Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Fracture-isthmus diameter ratio predicts delayed union in tibial nailing.","authors":"Li-Kai Kuo, Chun-Yu Chen, Kai-Cheng Lin","doi":"10.1097/JCMA.0000000000001385","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001385","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary nailing is widely acknowledged as the preferred treatment for tibial shaft fractures. However, delayed union remains common in non-isthmal patterns. We aimed to assess the factors and imaging parameters associated with nonunion or delayed union following intramedullary nailing in these patients.</p><p><strong>Methods: </strong>This retrospective study included patients with non-isthmal tibial shaft fractures who underwent intramedullary nailing from 2015 to 2020. The fracture site diameter to the isthmus canal diameter ratio (FI ratio) was measured on pre- and postoperative AP radiographs. Delayed union was defined as no union at 6 months, with union by 12 months. The variables were tested with univariate analyses and multivariable logistic regression; ROC analysis determined a cut-off.</p><p><strong>Results: </strong>A total of 66 patients were included, and delayed union occurred in 34 (51.5%). Forty-seven patients sustained infra-isthmal fractures, while 19 patients experienced supra-isthmal fractures. The postoperative FI ratio was higher in the delayed-union group (median 1.67 vs 1.36; p=0.001) and was the only independent predictor on multivariable analysis (p=0.007). A postoperative FI ratio ≥1.43 predicted delayed union with sensitivity 0.79 and specificity 0.66 (AUC 0.74); delayed union was more frequent when FI ≥1.43 than <1.43 (27/39 [69.2%] vs 7/27 [25.9%], OR=6.43). Intraoperative blood loss was associated with univariate testing (p=0.013) but not after adjustment; nail-canal ratio, fracture length, and screw-fracture distance were not significant.</p><p><strong>Conclusion: </strong>The postoperative FI ratio is a feasible indicator of delayed union in patients who received intramedullary nailing for supra-isthmal or infra-isthmal tibial shaft fractures. A postoperative FI ratio ≥ 1.43 indicates a significantly higher risk of delayed union. In such cases, it may be recommended that patients undergo prolonged protected weight-bearing and shortened follow-up intervals.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative gene ontology-driven analysis of the eutopic endometrium reveals key dysregulated functionomes and pathways in endometriosis.","authors":"Jyun-Cheng Ke, Chia-Ming Chang, Peng-Hui Wang, Yu-Chi Wang, Ping-Lin Hsieh, Kuo-Min Su","doi":"10.1097/JCMA.0000000000001382","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001382","url":null,"abstract":"<p><strong>Background: </strong>Endometriosis is a chronic estrogen-dependent inflammatory disorder associated with pelvic pain, infertility, and an increased risk of endometriosis-associated ovarian cancer. Despite extensive research, its molecular mechanisms remain incompletely understood. This study aimed to identify dysregulated biological functions and potential molecular signatures in the eutopic endometrium of women with endometriosis using an integrative functionome-based approach.</p><p><strong>Methods: </strong>An integrative gene ontology-driven functionome analysis was conducted using publicly available transcriptomic datasets. A modified Differential Rank Conservation algorithm was applied to reconstruct sample-specific Gene Set Regularity (GSR) indices across 10,192 Gene Ontology (GO)-defined gene sets. Statistical analyses, exploratory factor analysis, and support vector machine (SVM)-based machine learning were used to identify dysregulated functionomes, dysfunctional pathways, and key differentially expressed genes (DEGs).</p><p><strong>Results: </strong>The analysis included 196 patients with endometriosis and 246 healthy controls. Functionome profiling revealed widespread dysregulation of immune, metabolic, angiogenic, and extracellular matrix-related pathways. Among the top 50 dysregulated functionomes, eight were related to copper ion transport and homeostasis. Integrative analysis identified a recurrent four-gene copper-regulatory signature consisting of ATP7A, ATP7B, ATOX1, and SLC31A1 (p <0.05), suggesting coordinated disruption of copper homeostasis in endometriosis.</p><p><strong>Conclusion: </strong>Dysregulation of copper ion homeostasis and cuproptosis-related pathways may represent a previously underappreciated molecular feature of endometriosis. Although causal relationships cannot be established from this comparative analysis, the identified copper-regulatory signature provides a reproducible transcriptomic framework for future mechanistic and translational studies.