Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Elevated CCL20 expression associates with adverse prognosis in breast cancer patients: A clinical perspective.","authors":"Xia Zhao, Yanping Li, Yu Feng, Shuzhen Lv","doi":"10.1097/JCMA.0000000000001233","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001233","url":null,"abstract":"<p><strong>Background: </strong>The chemokine CCL20 exhibits pronounced expression within tumor cells, effectively facilitating tumor progression by modulating the immunosuppressive microenvironment and promoting tumor cell aggressiveness.</p><p><strong>Methods: </strong>Breast cancer and matched adjacent normal tissues from 113 adult breast cancer patients were collected for immunohistochemical staining of CCL20, E-Cadherin, Vimentin, and N-Cadherin. The assessment evaluated the association between CCL20 expression and clinicopathological factors using Pearson's chi-squared test, EMT markers expression using Spearman's rank correlation test, both OS and DFS using Kaplan-Meier survival analysis and Cox proportional hazards regression modeling.</p><p><strong>Results: </strong>Cytoplasmic CCL20 expression was stronger in cancer tissues, compared to normal tissue (69.9% vs 23%). Strong correlations were observed between CCL20 expression and many clinicopathological features, including tumor size (p = 0.000), estrogen receptor (ER) status (p = 0.003), Ki67 status (p = 0.000), vascular invasion (p = 0.001), and tumor-node-metastasis stage (p = 0.001). Additionally, CCL20 expression was an independent prognostic predictor for OS (HR, 3.207; 95% confidence interval [CI], 1.142 - 9.005, p = 0.027). Furthermore, a significant association between CCL20 expression and EMT markers was observed. CCL20 expression was linked to unfavorable outcomes in all patients (p = 0.000), ER-positive patients (p = 0.001), and node-positive/negative (p = 0.005/0.001) subgroups.</p><p><strong>Conclusion: </strong>These findings highlighted that elevated CCL20 expression was linked to a more aggressive tumor phenotype and a disappointing OS in breast cancer patients, thus advocating for the consideration of CCL20 expression being a novel independent prognostic biomarker for guiding bespoke treatment strategies.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756541","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":"Effectiveness of multiple mnemonic strategies for improving verbal memory in older adults.","authors":"Yu-Ruei Lin, Yu-Hsiang Cheng, Dai-Wei Lin, Yu-Chen Chuang, Hsiu-Ling Huang, Yann-Ying Hsiao, Chieh-Ning Huang, Ting-Jung Hsu, Jong-Ling Fuh","doi":"10.1097/JCMA.0000000000001228","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001228","url":null,"abstract":"<p><strong>Background: </strong>Cognitive training is an evidence-based intervention for preserving memory in older adults. The effectiveness of cognitive training varies, depending on the approach used. This study examined the efficiency of cognitive training using multiple mnemonic strategies in older adults.</p><p><strong>Methods: </strong>This study adopted a pretest-posttest control-group design, with all participants undergoing two neuropsychological assessments. The cognitive training program consisted of four 60-minute sessions over a month. In the interventions, participants practiced the mnemonic strategies of elaboration and self-reference. The effect of cognitive training was analyzed using both dependent and independent t-tests.</p><p><strong>Results: </strong>The mean ages were 69.7 ± 12.0 for the control group (n= 23) and 70.7 ± 5.6 for the intervention group (n= 27), with educational attainment of 11.9 ± 3.2 and 12.1 ± 3.9 years, respectively. Both groups showed an overall improvement in memory tests, but only the intervention group's learning and delayed recall aspects of the verbal memory test remained statistically significant after adjusting for multiple comparisons (p < 0.00625).</p><p><strong>Conclusion: </strong>Our study demonstrates that multiple-mnemonic strategy-based cognitive training effectively enhances memory function in older adults and should be regarded as an alternative intervention for older adults.