Aims: A randomized controlled trial was conducted to examine the effects of a home-based multicomponent exercise programme on frailty in patients who underwent cardiac surgery. Methods and results: A convenience sample of 92 patients who underwent cardiac surgery at two medical centres in Taiwan were recruited and randomly allocated to the intervention (n = 46) and control (n = 46) groups. The intervention group underwent a 12-week home-based multicomponent exercise programme, including individual nursing consultation, home-based exercise intervention, nutritional assessment and guidance, and continuous support. The control group did not receive any interventions. Frailty was assessed with the Fried Frailty Phenotype at baseline, 6 weeks, and 12 weeks. The prevalence rates of prefrailty and frailty at baseline were 67% and 33%, respectively, and no statistically significant differences in frailty status were noted between the two groups at baseline. However, patients in the intervention group demonstrated significantly greater improvements in their frailty scores, handgrip strength, and physical activity than the control group at 6 weeks and 12 weeks postintervention, with no adverse events reported. Conclusion: A home-based multicomponent exercise programme is safe and effective in improving frailty outcomes among postcardiac surgery patients and is suitable for application in clinical practice. Future studies with larger sample sizes and long-term follow-up are needed to verify the long-term effects of this home-based multicomponent exercise programme. Registration: Clinicaltrial.gov: NCT04332887.

The terrestrial environment is a significant source of anthropogenic debris emissions. While most studies on anthropogenic debris focus on the marine environment, our research delves into the effects of human activity on anthropogenic debris ingestion by studying the carcasses of feral pigeons. From January to June 2022, we collected the gastrointestinal tracts (GI tracts) of 46 pigeon carcasses in Taipei, Taiwan’s capital city. The results revealed that 224 anthropogenic debris samples were found, with the dominant form being fibers (71.9%), which are primarily black (29.9%). Fourier transform infrared spectroscopy (FTIR) revealed that the main component of anthropogenic debris is polyethylene (PE) (20.5%), followed by anthropogenic cellulose (19.2%) and various other plastics. This study revealed that the amount of anthropogenic debris and chemical composition in the GI tract significantly increase with increasing human activity. These results prove that feral pigeons are valuable indicators for monitoring anthropogenic debris pollution in urban ecosystems. On the other hand, past research focused on analyzing microplastics, but we confirmed that the GI tract of pigeons has a high proportion of anthropogenic cellulose. Importantly, future studies should consider the potential impacts of anthropogenic cellulose in terrestrial ecosystems, as this could have significant implications for ecosystem health.

BACKGROUND: Despite the well-known importance of witnessed arrest and bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest outcomes, previous studies have shown significant statistical inconsistencies. We hypothesized an interaction effect and conducted stratified analyses to investigate whether witnessed arrest is more important than bystander CPR. METHODS: This study enrolled patients with out-of-hospital cardiac arrest between January 2010 and December 2022 in 3 emergency medical service (systems in Taiwan). Data were extracted from emergency medical service dispatch reports, including patient characteristics, witnessed arrest, bystander CPR, time for each dispatch, and prehospital interventions. The outcome measure was prehospital return of spontaneous circulation (ROSC). Patients were categorized into 4 groups: witnessed and bystander CPR present (W+B+), witnessed present but bystander CPR absent (W+B-), witnessed absent but bystander CPR present (W-B+), and witnessed and bystander CPR absent (W-B-). Multiple logistic regression on prehospital ROSC were performed in the 4 subgroups separately. RESULTS: A total of 14 737 patients with out-of-hospital cardiac arrest were identified, of whom 977 (6.6%) achieved prehospital ROSC. The W+B+ group exhibited the highest prehospital ROSC rate (14.0%). Stratification confirmed a statistically significant interaction between witnessed arrest and bystander CPR. Defibrillation, endotracheal intubation, and epinephrine administration were significantly associated with prehospital ROSC in all subgroups. Most explanatory variables significant in the witnessed arrest group were adjusted for in the nonwitnessed arrest group. Younger age was associated with prehospital ROSC only in the W+B+ group. CONCLUSIONS: Witnessed arrest and bystander CPR may interact to predict prehospital ROSC in out-of-hospital cardiac arrest, with witnessed arrest likely having more significant impact on outcomes.

Objective: Drainless minimally invasive anatomical lung resection surgery for pulmonary malignancies is safe and feasible in terms of early postoperative outcomes. However, the quality of surgery in the long term remains uncertain. This study aimed to investigate the perioperative outcomes, 3-year overall, and disease-free survival rates of patients who underwent minimally invasive anatomical lung resection surgery with the drainless technique for pulmonary malignancies. Methods: Fifty-eight patients who underwent drainless minimally invasive anatomical lung resection surgery for pulmonary malignancies (36 -lobectomy; 22 -segmentectomy) between November 2017 and June 2022 by a single surgeon were enrolled. Patients' characteristics and perioperative, early postoperative, and long-term data were collected. The lymph node dissection stations and number, resection margin, 3-year overall and disease-free survival rates were assessed. Results: The median age was 64 years. Forty-four patients were females (76%) and forty-seven patients were non-smokers (81%). The median five-factor modified frailty index was 1. Most patients had primary lung cancer; four (7%), 43 (74%), seven (12%), and three (5%) had stage 0, I, II, and III, respectively. The median lymph node dissection stations was four, and the number was 17. The resection margin was free in 98% of the cases. The 3-year overall survival rate was 98.3% in all patients, and 97.2% and 100% in the lobectomy and segmentectomy subgroups, respectively. The 3-year disease-free survival rate was 85.3% in all patients and 80.5% and 92.9% in the lobectomy and segmentectomy subgroups, respectively. Conclusion: The drainless technique is safe and feasible for minimally invasive anatomical lung resection surgery for pulmonary malignancies in terms of early postoperative and long-term outcomes. However, further randomized controlled studies are warranted.

Pei-Lin Lee serves as Clinical Associate Professor, School of Medicine, National Taiwan University; Consultant, Center of Sleep Disorder, National Taiwan University Hospital. Her current academic positions at international sleep societies include American Academy of Sleep Medicine Fellow and Co-Chair International Assembly; Asian Society of Sleep Medicine, Sleep Medicine Education Task Force committee member. Her current research focuses on the era of new technology and big data in sleep medicine; and intervention on sleep and metabolism in sleep disordered breathing.