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining acceptable duration for chemoradiation of esophageal squamous cell carcinoma.","authors":"Kam-Hong Kam, Cheng-Yen Lee, Jia-Ming Chang, Hsin-Yi Yang, Chih-Chia Chang, Yuk-Wah Tsang, Yu-Wen Wang, Wei-Yu Wang, Chin-Ho Kuo, Ming-Yang Lee, Yin-Che Lu, Yu-Ting Lee, Michael W Y Chan","doi":"10.1097/JCMA.0000000000001383","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001383","url":null,"abstract":"<p><strong>Background: </strong>Chemoradiotherapy (CRT) remains the standard practice for patients with non-surgical esophageal squamous cell carcinoma (ESCC). However, the impact of radiation duration is poorly understood. We aimed to determine the effect of CRT duration on the prognosis of patients with ESCC.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with ESCC treated with CRT at the Ditmanson Medical Foundation Chia-Yi Christian Hospital between January 1, 2010 and December 31, 2021. Patients were either treated with continuous CRT or protracted CRT, which was interrupted due to reassessment of disease status. Differences in survival according to the treatment strategy were examined using propensity score matching (PSM). The risk factors for survival and recurrence were analyzed using Cox regression models.</p><p><strong>Results: </strong>A total of 238 patients who underwent CRT were included in our cohort. After 2:1 PSM, the continuous and protracted CRT groups comprised 41 and 82 patients, respectively. Median survival was 12.2 [interquartile range (IQR), 10.0-19.1] months for the protracted CRT group and 11.4 (IQR, 9.9-17.1) months for the continuous CRT group (p=0.395). The multivariable analysis revealed that duration of radiation > 90 days was an independent risk factor for survival [adjusted hazard ratio (HR), 2.14; 95% confidence interval (CI), 1.23-3.70, p=0.006] and progression-free survival (adjusted HR, 1.74; 95% CI, 1.08-2.80, p=0.022). In addition, a neutrophil-to-lymphocyte ratio > 3 was associated with poor prognosis (adjusted HR, 1.83; 95% CI, 1.09-3.05, p=0.02).</p><p><strong>Conclusion: </strong>This study demonstrated that continuous CRT and protracted CRT resulted in similar prognoses; however, a radiotherapy duration exceeding 90 days was associated with inferior survival. These findings have implications for treatment planning in patients with ESCC.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Male- and female-factor infertility and partners' quality of life during assisted reproductive technology: A dyadic actor-partner analysis.","authors":"Po-Hung Pan, Yu-Chen Hsu, Chun-Han Tseng, Ting Chien Lin, Tasheng Chen, Yu Hsien Wu, Chih-Wei Lin, Meng-Hsing Wu","doi":"10.1097/JCMA.0000000000001380","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001380","url":null,"abstract":"<p><strong>Background: </strong>Infertility constitutes a dyadic stressor, as it inherently involves both members of a couple; nevertheless, its psychological impact is frequently evaluated from an individual perspective. We tested whether etiologic diagnosis (male and female factors) is associated with both partners' quality of life (QoL) during assisted reproductive technology (ART).</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study at the assisted reproduction center of a tertiary university hospital in southern Taiwan, enrolling married heterosexual couples undergoing ART who completed the Fertility Quality of Life questionnaire during treatment. Using a distinguishable-dyads actor-partner interdependence model (APIM), we estimated actor effects (one's diagnosis on one's QoL) and partner effects (one's diagnosis on the partner's QoL) in all domains. Sensitivity analyses of the APIM adjusted for age, body mass index, infertility duration, and prior embryo-transfer attempts.</p><p><strong>Results: </strong>A total of 105 couples were eligible to be enrolled. Men reported higher QoL than women across domains (p < 0.01). The APIM showed a significant, asymmetric partner effect: female-factor infertility was associated with lower Mind-Body (β = -17.54, p = 0.017) and Core (β = -10.15, p = 0.045) scores in male partners. No partner effect of male-factor infertility on women's QoL was detected, and actor effects were not significant for either partner. Adjusted models yielded directionally consistent results.</p><p><strong>Conclusion: </strong>Infertility etiology relates to the couple's well-being in an asymmetric pattern. Female-factor infertility is linked to poorer QoL in male partners, consistent with distress from witnessing treatment and sociocultural expectations, underscoring the need for dyadic, couple-centered support during ART. Limitations include the cross-sectional design and potential selection bias arising from a high exclusion rate of incomplete dyads, which restricts generalizability.