level within 1 to 2 weeks after carbapenem discontinuation. : The drug interaction between valproate and carbapenem causes substantial SVC decreases, even to subtherapeutic levels, which may increase the risk of seizures.
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http://dx.doi.org/10.1080/14740338.2021.1865307DOI Listing
February 2021

Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis.

Vasc Endovascular Surg 2021 Feb 24;55(2):164-170. Epub 2020 Nov 24.

Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, 38032Taipei Medical University, New Taipei City.

Background: Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis.

Methods: A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions.

Results: Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001).

Conclusion: Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.
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http://dx.doi.org/10.1177/1538574420969252DOI Listing
February 2021

Efficacy of Fibrin Sealant in Reducing Complication Risk After Bariatric Surgery: a Systematic Review and Meta-analysis.

Obes Surg 2021 Mar 3;31(3):1158-1167. Epub 2020 Nov 3.

Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Background: Complications including staple-line leakage and bleeding may occur after sleeve gastrectomy and Roux-en-Y gastric bypass. In this meta-analysis, the efficacy of fibrin sealant in strengthening the staple line and reducing complication risk after bariatric surgery was evaluated.

Methods: We searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) published up to October 2020. Pooled estimates of the outcomes were computed using a random effects model. The primary outcomes were bleeding and leakage; secondary outcomes were gastric stricture, length of hospital stay, reoperation rate, and total operation time.

Results: In total, 9 RCTs including 2136 patients were reviewed. Our meta-analysis revealed that compared with controls, fibrin sealants decreased incidence of bleeding significantly (risk ratio [RR] = 0.42; 95% confidence interval [CI], 0.18-0.97), but did not demonstrate significant differences in reducing the incidence of leakage (RR = 0.62; 95% CI, 0.23-1.73), gastric stricture (RR = 1.16; 95% CI, 0.46-2.91), reoperation rate (RR = 0.85; CI, 0.14-5.14), or length of hospital stay (weighted mean difference = 0.62; 95% CI, - 0.31 to 1.55). Compared with oversewing, fibrin sealant use reduced the operation time; however, their efficacies in reducing the incidence of postoperative bleeding and leakage did not differ significantly.

Conclusions: Although applying fibrin sealants to the staple line in bariatric surgery may provide favorable results, but it may not reduce postoperative leakage and stricture incidence significantly. Nevertheless, the application of fibrin sealants as a method for reducing risks of complications after bariatric surgery warrant further investigation.
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http://dx.doi.org/10.1007/s11695-020-05098-8DOI Listing
March 2021

High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis.

Clin Rehabil 2021 Feb 11;35(2):169-181. Epub 2020 Oct 11.

School of Medicine, College of Medicine, Taipei Medical University, Taipei.

Objective: This study aimed to investigate the efficacy of high-intensity functional exercise among older adults with dementia.

Methods: In this systematic review and meta-analysis of randomized controlled trials, we collected articles published before August 2020 from PubMed, Embase, and the Cochrane Library to evaluate the effect of high-intensity functional exercise on older adults with dementia. Primary outcomes included improvements in balance function and gait performance (speed, cadence, and stride length). The secondary outcomes included lower limb strength, activities of daily living, psychiatric well-being, depression, and cognition. Furthermore, we performed subgroup analysis with two high-intensity functional exercise programs: the Umeå program and Hauer's program.

Results: We identified 15 articles describing six trials including older adults with dementia undergoing high-intensity functional exercise or control activity. The meta-analysis indicated that high-intensity functional exercise, both in Hauer's program and in the Umeå program, significantly improved balance function (pooled standardized mean difference 0.57, 95% confidence interval 0.31-0.83). Hauer's program significantly improved gait speed, cadence, stride length, and lower limb strength. Beneficial effects on speed, cadence, and lower limb strength were retained for several months. The Umeå program facilitated activities of daily living and psychiatric well-being, with effects on activities of daily living lasting several months. In the only eligible trial, no effects on cognition were observed. Adverse effects of high-intensity functional exercise were minimal to none.

