Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Agitation in dementia: Evidence-based consensus recommendations.","authors":"Ying-Yu Chen, Chien-Shu Tai, Hsiu-Han Wen, Hsin-Jou Yi, Yu-Chen Chuang, Ting-Wei Hsu, Wen-Ting Lee, Ssu-Chieh Huang, Chieh-Ning Huang, Jou-Yen Wu, Jong-Ling Fuh, Mu-N Liu, Ming-Hsien Lin, Liang-Yu Chen","doi":"10.1097/JCMA.0000000000001411","DOIUrl":"10.1097/JCMA.0000000000001411","url":null,"abstract":"<p><p>Agitation is among the most disabling behavioral and psychological symptoms of dementia, contributing substantially to caregiver burden, institutionalization, and healthcare utilization. Considering the modest efficacy and significant adverse effects associated with psychotropic medications, person-centered approach (PCA) and non-pharmacological interventions are recommended as first-line management strategies. We conducted a comprehensive search on PubMed, Medline, Embase, PsycINFO, CINAHL, and the Cochrane Library for systematic reviews, meta-analyses, and randomized controlled trials evaluating PCA and non-pharmacological interventions for agitation in dementia published before September 30, 2025. The quality of evidence and strength of recommendations were evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework. Moderate-quality evidence supports the use of massage and touch therapy, particularly individualized music therapy, tailored activity programs, and multicomponent interventions. By contrast, sensory-based approaches such as aromatherapy and Snoezelen demonstrated inconsistent or low-quality evidence. The organizational-level implementation of PCA and structured need-driven assessments are associated with improved quality of life and appear to enhance the effectiveness of subsequent non-pharmacological interventions. The most consistent and clinically meaningful benefits were observed when individualized strategies were preceded by systematic PCA-based assessment. Overall, PCA-guided, multifaceted non-pharmacological interventions provide the preferred foundation for managing agitation in dementia, reducing reliance on pharmacotherapy while promoting care quality, dignity, and overall well-being. Future efforts should focus on optimizing implementation through structured staff training, interdisciplinary collaboration, and technology-assisted assessment models to improve feasibility and scalability across diverse care settings.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"652-660"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of hepatotoxicity with ribociclib in hormone receptor-positive breast cancer.","authors":"Wei-Chi Lin, Yu-Li Chang, Sheng-Fan Wang, Chia-Chen Hsu, Chian-Ying Chou, Ling-Ming Tseng, Ta-Chung Chao","doi":"10.1097/JCMA.0000000000001417","DOIUrl":"10.1097/JCMA.0000000000001417","url":null,"abstract":"<p><strong>Background: </strong>The standard first-line treatment for hormone receptor-positive metastatic breast cancer is a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor, including palbociclib, ribociclib, or abemaciclib, combined with endocrine therapy. Hepatobiliary toxicity is an important adverse effect of ribociclib. This study compared the risk of hepatotoxicity between ribociclib and palbociclib and identified factors associated with hepatotoxicity.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with hormone receptor-positive breast cancer receiving ribociclib or palbociclib between January 1, 2018, and June 1, 2022. Hepatotoxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 5.0, with grade 2 or higher considered as the study outcome. Kaplan-Meier analysis assessed time to hepatotoxicity, and a multivariable Cox proportional hazards model estimated adjusted hazard ratios.</p><p><strong>Results: </strong>The mean age was 61 years, and all patients were women. Among 145 patients receiving ribociclib, 28 developed hepatotoxicity, compared with 19 of 153 patients receiving palbociclib. The median time to hepatotoxicity was 42 days in both groups. After adjustment for age, Charlson Comorbidity Index (CCI) score, history of hepatitis B virus (HBV) infection, fatty liver, and liver metastasis, the adjusted hazard ratio (HR) for palbociclib compared with ribociclib was 0.467 (95% CI, 0.233-0.936; p = 0.0320). In the overall population, liver metastasis (HR, 2.159; 95% CI, 1.175-3.966; p = 0.0131), history of HBV infection (HR, 2.216; 95% CI, 1.102-4.458; p = 0.0256), and fatty liver (HR, 3.536; 95% CI, 1.840-6.794; p = 0.0002) were associated with higher risk of hepatotoxicity.