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different aflibercept regimens for wet age-related macular degeneration: A systematic review and network meta-analysis.","authors":"Yu-Sheng Chen, Hua-Ching Chang, Sheng-Chu Chi, Koji Tanaka, Shih-Jen Chen, Tai-Chi Lin","doi":"10.1097/JCMA.0000000000001379","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001379","url":null,"abstract":"<p><strong>Background: </strong>Intravitreal aflibercept injection for wet age-related macular degeneration (AMD) was initially approved with a regimen consisting of three monthly loading doses followed by maintenance doses every 8 weeks. Alternative regimens with a reduced treatment burden have been explored. The treat-and-extend (TAE) regimen involves gradually extending the treatment interval in accordance with disease activity, and the pro re nata (PRN) regimen involves administering injections only when signs of disease activity are observed during follow-up visits. This study evaluated these alternative regimens aimed at reducing treatment burden in real-world clinical practice.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases for relevant randomized controlled trials (RCTs). A random-effects model was adopted for network meta-analysis. Results are presented as standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs). Methodological quality of the included RCTs was assessed using the Cochrane risk-of-bias 2.0 tool.</p><p><strong>Results: </strong>Seven RCTs (1,683 patients with wet AMD) were included in the network meta-analysis. No significant interregimen differences were observed in visual acuity or central retinal thickness. The TAE and PRN regimens required significantly fewer injections than did bimonthly and monthly regimens, respectively (TAE vs. bimonthly: SMD -1.091, 95% CI -2.030 to -0.153; TAE vs. monthly: SMD -3.024, 95% CI -4.584 to -1.465; PRN vs. Bimonthly: SMD -1.919, 95% CI -3.307 to -0.532; PRN vs. Monthly: SMD -3.852, 95% CI -5.717 to -1.988). However, injection count did not differ significantly between the TAE and PRN regimens (TAE vs. PRN: SMD 0.828, 95% CI -0.847 to 2.503). Nonetheless, the TAE regimen was associated with fewer clinic visits than the PRN regimen.</p><p><strong>Conclusion: </strong>The TAE regimen maintains efficacy while reducing treatment burden in patients with wet AMD receiving intravitreal aflibercept.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chinese herbal medicine and acupuncture reduce mortality after intracerebral hemorrhage.","authors":"Dai-Ying Lin, Ming-Jen Wang, Ying-Hsiu Shih, Chiu-Lin Tsai, Yow-Wen Hsieh, Fuu-Jen Tsai, Hsien-Yin Liao, Ching-Mao Chang","doi":"10.1097/JCMA.0000000000001381","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001381","url":null,"abstract":"<p><strong>Background: </strong>Intracerebral hemorrhage (ICH) is the second most common stroke worldwide and is associated with high mortality rates. Despite established guidelines for ICH treatment, the prognosis of ICH remains poor. Traditional Chinese Medicine (TCM), including Chinese herbal medicine (CHM) and acupuncture, has been used as complementary therapy; however, its long-term survival benefits remain uncertain.</p><p><strong>Methods: </strong>This study aimed to evaluate the effectiveness of TCM, including CHM and acupuncture, in reducing mortality among patients with ICH, using data from Taiwan's National Health Insurance Research Database (NHIRD). This retrospective cohort study analyzed patients with ICH (ICD-9-CM, 430-432; ICD-10-CM, I60-I62) between 2000 and 2018. Patients who received TCM or acupuncture (≥2 outpatient or ≥1 inpatient visits) were matched 1:1 with non-TCM patients based on age, sex, urbanization, and income. Mortality was the primary outcome; analyzed using Cox proportional hazards models.</p><p><strong>Results: </strong>Among 6,450 patients (3,225 TCM; 3,225 control), TCM, including CHM and acupuncture, was significantly associated with reduced all-cause mortality in patients with ICH (adjusted hazard ratio [aHR]=0.42; 95% confidence interval [CI]: 0.39-0.46; p<0.001), with CHM alone showing aHR=0.40 (95%CI: 0.35-0.45; p<0.001) and CHM combined with acupuncture showing aHR=0.43 (95%CI: 0.39-0.47; p<0.001) compared with non-TCM users. Among the top 10 single herbs used, Di-Long (Lumbricus rubellus) exhibited the greatest reduction in mortality risk, with an aHR of 0.36 (95%CI: 0.28-0.47; p<0.001), followed closely by Dan-Shan (Salvia miltiorrhiza), Tian-Ma (Gastrodia elata), Ji-Xue-Teng (Millettia dielsiana), and Gou-Teng (Uncaria rhynchophylla), each with an aHR of 0.37. For formula, Xue‑Fu‑Zhu‑Yu‑Tang and Chai‑Hu‑Jia‑Long‑Gu‑Mu‑Li‑Tang demonstrated the strongest protective associations with mortality (aHR: 0.35; p<0.001), followed by Huang‑Qi‑Wu‑Wu‑Tang and Shao‑Yao‑Gan‑Cao‑Tang (both aHR: 0.35), suggesting consistent survival benefits associated with these core herbal formulas in the management of ICH. Network core pattern analysis identified the key components of treatment, including Bu-Yang-Huan-Wu-Tang, Yuan-Zhi (Polygala tenuifolia), Shi-Chang-Pu (Acorus tatarinowii), Tian-Ma (Gastrodia elata), and Gou-Teng (Uncaria rhynchophylla). Acupuncture exhibited a similar dose-response effect, with mortality risk decreasing progressively with more sessions (aHR: for ≥18 sessions: 0.45; 95%CI: 0.40-0.49; p<0.001).