Conclusions: High-intensity functional exercise is generally safe and is recommended for older individuals with mild or moderate dementia to provide benefits in motor performance and daily functioning.
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http://dx.doi.org/10.1177/0269215520961637DOI Listing
February 2021

Effectiveness of -acetylcysteine in autism spectrum disorders: A meta-analysis of randomized controlled trials.

Aust N Z J Psychiatry 2021 02 8;55(2):196-206. Epub 2020 Sep 8.

Center for Evidence-Based Health Care and Shared Decision Making Resource Center, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City.

Objective: Currently, pharmaceutical treatment options for autism spectrum disorder are limited. Brain glutaminergic dysregulation is observed in autism spectrum disorder. -acetylcysteine, which can be converted to glutathione and subsequently release glutamate into the extracellular space, and thus reduce glutamatergic neurotransmission at synapses, is considered a potential drug for autism spectrum disorder treatment. Here, we analyzed the treatment effects of -acetylcysteine on autism spectrum disorder in randomized controlled trials.

Study Design: Updated systematic review and meta-analysis.

Data Sources: By systematically searching the PubMed, Embase and Cochrane Library, we obtained five randomized controlled trials.

Study Selection: Meta-analyses were performed to examine the improvement in autistic behaviors as measured by the Aberrant Behavior Checklist, Social Responsiveness Scale and Repetitive Behavior Scale-Revised, using mean difference with a 95% confidence interval and a random-effects model.

Data Synthesis: After 8-12 weeks of -acetylcysteine supplementation, the pooled result of four trials revealed an improvement in Aberrant Behavior Checklist total score (mean difference = 1.31, 95% confidence interval = [0.42, 2.20]). When one trial was excluded, the sensitivity test result was stronger (mean difference = 1.88, 95% confidence interval = [0.92, 2.83]). The pooled results of three trials revealed significant improvements in hyperactivity (mean difference = 4.80, 95% confidence interval = [1.20, 8.40]) and irritability (mean difference = 4.07, 95% confidence interval = [1.13, 7.04]). Regarding Social Responsiveness Scale, the pooled result of two trials showed significant improvement in social awareness after 8-12 weeks of -acetylcysteine supplementation (mean difference = 1.34, 95% confidence interval = [0.09, 2.59]). No differences were observed in the pooled results of two trials using Repetitive Behavior Scale, either in the total or the subscales.

Conclusion: We concluded that -acetylcysteine is safe and tolerable, reduces hyperactivity and irritability and enhances social awareness in children with autism spectrum disorder. However, further evidence should be sought before a general recommendation.
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http://dx.doi.org/10.1177/0004867420952540DOI Listing
February 2021

The impact of shared decision making with patient decision aids on the rotavirus vaccination rate in children: A randomized controlled trial.

Prev Med 2020 12 4;141:106244. Epub 2020 Sep 4.

Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pediatric Gastroenterology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. Electronic address:

Rotavirus vaccination reduces the incidence and severity of acute gastroenteritis due to rotavirus infection. However, because of a lack of understanding and private payment for the rotavirus vaccine, the rotavirus vaccination rate is still low in some countries. We intended to assess the impact of shared decision-making (SDM) with the assistance of patient decision aids (PDAs) on the rotavirus vaccination rate, and the knowledge, confidence, and congruence of value among baby's parents when decision-making. The study was a two-group, outcome assessor-blind, randomized, controlled trial. The families of 1-month-old infants for routine vaccination were enrolled; they were divided randomly into non-SDM and SDM groups. The influence of SDM on the acceptance of rotavirus vaccination was assessed when their infants were 2 months old. Outcome measures were decisional conflict, decision-making difficulties, and rotavirus vaccine knowledge, and the overall rotavirus vaccination rate. The study enrolled 180 participants. SDM, parents' education level, and rotavirus vaccination of a previous child were variables that influenced acceptance of rotavirus vaccination. The SDM group scored significantly higher for understanding the information on the oral rotavirus vaccine than the non-SDM group, which helped them to decide whether to vaccinate the baby against rotavirus. The rotavirus vaccination rate was 16.7% higher in the SDM group than the non-SDM group. SDM assisted with PDAs gives more information and helps infants' families understand what they need, reduces their decision conflict, and increases their baby's vaccination against rotavirus, which promotes public health. The clinical trial is registered at ClinicalTrials.gov (NCT03804489).
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http://dx.doi.org/10.1016/j.ypmed.2020.106244DOI Listing
December 2020

Efficacy of levetiracetam for migraine prophylaxis: A systematic review and meta-analysis.