</p><p><strong>Conclusion: </strong>Compared with palbociclib, ribociclib was associated with a higher risk of hepatotoxicity during the first 6 months of treatment. Closer monitoring of liver function may be warranted, particularly in patients with liver metastases, a history of HBV infection, or fatty liver who receive ribociclib.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"694-700"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of sedentary time and physical activity with colorectal adenoma: A colonoscopy-based study.","authors":"Chung-Chi Lin, Hsin-Jen Chen, Ying-Wen Wang, Chung-Yu Chang, Shao-Sung Huang, Pai-Feng Hsu, Teh-Ling Liou, Hsin-Bang Leu","doi":"10.1097/JCMA.0000000000001412","DOIUrl":"10.1097/JCMA.0000000000001412","url":null,"abstract":"<p><strong>Background: </strong>To assess the association of sedentary time and physical activity with the occurrence of colorectal adenomas in asymptomatic participants.</p><p><strong>Methods: </strong>We conducted a case-control study at Taipei Veterans General Hospital, Taiwan, to examine sedentary time, physical activity, and their joint effects on colorectal adenoma risk among asymptomatic participants. Conditional logistic regression analysis was used to estimate odds ratios (ORs) and 95% CIs.</p><p><strong>Results: </strong>Among 5982 asymptomatic adults undergoing health screening, shorter sedentary time was independently associated with a lower risk of colorectal adenoma (n = 3616), after adjusting for other risk factors, including physical activity. The ORs (95% CIs) for each category of sedentary time >450, 300 to 450, and <300 min/d were 1.00 (reference), 1.10 (0.90-1.34), and 0.52 (0.40-0.69), respectively ( ptrend < 0.001). Joint analysis demonstrated that higher physical activity was associated with a lower risk of colorectal adenoma, particularly among individuals with a sedentary time of 300 to 450 min/d. Moreover, within the moderate- and high-physical activity categories, shorter sedentary time was consistently associated with additional risk reduction. A similar pattern was observed for the advanced adenoma subgroup.</p><p><strong>Conclusion: </strong>Sedentary time was independently associated with increased colorectal adenoma risk, whereas reducing sedentary time may lower advanced adenoma risk and augment the benefits of moderate- to high-physical activity among the asymptomatic population in Taiwan.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"676-683"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of pulsatile tinnitus arising from sigmoid sinus wall anomalies.","authors":"Dong Woo Nam, Jung Kyu Lee, Jae-Jin Song","doi":"10.1097/JCMA.0000000000001420","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001420","url":null,"abstract":"<p><p>Pulsatile tinnitus (PT) caused by sigmoid sinus (SS) wall anomalies, most commonly diverticulum and dehiscence, represents a prevalent and potentially reversible venous etiology. This narrative review summarizes contemporary concepts in diagnosis and treatment and proposes a practical framework for clinical decision-making. The characteristic features of venous-type PT are first outlined, with emphasis on strict clinicoradiologic correlation using high-resolution temporal bone computed tomography and magnetic resonance venography to distinguish SS wall abnormalities from other vascular causes, such as dural arteriovenous fistulas (AVFs), high-riding jugular bulbs, and idiopathic intracranial hypertension. Patient selection, contraindications, and clinical \"red flags\" are then discussed, with particular attention to scenarios in which transmastoid surgery may be ineffective or pose substantial risk and in which systemic therapy or venous sinus stenting should be prioritized. The main transmastoid strategies include sinus wall resurfacing, tailored re-roofing with autologous bone, and diverticulectomy with multilayer reconstruction. These strategies are compared with endovascular approaches in terms of their technical principles, indications, and