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733831","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":"Insulin initiation for patients with poorly controlled type 2 diabetes mellitus.","authors":"Hsin-An Chen, Chia-Hung Lin, Feng-Hsuan Liu","doi":"10.1097/JCMA.0000000000001232","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001232","url":null,"abstract":"<p><strong>Background: </strong>We examined the initiation of insulin therapy in patients with poorly controlled type 2 diabetes mellitus (T2DM), analyzed their glycemic responses, and compared patient profiles based on glycemic outcomes.</p><p><strong>Method: </strong>Patients with T2DM initiated on insulin therapy were retrospectively analyzed. Data were collected from endocrinology clinic before and 3- and 6-months after insulin initiation. The primary outcome was hemoglobin A1c (HbA1c) level 6 months after commencing insulin treatment. Secondary outcomes included HbA1c levels at 3 months after insulin treatment and fasting blood glucose levels at 3 and 6 months after treatment. We analyzed the effects of insulin initiation and categorized patients based on their 6-month HbA1c levels: below the median of 7.8% (better response) and above 7.8% (worse response). Additionally, we evaluated patients based on HbA1c changes at 6 months, with greater or lesser changes defined by the cohort's median change of -1.4%.</p><p><strong>Result: </strong>Insulin therapy significantly reduced HbA1c (from 9.8% to 8.2%) and fasting blood glucose levels (from 221.4 to 147.2 mg/dL) within 3 months. After 6 months, HbA1c and fasting blood glucose levels decreased by 2.1% (9.8-7.7%) and 77.2 mg/dL (221.4-144.2 mg/dL), respectively. Patients who responded better to insulin treatment showed lower fasting blood glucose levels by 6 months after insulin initiation and lower HbA1c levels as soon as 3 months after initiation. Patients with higher baseline glycemic profiles experienced significantly greater HbA1c reductions at 6 months post-treatment.</p><p><strong>Conclusion: </strong>Insulin therapy significantly improved glycemic control in patients with T2DM within 3 months after initiation. Patients with higher baseline glycemic profiles experienced greater responses to insulin therapy.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733832","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":"High muscle-to-fat ratio predicts slow muscle strength decline in middle-aged and older adults: Results from longitudinal aging study of Taipei.","authors":"Ching-Jen Chang, Ming-Hsien Lin, Liang-Yu Chen, Sung-Hua Tseng, An-Chun Hwang, Chung-Yu Huang, Ko-Han Yen, Liang-Kung Chen, Li-Ning Peng","doi":"10.1097/JCMA.0000000000001229","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001229","url":null,"abstract":"<p><strong>Background: </strong>Handgrip strength is a vital marker of muscle function and predictor of health outcomes in older adults. This study investigated the relationship between the muscle-to-fat ratio and 3-year decrease in handgrip strength in community-dwelling adults aged ≥50 years.</p><p><strong>Methods: </strong>Data were obtained from the Longitudinal Aging Study of Taipei (LAST), a cohort study of adults aged 50 years and older. Measurements from two waves, 3 years apart, were analyzed. Demographics, laboratory data, and handgrip strength data were collected. Appendicular skeletal muscle mass was assessed using bioimpedance analysis, and the relative appendicular skeletal muscle mass index was calculated by dividing appendicular muscle mass by height squared. The muscle-to-fat ratio was derived by dividing appendicular muscle mass by total body fat. Handgrip strength decrease was divided into quartiles; slow decliners experienced the smallest decrease, whereas rapid decliners had the greatest decrease. Associations between the muscle-to-fat ratio and other risk factors were analyzed.</p><p><strong>Results: </strong>Over 3 years, the Charlson Comorbidity Index, medication use, waist-to-hip ratio, and fat percentage increased, whereas skeletal muscle mass, the muscle-to-fat ratio, and handgrip strength decreased. Rapid decliners were less likely to be male (21.6% vs. 33.3%, P=0.008) or alcohol drinkers (53.8% vs. 66.2%, p=0.01) and had lower skeletal muscle mass (6.3 ± 0.9 vs. 6.6 ± 1.0, p=0.006) and muscle-to-fat ratios (1.0 ± 0.4 vs. 1.1 ± 0.5, p=0.004) but greater fat percentages (30.4 ± 6.6 vs. 29.0 ± 7.6, P=0.045). A greater muscle-to-fat ratio (OR 3.751, p=0.047), greater physical activity (OR 1.694, p=0.04), and lower HbA1c (OR 0.61, p=0.008) reduced the risk of rapid decline.