J Formos Med Assoc 2021 Jan 27;120(1 Pt 3):755-764. Epub 2020 Aug 27.

Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Ph.D. Program in Global Health and Health Security, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background: Migraine is characterized by moderate to severe recurrent headache lasting for 4-72 h. Cortical hyperexcitability may play a crucial role in migraine onset. Therefore, antiepileptic drugs, such as levetiracetam, may be beneficial.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of levetiracetam in migraine prophylaxis. Electronic databases, including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, were searched for articles on migraine prophylaxis and levetiracetam published before May 2020. The main outcomes were number of patients with >50% headache frequency reduction, frequency of headache, and headache severity.

Results: We identified 4 RCTs involving 192 patients and 4 prospective studies involving 85 patients. The overall data on number of patients with >50% headache frequency reduction, headache frequency, and headache severity were subjected to meta-analysis, which revealed significant differences between the levetiracetam and the placebo groups (risk ratio [RR] of number of patients with >50% headache frequency reduction = 0.46, 95% confidence interval [CI] = 0.35 to 0.61; weighted mean difference [WMD] of headache frequency per month = -3.78, 95% CI = -5.52 to -2.03; standard mean difference [SMD] of headache severity = -2.42, 95% CI = -4.47 to -0.37).

Conclusion: Our study indicated that levetiracetam can significantly reduce headache frequency and severity in adults and children. Thus, oral levetiracetam can be a therapeutic option for migraine prophylaxis, especially concerning with the adverse effects or teratogenicity of other preventive treatments.
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http://dx.doi.org/10.1016/j.jfma.2020.08.020DOI Listing
January 2021

Effects of ultraviolet and blue-light filtering on sleep: a meta-analysis of controlled trials and studies on cataract patients.

Eye (Lond) 2021 Jun 17;35(6):1629-1636. Epub 2020 Aug 17.

Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.

Purpose: Two types of intraocular lenses (IOLs), namely ultraviolet-filtering IOL (UVF-IOL) and blue-light-filtering IOL (BF-IOL), are used to replace the aging lens in cataract patients. This provides a clinical scenario to investigate the BF and UVF effects on circadian rhythm. We revisited this topic and conducted an updated meta-analysis investigating the effects of UVF-IOL and BF-IOL on sleep quality.

Methods: A literature search was conducted using the PubMed, Embase, and Cochrane Library databases, and finally, four randomized controlled trials, one nonrandomized controlled study, and two cohort studies were included in this meta-analysis.

Results: The fixed-effect model revealed a significantly larger sleep quality improvement in the UVF-IOL group than in the BF-IOL group (standard mean difference [SMD] = 0.10, 95% confidence interval [CI]: 0.00-0.21) at 3-8 weeks but not 7-12 months after IOL implantation (SMD = 0.03, 95% CI: -0.08 to 0.13). The random effects model revealed no difference between groups at 3-8 weeks (SMD = 0.16, 95% CI: -0.07 to 0.39) and 7-12 months (SMD = 0.03, 95% CI: -0.08 to 0.13) after IOL implantation.

Conclusions: Our study found some weak evidence supporting that UVF-IOL implantation demonstrated a greater improvement in subjective sleep quality than the BF-IOL implantation only in a shorter period but not in a longer period. More trials should be conducted before further recommendations. Nevertheless, our study provides some insights into the effects of short wavelength electromagnetic radiation on the circadian rhythm. PROSPERO registration number: CRD42019128832.
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http://dx.doi.org/10.1038/s41433-020-01132-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169870PMC
June 2021

Correction to: Axillary Management in Women with Early Breast Cancer and Limited Sentinel Node Metastasis: A Systematic Review and Metaanalysis of Real-World Evidence in the Post-ACOSOG Z0011 Era.

