Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Optimizing care for chronic kidney disease: Considerations from A to Z.","authors":"Fan-Yu Chen, Wan-Chen Chang, Zih-Kai Kao, Ann Charis Tan, Szu-Yuan Li, Chih-Yu Yang, Hsuan Lin, Chih-Ching Lin","doi":"10.1097/JCMA.0000000000001280","DOIUrl":"10.1097/JCMA.0000000000001280","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) management requires a comprehensive and multidisciplinary approach to optimize clinical outcomes. This review systematically outlines essential components of CKD care from A to Z, offering evidence-based guidance to enhance patient management. Anemia treatment emphasizes iron supplementation, erythropoiesis-stimulating agents, and novel hypoxia-inducible factor prolyl hydroxylase inhibitors. Achieving optimal blood pressure control through renin-angiotensin system inhibitors and calcium channel blockers reduces cardiovascular risk and delays CKD progression. Cardiovascular risk management includes statins combined with ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors, along with appropriate anticoagulation therapy for atrial fibrillation. Individualized glycemic control strategies prioritize sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists for their cardiovascular and renal protective effects. Vigilance in avoiding nephrotoxic agents, such as non-steroidal anti-inflammatory drugs, proton pump inhibitors, aminoglycosides, and contrast media, is essential for preventing renal injury. Rigorous management of electrolytes and acid-base disturbances, involving dietary sodium and potassium restrictions, phosphate binders, and bicarbonate supplementation, reduces CKD progression and related complications. Appropriate fluid management through dietary sodium and water restriction with individualized diuretic therapy prevents volume overload and associated cardiovascular complications. Nutritional interventions, particularly low-protein diets supplemented with ketoanalogues of amino acids, effectively delay CKD progression and control metabolic disturbances. Therapies addressing CKD-related mineral and bone disorders, including phosphate binders, vitamin D analogues, and calcimimetics, reduce the risk of vascular calcification. In addition, lipid-lowering therapies, anticoagulation therapy, optimal vascular access management for dialysis, and early detection of arrhythmias and thrombotic microangiopathy significantly enhance patient outcomes. Attention to quality of life issues, such as alleviating xerosis symptoms, promoting optimal body mass index through weight management strategies, and providing psychosocial support, further enhances patient-centered care. This comprehensive review highlights the crucial importance of a multidisciplinary approach in CKD management.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"738-746"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823554","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":"Genomic insights for triple-negative breast cancer patients in Taiwan.","authors":"Peng-Hui Wang, Szu-Ting Yang, Hsiang-Tai Chao","doi":"10.1097/JCMA.0000000000001283","DOIUrl":"10.1097/JCMA.0000000000001283","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"735-737"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984165","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 features and surgical treatment of hemophilic pseudotumors: A single-center experience over a 20-year period.","authors":"Cheng-Fong Chen, Liang-Tsai Hsiao, Jan-Wei Chiu, Shang-Wen Tsai, Chao-Ming Chen, Po-Kuei Wu, Wei-Ming Chen","doi":"10.1097/JCMA.0000000000001290","DOIUrl":"10.1097/JCMA.0000000000001290","url":null,"abstract":"<p><strong>Background: </strong>Hemophilic pseudotumor (HPT) is an uncommon but severe complication in patients with hemophilia (PWH). Given the rarity, case series were scarce and largely confined to case report in the literature. Consequently, the aim of this study is to present surgical results of HPT over a 20-year period from a single institute.</p><p><strong>Methods: </strong>We retrospectively reviewed 11 HPT in 10 PWH who underwent surgical treatment in our institute between 1999 and 2020. Their clinical features, surgical management, outcomes, and complications were identified.</p><p><strong>Results: </strong>There are 10 men PWH with 11 HPT who had undergone a total of 20 surgical procedures over a 20-year period. The mean age at surgery was 41.2 years with an average follow-up of 9.7 years. Nine patients had hemophilia A (five severe, three moderate, and one mild) and one patient had severe hemophilia B. Localization of the HPT was confined to soft tissue in two patients (9.1%), to intraosseous lesion in five patients (45.5%) and to subperiosteal location in the remaining four patients (36.4%). Three patients (27.2%) had complications, including one wound infection, one chronic osteomyelitis, and one recurrence. Postoperative complete resolution was achieved in nine HPT except one recurrence and one persistent chronic osteomyelitis; the former was stable after further excision, and the latter was resolved by amputation.