reported outcomes. Particular attention is given to reconstructive materials, such as polymethylmethacrylate cement, hydroxyapatite, and bone grafts, with consideration of their short- to midterm performance and the current limitations of evidence regarding long-term durability. Integrating these considerations, a stepwise algorithm is proposed to guide the selection of conservative, surgical, or endovascular treatment based on symptom profiles and imaging findings. In carefully selected patients, these strategies can achieve high rates of PT improvement and meaningful gains in quality of life, while highlighting the need for prospective outcome studies with long-term follow-up.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868797","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":"Acute radiation dermatitis during head-and-neck radiotherapy: VMAT vs IMPT.","authors":"Wen-Ling Tsai, Ko-Chun Fang, Yu-Jie Huang, Shang-Yu Chou, Fu-Min Fang","doi":"10.1097/JCMA.0000000000001413","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001413","url":null,"abstract":"<p><strong>Background: </strong>Acute radiation dermatitis (ARD) is common during head-and-neck radiotherapy (RT) and may impair skin-related quality of life (QoL). Whether intensity-modulated proton therapy (IMPT) improves patient-reported skin outcomes compared with volumetric modulated arc therapy (VMAT) remains uncertain. We compared longitudinal outcomes of skin toxicity between RT modalities and identified significant predictors of ARD and skin-related QoL.</p><p><strong>Methods: </strong>This prospective and non-randomized cohort study enrolled adults with newly diagnosed head-and-neck cancer receiving curative-intent VMAT or IMPT at Kaohsiung Chang Gung Memorial Hospital. Skin-related QoL was assessed using Skindex-16 at baseline, end of RT, and 3 months after RT. ARD was graded weekly using Common Terminology Criteria for Adverse Events version 5.0. Longitudinal outcomes were analyzed using linear mixed-effects models, and predictors of ARD grade ≥2 and ≥10-point worsening in Skindex-16 Global score were evaluated using multivariable regression.</p><p><strong>Results: </strong>Among 158 patients, 113 received VMAT and 45 received IMPT; the mean age was 56.5 years, and 130 patients (82.3%) were men. Clinically meaningful Global score worsening occurred in 37.0% of patients at the end of RT and 7.0% at 3 months after RT. Skindex-16 scores worsened significantly at the end of RT and improved by 3 months across all domains (all p<0.01), with no significant difference between VMAT and IMPT or time-by-modality interactions. Maximum ARD severity was comparable between VMAT and IMPT (grade 2: 30.0% vs 29.5%; grade 3: 7.0% vs 4.8%; p=0.85). Advanced nodal disease (N2-3) and RT dose ≥66 Gy independently predicted ARD grade ≥2 and Skindex-16 Global score worsening.</p><p><strong>Conclusion: </strong>Acute patient-reported skin toxicity during contemporary head-and-neck RT was not associated with RT modality but with nodal extent and RT dose. These findings support risk-adapted planning and proactive supportive care, although interpretation is limited by the non-randomized design and lack of skin-specific dosimetry.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803825","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 applications of biomarker guidance extend beyond treatment to diagnosis.","authors":"Peng-Hui Wang","doi":"10.1097/JCMA.0000000000001358","DOIUrl":"10.1097/JCMA.0000000000001358","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"559-561"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147278077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interactions between cytochrome P450 enzymes and traditional Chinese herbs: A comprehensive review.","authors":"Ying-Hsueh Hsieh, Sheng-Teng Huang","doi":"10.1097/JCMA.0000000000001404","DOIUrl":"10.1097/JCMA.0000000000001404","url":null,"abstract":"<p><p>Cytochrome P450 (CYP) enzymes, predominantly expressed in the liver and intestine, are central to phase I drug metabolism. The CYP1, CYP2, and particularly CYP3 families account for most oxidative biotransformation and nearly half of all drug elimination. Their activities are modulated by genetic polymorphisms, environmental factors, and