</p><p><strong>Conclusion: </strong>The muscle-to-fat ratio, together with physical activity and glycemic control, predicts a decrease in handgrip strength, highlighting its potential as a biomarker of intrinsic capacity and muscle‒fat interplay. Further research is needed to explore the underlying biological mechanisms involved.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702505","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":"TwPAD registry: A prospective, multicenter registry of chronic peripheral arterial disease involving lower limbs in Taiwan.","authors":"Yueh-Hung Lin, Chung-Ho Hsu, Jen-Kuang Lee, Po-Chao Hsu, Chiu-Yang Lee, Chun-Chi Chen, Po-Wei Chen, Hsu-Ping Wu, Min-I Su, Chun-Wei Lee, Hung-I Yeh","doi":"10.1097/JCMA.0000000000001224","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001224","url":null,"abstract":"<p><strong>Background: </strong>Peripheral arterial disease (PAD) is a consequence of systemic atherosclerosis, resulting in arterial narrowing and diminished blood flow, leading to complications like claudication, rest pain, ulcers, gangrene, and functional limitations. Despite its impact on cardiovascular mortality, physical function, and quality of life, PAD has received less attention than other atherosclerotic disorders. This study addresses the paucity of comprehensive clinical data on PAD in Taiwan, aiming to analyze its incidence, risk factors, pharmacological and interventional treatments, and outcomes.</p><p><strong>Methods: </strong>This prospective, multicenter, observational registry includes PAD patients from 10 medical centers or teaching hospitals across Taiwan. Data collected encompass demographic characteristics, medical history, laboratory results, and treatment history. Patients are followed up annually to monitor all-cause mortality, major clinical events (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke), and total cardiovascular events (including hard events, unplanned revascularizations, hospitalizations for endovascular therapy, stroke, transient ischemic attacks, and heart failure).</p><p><strong>Results: </strong>From September 2020 to December 2022, 1005 patients were enrolled. The mean age of the cohort was 70.3 years, with men constituting the majority (59.3%). The prevalence rates of key medical conditions were 68.2% for diabetes, 76.3% for hypertension, 72.6% for hypercholesterolemia, 40.6% for smoking and 26.2% for end-stage renal disease. Central Taiwan patients were younger, had a higher BMI and prevalence of obesity, but lower rates of comorbidities such as hypertension, diabetes, and smoking history. In contrast, eastern Taiwan patients were older, had a lower BMI and prevalence of obesity, but exhibited higher levels of comorbidity.</p><p><strong>Conclusion: </strong>The TwPAD registry provides comprehensive insights into patient characteristics, treatments, and outcomes. Regional variations in age, BMI, and comorbidity levels were noted between central and eastern Taiwan. Importantly, the registry identified gaps in adherence to guideline-directed medical therapy, particularly in statin use. Continued data collection will support improvements in PAD management nationwide.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702507","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":"AI's deep research revolution: Transforming biomedical literature analysis.","authors":"Ying-Mei Wang, Tzeng-Ji Chen","doi":"10.1097/JCMA.0000000000001231","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001231","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702504","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":"Metabolic dysfunction-associated steatotic liver disease and its associated health risks.","authors":"Xia-Rong Liu, Szu-Ching Yin, Yi-Ting Chen, Mei-Hsuan Lee","doi":"10.1097/JCMA.0000000000001230","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001230","url":null,"abstract":"<p><p>This review article synthesizes the current knowledge on the epidemiology of metabolic dysfunction-associated steatotic liver disease (MASLD), its associated risks, and its genetic determinants. The findings presented in this article can be used to develop clinical strategies to reduce MASLD's growing global burden. MASLD has become a major global health concern due to increasing rates of obesity, sedentary lifestyles, and metabolic disorders. MASLD