</p><p><strong>Conclusion: </strong>TCM, particularly with longer treatment and more acupuncture sessions, is associated with lower mortality in patients with ICH. Further research is needed to confirm these findings and explore the underlying mechanisms.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical presentations and prognostication of HER2-low and HER2-zero early breast cancer in Taiwan.","authors":"Yen-Jen Chen, Pei-Ju Lien, Ling-Ming Tseng, Chi-Cheng Huang","doi":"10.1097/JCMA.0000000000001376","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001376","url":null,"abstract":"<p><strong>Background: </strong>Human epidermal growth factor receptor II (HER2)low breast cancer has emerged as a clinically relevant subset of HER2‑negative disease, but its prognostic significance in early‑stage, real‑world populations remains uncertain. We aimed to compare clinicopathological features and outcomes of HER2‑low versus HER2‑zero early breast cancers using a nationwide registry and to clarify the impact of hormone‑receptor (HR) status through stratified analyses.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the Taiwan Cancer Registry (2011-2020). Eligible cases were stages 0-III HER2‑negative breast cancers managed with upfront surgery. We compared clinical characteristics and estimated overall survival (OS) and relapse‑free survival (RFS). As HR status is a dominant prognostic factor, all analyses were stratified by HR (positive vs. negative) and by pathological stage. Multivariable models adjusted for clinical covariates were used to estimate hazard ratios.</p><p><strong>Results: </strong>We analyzed 38,773 patients; 65.4% were HER2-low and 34.6% were HER2-zero. HER2-low tumors were diagnosed at a slightly younger age (median 56.3 vs 57.1 years; P<0.001) and were more often HR-positive (ER and PR, both P<0.0001). Across HR- and stage-defined strata, pathological stage and HR status remained the principal determinants of prognosis. Compared with HER2-zero, HER2-low showed modestly higher hazards, with small but consistent separations in OS (91.8%, 93%, 83.3% and 86.2% for HR-positive/HER2-low, HR-positive/HER2-zero, HR-negative/HER2-low, and HR-negative/HER2-zero breast cancers, P<0.0001) and RFS (95.6%, 97.1%, 89.6% and 91.1% for HR-positive/HER2-low, HR-positive/HER2-zero, HR-negative/HER2-low, and HR-negative/HER2-zero breast cancers, P<0.0001) within strata, with the exception of stage 0, where curves largely overlapped.</p><p><strong>Conclusion: </strong>In Taiwanese early stage breast cancer, HER2-low is common and associated with greater HR positivity and modestly inferior OS/RFS relative to HER2 zero after HR and stage stratification. These clinicopathological distinctions may influence future eligibility for the novel targeted therapy at metastatic relapse, even when early stage outcome differences are small. Further studies are warranted to understand the biological and therapeutic relevance of this newly established taxonomy.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal links of 233 metabolic markers to benign prostatic hyperplasia: Mendelian randomization and RNA- sequencing insights.","authors":"Pengfei Zhou, Zaisheng Zhu","doi":"10.1097/JCMA.0000000000001377","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001377","url":null,"abstract":"<p><strong>Background: </strong>Benign prostatic hyperplasia (BPH) is a common urological condition affecting middle-aged and elderly men, and it significantly impairs their quality of life. Although metabolic disorders are suspected to contribute to BPH, the causal relationship between metabolic markers and BPH remains unclear due to the limitations of traditional observational studies.