</p><p><strong>Conclusion: </strong>Surgical therapy for HTP is feasible and effective when covered with adequate factor replacement. Given the variety, careful case-to-case evaluation is important to take the appropriate surgical modality and avoid potential complication.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"774-782"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031554","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":"Artificial intelligence-assisted glaucoma detection on color fundus images: with comorbidity and cross-institutional analysis.","authors":"Wei-Shiang Chen, Yu-Chieh Ko, Yen-Cheng Chen, Henry Horng-Shing Lu","doi":"10.1097/JCMA.0000000000001289","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001289","url":null,"abstract":"<p><strong>Background: </strong>Glaucoma is a major cause of irreversible blindness, and early detection is essential to prevent vision loss. Color fundus photography is a simple, low-cost, and noninvasive eye screening method, but diagnosis through this method can be difficult in patients with additional retinal diseases. Although artificial intelligence (AI) can address this difficulty, its effectiveness may vary between hospitals. In this study, an AI glaucoma detection system was developed and tested for reliability across different populations and clinical settings.</p><p><strong>Methods: </strong>A stepwise AI pipeline was designed that combined image enhancement, automated identification of the optic nerve area, and deep learning-based classification. The system was trained on 1696 images from Taipei Veterans General Hospital and tested on five cross-regional external datasets. The system was also evaluated on a separate internal set of 151 images representing comorbid eye diseases.</p><p><strong>Results: </strong>The AI system achieved a balanced accuracy of at least 80% on all external datasets. For images with other eye diseases, it achieved an area under the curve of 0.93 and a balanced accuracy of 80.9%. Its performance remained consistent regardless of differences in patient ethnicity, camera types, and image quality.</p><p><strong>Conclusion: </strong>The proposed AI system can detect glaucoma on standard color fundus photographs with high accuracy across clinical environments and in the presence of comorbid eye diseases. The system may be a practical and affordable tool for large-scale glaucoma screening, particularly in institutions with limited resources.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":"88 10","pages":"747-759"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310552","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 characteristics and prognostic factors in patients with stool cytomegalovirus positivity.","authors":"Yi-Tien Hsuan, Ching-Hao Hsu, Cheng-Yu Chen, Yu-Jiun Chan, Hsin-Pai Chen","doi":"10.1097/JCMA.0000000000001300","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001300","url":null,"abstract":"<p><strong>Background: </strong>The clinical association between cytomegalovirus (CMV) DNA detection in stool samples and patient outcomes remains underexplored. This study aimed to assess prognostic factors and viral kinetics in patients with positive stool CMV polymerase chain reaction (PCR).</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients with positive stool CMV-PCR results at Taipei Veterans General Hospital (2016-2021). Clinical data, plasma and stool viral loads (VLs) were analyzed. Receiver operating characteristic (ROC) curves and area under the curve (AUC) evaluated 30-day mortality prediction, with optimal cutoffs maximizing sensitivity and specificity. Kaplan-Meier survival analyses and Cox proportional hazards models identified predictors of 30-day mortality.</p><p><strong>Results: </strong>A total of 114 patients (mean age: 64.0 years, 64% male) were included. The median stool CMV VL was 629 copies/mL [interquartile range (IQR): 263 -7,949]. Plasma CMV DNA was detected in 76% with a median VL of 341 copies/mL (IQR: 10 -1,771). Stool and plasma VLs showed moderate correlation (ρ= 0.38, p < 0.0001). ROC analysis identified cutoffs for predicting 30-day mortality: stool 9,654 copies/mL (AUC = 0.54; sensitivity 42%; specificity 81%) and plasma 1,738 copies/mL (AUC = 0.60; sensitivity 47%; specificity 70%). In multivariate Cox analysis, stool CMV VL >9,654 copies/mL (adjusted hazard ratio [HR] 2.69, 95% confidence interval [CI]: 1.06-6.84, p = 0.04) and plasma CMV VL >1,738 copies/mL (adjusted HR 2.66, 95% CI: 1.14-6.17, p = 0.02) were independent predictors of 30-day mortality. Septic shock and steroid use were also associated with increased mortality, whereas antiviral therapy ≥7 days was independently protective (adjusted HR 0.26, 95% CI: 0.10-0.64, p = 0.003).