is a leading cause of end-stage liver diseases, including cirrhosis and hepatocellular carcinoma (HCC), and MASLD also significantly increases the risk of cardiovascular disease (CVD), thereby exerting dual effects on liver and cardiovascular health. MASLD was once referred to as non-alcoholic fatty liver disease, and this change in nomenclature reflects a growing focus on its metabolic underpinnings, facilitating the more precise diagnosis and clinical management of this disease. Epidemiological studies have demonstrated that the prevalence of MASLD is increasing worldwide, although the prevalence varies across regions and populations. Noninvasive diagnostic tools such as ultrasound and fatty liver indices along with biomarkers such as alanine aminotransferase (ALT) are crucial for early detection and risk stratification. Genetic research has identified key gene variants, including PNPLA3 (rs738409) and TM6SF2 (rs58542926), that influence MASLD susceptibility and progression, and these findings have created opportunities for improving precision medicine with respect to treating MASLD. Research has revealed an association between MASLD and major adverse cardiovascular events and increased mortality, which highlights the importance of integrating cardiovascular risk management into treatment strategies for MASLD. Future research should focus on advancing noninvasive diagnostics, leveraging genetic insights to provide tailored care, and implementing population-specific interventions to address regional variations.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702506","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":"Electroacupuncture treatment enhances synaptic plasticity in middle cerebral artery occlusion mice via the miR-670-3p/HMGB1 axis.","authors":"Jingyan Cheng, Guoyuan Pan, Zhen Wang, Haoran Chu, Yanpeng Pu","doi":"10.1097/JCMA.0000000000001226","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001226","url":null,"abstract":"<p><strong>Background: </strong>Electroacupuncture (EA) is a physical therapy of traditional Chinese medicine, which has been widely used in clinical practice. This paper was designed to explore the effect of EA treatment on synaptic plasticity in mice subjected to middle cerebral artery occlusion (MCAO) and to elucidate the associated molecular mechanisms.</p><p><strong>Methods: </strong>After MCAO modeling, C57BL/6 mice underwent EA treatment or/and miR-670-3p mimic injection, followed by assessment of neurological deficit by modified neurological severity score (mNSS) and evaluation on cerebral infarction area by TTC staining. The changes of synaptic ultrastructure related parameters were observed using transmission electron microscopy (TEM). The expression levels of miR-670-3p, HMGB1, TLR4/NF-κB pathway related proteins, and synaptic associated proteins (synapsin 1, PSD95, BDNF, and GAP43) were quantified by RT-qPCR and western blot analysis. The binding relationship between miR-670-3p and HMGB1 was assessed through dual-luciferase reporter assays and RNA pull down assays.</p><p><strong>Results: </strong>Mice underwent EA treatment or miR-670-3p mimic injection exhibited increased miR-670-3p expression, reduced expression levels of HMGB1 and TLR4/NF-κB pathway related proteins, improved neurological function, and enhanced synaptic plasticity. Furthermore, the combination of EA treatment and miR-670-3p mimic injection produced a synergistic effect, further amplifying these outcomes. Mechanistically, miR-670-3p was found to negatively regulate HMGB1.</p><p><strong>Conclusion: </strong>EA treatment enhances synaptic plasticity in MCAO mice by promoting miR-670-3p expression to negatively regulate the HMGB1/TLR4/NF-κB pathway.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652915","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":"Cancer publications using real-world data from the Taiwan National Health Insurance Research Database: conceptual framework and bibliometric analysis.","authors":"Wing Hin Stanford Siu, Ai Yin Lim, Jia-Rou Liu, Shu-Hao Chang, Wei-Min Chen, Pei-Ru Li, Lai-Chu See","doi":"10.1097/JCMA.0000000000001227","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001227","url":null,"abstract":"<p><strong>Background: </strong>Bibliometric analysis often overlooks study-based components such as study aims, design, and statistical methods. In this study, we propose a conceptual framework incorporating these study-based components with disease-based components for the bibliometric analysis of cancer articles using real-world data. This framework is a significant step forward in cancer research. We then investigated the distribution and temporal trends of these components for cancer articles using the Taiwan National Health Insurance Research Database (NHIRD) published from 2006 to 2022.