drug interactions, contributing to interindividual variability in drug efficacy, safety, and susceptibility to drug-induced liver injury. This study systematically evaluated the regulatory effects of commonly used Traditional Chinese Medicine (TCM) and Western herbal medicines on major CYP isoforms. PubMed and Google Scholar were searched for studies published between January 2000 and March 2025, with UpToDate used as a supplementary resource. Eligible evidence included in vitro assays, in vivo animal studies, human pharmacokinetic investigations, and well-documented case reports assessing herbal effects on CYP3A4, CYP2C9, CYP2D6, and CYP1A2. Evidence was graded by strength and integrated with mechanistic and pharmacokinetic data for interaction risk assessment. Herbal candidates included Astragalus membranaceus (Huangqi, ), Salvia miltiorrhiza (Danshen, ), Ginkgo biloba (Ginkgo, ), Bupleurum chinense (Chaihu, ), and Hypericum perforatum (St. John's wort, ). Many herbs demonstrated clinically relevant induction or inhibition of CYP activity, particularly CYP3A4, with the potential to alter drug exposure, reduce therapeutic efficacy, or increase toxicity. Collectively, these findings underscore the imperative for systematic assessment of CYP-mediated herb-drug interactions in integrative medicine and support the development of safer, personalized therapeutic strategies grounded in a refined understanding of metabolic variability.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"578-592"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence after modified type III cordectomy for glottic cancer: Predisposing factors and management.","authors":"Chin-Hsuan Liu, Chia-Fan Chang, Li-Mei Wang, Ya-Chuan Kao, Yueh-Ju Tsai, Pen-Yuan Chu","doi":"10.1097/JCMA.0000000000001402","DOIUrl":"10.1097/JCMA.0000000000001402","url":null,"abstract":"<p><strong>Background: </strong>Modified type III cordectomy provides satisfactory oncological and voice outcomes in selected patients with early glottic cancer. However, the factors associated with local recurrence following this procedure remain unclear. This study investigated the predictors of local recurrence following modified type III cordectomy and evaluated subsequent salvage management.</p><p><strong>Methods: </strong>Patients who underwent modified type III cordectomy for glottic cancer at a tertiary referral center between 2006 and 2022 were retrospectively reviewed. Clinicopathological factors, including tumor stage, pathology, morphology, involved subsites, surgical margin status, and history of biopsy or surgery, were analyzed for their association with local recurrence. Salvage treatment outcomes were evaluated.</p><p><strong>Results: </strong>A total of 58 patients were included in this study. The cohort was predominantly male (95%) with a median age of 61 years. The mean follow-up period was 78 months. Local recurrence occurred in 13 patients (22%) at a mean interval of 22 months after surgery. Tumor pathology and morphology were significantly associated with recurrence. Spindle cell carcinoma (SpCC) and endophytic tumors were associated with a substantially higher risk of recurrence than conventional squamous cell carcinoma and exophytic lesions. All recurrent tumors were treated with salvage transoral laser microsurgery (TLM), and six patients received postoperative radiotherapy. Successful salvage with laryngeal preservation was achieved in 11 (85%) patients.</p><p><strong>Conclusion: </strong>Endophytic morphology and SpCC pathology are significant predictors of local recurrence after modified type III cordectomy. Careful postoperative surveillance is particularly important in these patients. Primary treatment with TLM preserves multiple salvage treatment options and enables high rates of laryngeal preservation in patients with recurrent disease.