</p><p><strong>Conclusion: </strong>Stool and plasma CMV viral loads, antiviral treatment duration, and host factors such as immune status may influence outcomes in patients with intestinal CMV reactivation. Larger studies are needed to validate optimal viral load thresholds for risk stratification.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188108","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":"Salvage radiotherapy with PSMA-directed focal boost: A precision approach for recurrent prostate cancer.","authors":"Tien-Li Lan, Ko-Han Lin, Tzu-Chun Wei, Yu-Wen Hu, Tzu-Yu Lai, Yu-Mei Kang, Hsiao-Jen Chung, Shu-Huei Shen, Yu-Ming Liu","doi":"10.1097/JCMA.0000000000001298","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001298","url":null,"abstract":"<p><strong>Background: </strong>With the advent of novel therapies and advanced imaging modalities, prostate cancer patients are living longer, but biochemical recurrence has become increasingly common. Prostate-specific membrane antigen (PSMA) PET imaging demonstrates high sensitivity in detecting recurrence at low PSA levels, surpassing conventional imaging. While salvage radiotherapy traditionally targets the prostate fossa, PSMA PET enables focal dose escalation to PSMA-avid lesions. This study evaluated whether PSMA PET-guided salvage radiotherapy improves disease control compared with androgen deprivation therapy (ADT) alone, while maintaining an acceptable toxicity profile.</p><p><strong>Methods: </strong>Patients with suspected recurrent prostate cancer underwent PSMA PET, with eligibility defined as a PSMA score >3. Salvage treatment consisted of high-dose radiotherapy to the prostate fossa with focal boost to PSMA-avid lesions (with or without ADT) or ADT alone. The primary endpoint was failure-free survival. Secondary endpoints included treatment-related toxicities.</p><p><strong>Results: </strong>Fifty-six patients were included (mean age, 70.3 years). The mean initial PSA was 25.2 ng/mL, and the mean PSA prior to PSMA PET was 2.47 ng/mL. Patients who had previously undergone radical prostatectomy demonstrated significantly longer FFS compared with those initially treated with radiotherapy (41.2 vs. 31.5 months, p = 0.045), although baseline PSA was higher in the radiotherapy group. Salvage radiotherapy yielded significantly longer FFS than ADT alone (42.1 vs. 23.4 months, p < 0.001). Acute grade 1-2 gastrointestinal or genitourinary toxicities occurred in 23 patients (46.9%), late grade 1-2 events in 16 patients (32.7%), and grade 3 hematuria requiring intervention in 4 patients (8.2%).</p><p><strong>Conclusion: </strong>PSMA PET-guided salvage radiotherapy is an effective and personalized strategy for patients with biochemically recurrent prostate cancer. Compared with ADT alone, it provides superior failure-free survival with manageable toxicity, supporting its role as a standard component of salvage management.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139850","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":"A novel audiogram model for predicting the prognosis of sudden sensorineural hearing loss.","authors":"Hsia-Wei Tseng, Chien-Yeh Hsu, Chih-Hao Chen, Yuan-Chia Chu, Wen-Huei Liao","doi":"10.1097/JCMA.0000000000001299","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001299","url":null,"abstract":"<p><strong>Background: </strong>Sudden sensorineural hearing loss (SSNHL) is an otological emergency involving hearing loss greater than 30 dB across three consecutive frequencies within 72 hours. Prognosis is influenced by the initial pure tone audiogram (PTA), with ascending and U-shaped patterns showing better outcomes and descending patterns linked to poorer outcomes. Traditional audiograms are classified into 4 to 7 types based on hearing thresholds at 4 to 6 frequencies, such as flat, ascending, or descending types. However, the definitions of these patterns are often ambiguous and not easy to apply in clinical practice. This study aimed to compare the prognostic value of the traditional seven-type audiogram model with a novel three-type audiogram model.</p><p><strong>Methods: </strong>This retrospective cohort study included SSNHL patients from 2012 to 2023. Hearing outcomes, measured by PTA, were classified using both the traditional seven-type audiogram model and a new three-type model based on the 4 kHz threshold (the best, intermediate, the worst). The traditional seven-type model classifies audiograms into flat, descending, ascending, tent-shaped, U-shaped, jagged, and profound types based on the threshold patterns at four frequencies (0.5, 1, 2, and 4 kHz). The novel three-type model classified audiograms according to the relative position of the 4 kHz threshold: (1) 4 kHz the best (lowest threshold), (2) 4 kHz intermediate (threshold in between), or (3) 4 kHz the worst (highest threshold). Complete recovery (CR) was defined as a final hearing threshold ≤25 dB HL. Multiple and stratified linear regression analyses assessed its association with the CR rate, defined as the proportion of patients achieving CR.