</p><p><strong>Methods: </strong>Study- and disease-based components were extracted and cross-validated. The distribution and temporal trends of these components were then presented.</p><p><strong>Results: </strong>We analyzed 1232 articles and found a noticeable increase in the annual publication count from 2011 onward. This upward trend signified the growing momentum in cancer research. Cancer risk factors were the most studied (52%), followed by cancer outcomes (36%) and incidence/prevalence (3%). Among the publications on risk factors and outcomes, most were cohort studies (85%), followed by case-control studies (10.7%). In both study designs, the use of the propensity score method increased steadily from 2.4% in 2011 to 40% in 2022. The most frequently studied cancer site was 'all cancers or multiple cancers' (25.6%), followed by breast (9.6%), hepatobiliary (9.2%), and colorectal cancers (8.8%). Among the top 10 cited articles, the first and fourth focused on whether suppressing hepatitis B viral load with nucleoside analogs could reduce hepatocellular carcinoma recurrence and incidence in chronic hepatitis B patients. The remaining eight examined the association between medications and cancer risk.</p><p><strong>Conclusion: </strong>Beyond citation metrics, our research underscores the importance of considering study-based and disease-based components in bibliometric analysis. These components form the foundation of the real-world data cancer research framework and have practical implications for diseases beyond cancers, providing a broader perspective for researchers and practitioners.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652912","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":"While GPT-3.5 is unable to pass the Physician Licensing Exam in Taiwan, GPT-4 successfully meets the criteria.","authors":"Tsung-An Chen, Kuan-Chen Lin, Ming-Hwai Lin, Hsiao-Ting Chang, Yu-Chun Chen, Tzeng-Ji Chen","doi":"10.1097/JCMA.0000000000001225","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001225","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the performance of ChatGPT-3.5 and ChatGPT-4 in answering medical questions from Taiwan's Physician Licensing Exam, ranging from basic medical knowledge to specialized clinical topics. It aims to understand these artificial intelligence (AI) models' capabilities in a non-English context, specifically traditional Chinese.</p><p><strong>Methods: </strong>The study incorporated questions from the Taiwan Physician Licensing Exam in 2022, excluding image-based queries. Each question was manually input into ChatGPT, and responses were compared with official answers from Taiwan's Ministry of Examination. Differences across specialties and question types were assessed using the Kruskal-Wallis and Fisher's exact tests.</p><p><strong>Results: </strong>ChatGPT-3.5 achieved an average accuracy of 67.7% in basic medical sciences and 53.2% in clinical medicine. Meanwhile, ChatGPT-4 significantly outperformed ChatGPT-3.5, with average accuracies of 91.9% and 90.7%, respectively. ChatGPT-3.5 scored above 60.0% in 7 out of 10 basic medical science subjects and 3 out of 14 clinical subjects, while ChatGPT-4 scored above 60.0% in every subject. The type of question did not significantly affect accuracy rates.</p><p><strong>Conclusion: </strong>ChatGPT-3.5 showed proficiency in basic medical sciences but was less reliable in clinical medicine, whereas ChatGPT-4 demonstrated strong capabilities in both areas. However, their proficiency varied across different specialties. The type of question had minimal impact on performance. This study highlights the potential of AI models in medical education and non-English languages examination and the need for cautious and informed implementation in educational settings due to variability across specialties.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627332","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}