</p><p><strong>Methods: </strong>In this study, Mendelian randomization (MR) analysis was performed by integrating genome-wide association study (GWAS) data from European populations, integrating metabolites from the GWAS Catalog, BPH-related GWAS data from OpenGWAS, and gene expression data from GEO. Five regression models were employed for two-sample MR analysis, with reverse MR analysis also performed. Sensitivity analysis was carried out through stringent instrumental variable selection criteria, including heterogeneity tests, horizontal pleiotropy tests, and leave-one-out analysis. Additionally, differential gene expression analysis, consensus clustering of BPH subtypes, characteristic gene screening, diagnostic model construction, immune infiltration analysis, and single-gene Gene Set Enrichment Analysis (GSEA) were performed.</p><p><strong>Results: </strong>MR analysis identified several metabolic markers, including total cholesterol, valine, and alanine in HDL, that were significantly associated with BPH, all acting as risk factors. Reverse MR analysis revealed no evidence of reverse causal effects of BPH on most metabolic markers. Additionally, distinct BPH subtypes were identified, along with three key genes (GRAMD2B, HEBP2, and STRADB). A highly accurate diagnostic model was constructed based on these genes.</p><p><strong>Conclusion: </strong>This study elucidates the causal relationship between metabolic markers and BPH, offering new insights into the etiology, diagnosis, and treatment of the disease. However, limitations include the lack of in vitro experimental validation. Future research should address these limitations, further explore the pathogenesis of BPH, and facilitate the development of more effective prevention and treatment strategies.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating complex interactions between psychiatric disorders and their treatment in pregnancy: Clinical implications.","authors":"Juang Kai Dih","doi":"10.1097/JCMA.0000000000001373","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001373","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147648060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond disease treatment and prevention: From geroscience and molecular hallmarks to gerotherapeutics and precision geromedicine.","authors":"Li-Ning Peng, Fei-Yuan Hsiao, Liang-Kung Chen","doi":"10.1097/JCMA.0000000000001374","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001374","url":null,"abstract":"<p><p>Geroscience - the interdisciplinary field investigating the causal relationship between the biology of aging and age-related chronic disease - has undergone a remarkable evolution since its formalization within the United States National Institutes of Health in the early 2010s. Grounded in the recognition that aging is the paramount modifiable risk factor for most noncommunicable diseases, geroscience has produced a coherent molecular taxonomy of aging processes (twelve hallmarks), delineated pro-aging and anti-aging molecular pathways (gerogenes, gerosuppressors, and gerozymes), and catalyzed a new clinical vocabulary - geroprotection, gerodiagnostics, and gerotherapeutics. Two institutional milestones anchor the field's translational ambitions: the WHO's codification of Ageing-Associated Decline in Intrinsic Capacity as ICD-11 code MG2A; and the FDA's acceptance of the Targeting Aging with Metformin (TAME) trial - the first prospective clinical trial designed to delay aging as a composite multi-disease outcome, currently underway. The biomarker science of aging has advanced in parallel, from first-generation DNA methylation clocks to organ-specific plasma proteomic signatures capable of predicting various age-related diseases with clinical-grade precision. The gerotherapeutic landscape has expanded substantially. Metformin, which engages more aging hallmarks than any other candidate gerotherapeutic, provided the regulatory impetus for TAME; in a rigorous 40-month multi-omics study in cynomolgus monkeys, it decelerated plasma proteomic biological age by 6.41 years - the strongest pharmacological evidence to date for systemic biological age modification in a primate model. Senolytics and senomorphics target senescent cell burden; SGLT-2 inhibitors represent the first approved class with direct senotherapeutic properties; GLP-1 receptor agonists attenuate inflammaging; NAD⁺ precursors restore mitochondrial and sirtuin function; and the gerozyme (15-PGDH) inhibitor offers a mechanistically distinct pro-regenerative approach with emerging relevance as an adjunct to GLP-1 receptor agonist therapy. Multidomain lifestyle programs address multiple aging hallmarks simultaneously and have demonstrated measurable intrinsic capacity improvement in randomized trials. Building on these foundations, this review proposes the Geroscience-Responsive Aging Care Ecosystem (GRACE) - a three-element service model operationalizing geroscience and gerotherapeutic evidence within the WHO Integrated Care for Older People (ICOPE) framework.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}