</p><p><strong>Results: </strong>In total, 965 patients with SSNHL were recruited (51.5% men; mean age 50.8 ± 15.1 years). Left ear involvement was more common (53.3%). CR was achieved in 21.1% of patients. The three-type audiogram model classification were significantly associated with complete recovery (overall p < 0.001, multivariable logistic regression). 4 kHz was the worst, the CR rate was 20%, intermediate, 36%, the best, 49%. In contrast, the traditional seven-type audiogram model did not demonstrate such predictive characteristics.</p><p><strong>Conclusion: </strong>The novel three-type audiogram model provides better prognostic predictions for SSNHL, with 4 kHz frequency being a key factor influencing recovery. Traditional audiogram classification is relatively complex, whereas the novel three-type audiogram model, which uses the 4 kHz threshold for classification, is simple, clear, and provides better prognostic prediction for SSNHL, making it more suitable for clinical application.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139867","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":"Association between clinical learning portfolio recording and medical students' competencies and entrustable professional activities in Taiwan.","authors":"Jen-Feng Liang, Wan-Yu Yeh, Shiau-Shian Huang, Hsiao-Yun Yeh, Hsiao-Chin Shen, Chia-Chang Huang, Yi-Hsuan Lin, Hao-Min Cheng, Ying-Ying Yang, Jiing-Feng Lirng, Chen-Huan Chen, Shuu-Jiun Wang","doi":"10.1097/JCMA.0000000000001297","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001297","url":null,"abstract":"<p><strong>Background: </strong>The clinical reflection-oriented learning portfolio is widely applied in clinical rotation but it is time-consuming for clinical trainees and the effect on learning is still questionable. This study aims to provide effectiveness evidence of learning portfolio by examining the association between learning portfolio appraisal and clinical performance.</p><p><strong>Methods: </strong>From 2020 to 2022, data were evaluated to investigate the relationship between excellent portfolio award status, proficiency in entrustable professional activities (EPAs)-based assessments, and clinical competencies based on the core EPAs for entering residency of the American Association of Medical Colleges (AAMC), as well as eight core competencies evaluated every two weeks from each clinical department. In addition, clerks who continued their second-year clerkship at the research hospital (continuous follow-up group) were analyzed to further explore the association between first-year award status and second-year clinical outcomes.</p><p><strong>Results: </strong>A total of 148 first-year clerks were included in the overall group (award recipients and non-recipients). Among them, 86 continued their clerkship at the research hospital in the second year (continuous follow-up group). In the overall group, compared with excellent learning portfolio non-recipients, award recipients demonstrated higher scores in 11 of the 13 EPAs and in all 8 core competencies. Moreover, higher-frequency award winners obtained significantly higher scores compared to lower-frequency award winners. Stratified analyses based on gender yielded similar results during clerkship. However, this beneficial association was not observed in the continuous follow-up group.</p><p><strong>Conclusion: </strong>This database study supports that better learning portfolio recording is associated with better clinical performance during early stage of clerkship. Learning portfolio could be an effective tool to facilitate clinical in early clerkship.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088632","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":"Management of HR+/HER2- breast cancer patients: 1L therapy.","authors":"Peng-Hui Wang, Szu-Ting Yang, Wen-Hsun Chang","doi":"10.1097/JCMA.0000000000001296","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001296","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066953","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":"Optimising outcomes for the patients with extensive-stage small-cell lung cancer.","authors":"Peng-Hui Wang, Szu-Ting Yang, Kuan-Chong Chao","doi":"10.1097/JCMA.0000000000001293","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001293","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042803","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}