Ann Surg Oncol 2020 Dec;27(Suppl 3):986

Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

In the original version of the article, there was some misalignment of data in Table 1.
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http://dx.doi.org/10.1245/s10434-020-08987-5DOI Listing
December 2020

Axillary Management in Women with Early Breast Cancer and Limited Sentinel Node Metastasis: A Systematic Review and Metaanalysis of Real-World Evidence in the Post-ACOSOG Z0011 Era.

Ann Surg Oncol 2021 Feb 23;28(2):920-929. Epub 2020 Jul 23.

Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Background: After the publication of the Z0011 trial, the American Society of Clinical Oncology published an updated clinical practice guideline stating that clinicians should not recommend axillary lymph node dissection (ALND) for early-stage breast cancer patients with the involvement of one or two sentinel lymph nodes (SLNs). However, these recommendations have been challenged because they were mainly based on data from limited studies. The aim of the current study is to systematically compare the real-world outcomes of SLN biopsy (SLNB) alone and SLNB + ALND in patients with early-stage breast cancers and limited positive SLN metastasis in the post-Z0011 era PATIENTS AND METHODS: We searched articles in the PubMed, EMBASE, and Cochrane library databases. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were recurrence rate and the incidence of lymphedema.

Results: One randomized controlled trial and six retrospective studies with 8864 patients were retrieved. For patients with early-stage breast cancer with one or two SLN metastases, receiving SLNB alone showed no significant difference in OS, DFS, and recurrence rate compared with receiving SLNB + ALND. The incidence of lymphedema in patients who received SLNB alone was significantly lower than those who received SLNB + ALND (odds ratio 1.95, 95% confidence interval 1.02-3.71).

Conclusions: Current real-world evidence proved that the Z0011 strategy is safe with respect to survival outcomes and effective in reducing the incidence of lymphedema. ALND should be avoided in patients with early-stage breast cancer with one or two SLN metastases in the post-Z0011 era.
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http://dx.doi.org/10.1245/s10434-020-08923-7DOI Listing
February 2021

Efficacy of Pulsed Radiofrequency in Herpetic Neuralgia: A Meta-Analysis of Randomized Controlled Trials.

Clin J Pain 2020 11;36(11):887-895

Department of Surgery, Division of General Surgery, School of Medicine, College of Medicine.

Objectives: Herpes zoster and postherpetic neuralgia (PHN) are often refractory to current standard treatments and can reduce patients' quality of life (QoL). Pulsed radiofrequency (PRF) effectively controls intractable neurological pain. The aim of the study was to conduct a systematic review and meta-analysis to evaluate the efficacy of PRF in PHN management.

Materials And Methods: We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) published up to October 2019. The primary outcomes were pain levels and rescue analgesia at different postintervention time intervals. The secondary outcomes were QoL and sleep quality.

Results: We reviewed 6 RCTs involving 420 patients. The meta-analysis revealed that the PRF group exhibited significantly lower pain scores in PHN than did the control group at 2 to 3 days (weighted mean differences [WMD]=-2.82; 95% confidence interval [CI]: -5.08 to -0.55), 1 week (WMD=-2.95; 95% CI: -4.53 to -1.37), 2 weeks (WMD=-3.17; 95% CI: -4.11 to -2.23), 4 weeks (WMD=-2.59; 95% CI: -3.40 to -1.79), 8 weeks (WMD=-3.02; 95% CI: -4.17 to -1.88), and 6 months (WMD=-1.94; 95% CI: -2.85 to -1.03). After intervention, QoL was significantly higher in the PRF group than in the control group. No major complications were reported.

Discussion: PRF safely and effectively reduced pain scores and improved QoL in patients with herpes zoster in the cervical to lumbosacral areas. PRF could be considered during refractory PHN treatment. Future studies require standardized PRF settings and outcome assessment tools, including physical and emotional function assessments.
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http://dx.doi.org/10.1097/AJP.0000000000000867DOI Listing
November 2020
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