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"642-648"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyponatremia risk with antidepressant use: A retrospective study.","authors":"Tsung-Pi Lien, Wen-Chun Liu, Li-Yi Tang, Chun-Hao Yin, Jin-Shuen Chen, Yao-Shen Chen, Ying-Chun Li, Kuan-Pin Su, Ren-In Chang, Cheng-Ho Chang","doi":"10.1097/JCMA.0000000000001409","DOIUrl":"10.1097/JCMA.0000000000001409","url":null,"abstract":"<p><strong>Background: </strong>Serotonergic antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are associated with an increased risk of hyponatremia, whereas mirtazapine appears to confer a lower risk. However, evidence regarding newer antidepressants, specifically agomelatine, remains limited. This study aimed to evaluate the risk of hyponatremia associated with agomelatine compared with mirtazapine, escitalopram, and venlafaxine.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed electronic medical records from Kaohsiung Veterans General Hospital. Antidepressant-naïve patients who initiated at least 2 weeks of monotherapy with agomelatine, escitalopram, venlafaxine, or mirtazapine between May 2013 and April 2023 were included. Hyponatremia was identified using serum sodium measurements. Multivariable logistic regression was performed to assess the association between antidepressant use and hyponatremia after adjusting for demographic, clinical, and medication-related factors.</p><p><strong>Results: </strong>The incidence rates of hyponatremia were 5.8% for mirtazapine, 6.9% for agomelatine, 8.5% for escitalopram, and 10.2% for venlafaxine. In the univariate analysis, venlafaxine was associated with a higher risk of hyponatremia than was mirtazapine (odds ratio [OR] = 1.80, 95% CI: 1.09-2.97, p = 0.021). However, after adjustment, the risk of hyponatremia did not differ significantly among the antidepressants (agomelatine: adjusted odds ratio [aOR] = 0.79, escitalopram: aOR = 1.18, venlafaxine: aOR = 0.87; all p > 0.05). Independent predictors of hyponatremia included older age (aOR = 1.02, p < 0.001), malignancy (aOR = 2.52, p < 0.001), diabetes mellitus (aOR = 1.64, p < 0.001), and concomitant use of anticancer agents (aOR = 2.72, p < 0.001).</p><p><strong>Conclusion: </strong>These findings underscore the complexity of hyponatremia etiologies and highlight the need for individualized treatment strategies that account for comorbidities and potential drug interactions.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"619-626"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An in-hospital referral program for hepatitis C virus elimination in patients with type 2 diabetes mellitus.","authors":"Chen-Ta Chi, Tsung-Hui Wu, Pei-Chuan Lee, Guan-Yu Su, Ting-Yu Chen, I-Cheng Lee, Ming-Chih Hou, Chii-Min Hwu, Yi-Hsiang Huang","doi":"10.1097/JCMA.0000000000001405","DOIUrl":"10.1097/JCMA.0000000000001405","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization's goal of hepatitis C virus (HCV) elimination by 2030 remains a challenge. While type 2 diabetes mellitus (T2DM) is associated with HCV infection, identifying unrecognized cases in low-endemic areas is difficult. This study evaluates the feasibility and outcomes of a hospital-based microelimination referral program in T2DM patients and explores chronic kidney disease (CKD) stage as a potential risk stratifier.</p><p><strong>Methods: </strong>In this prospective study (March 2022-May 2023), T2DM patients enrolled in a pay-for-performance program underwent routine anti-HCV antibody screening. Seropositive patients were referred to hepatologists for HCV-RNA testing and direct-acting antiviral (DAA) evaluation. We used multivariable logistic regression to identify baseline predictors of HCV viremia and piecewise generalized estimating equations (GEE) to assess the impact of viremia and DAA therapy on estimated glomerular filtration rate (eGFR) trajectories.</p><p><strong>Results: </strong>Among 4402 T2DM patients, 104 (2.4%) were anti-HCV positive. Seroprevalence increased across CKD stages 1 to 5 (1.8%, 2.3%, 2.6%, 3.5%, and 7.8%; p = 0.014). Furthermore, among anti-HCV-positive patients, the proportion of advanced CKD (stages 3-5) significantly increased in those with higher Fibrosis-4 (FIB-4) index scores ( p = 0.020). Multivariable analysis of HCV viremia identified lower diastolic blood pressure (odds ratio [OR], 0.968; p = 0.017), total cholesterol (OR, 1.012; p = 0.015), triglycerides (OR, 0.991; p = 0.008), and alanine aminotransferase (OR, 1.011; p = 0.006) as independent predictors. While untreated viremia initially appeared to accelerate eGFR decline, this effect was attenuated after adjusting for age and glycated hemoglobin (HbA1c). Moreover, eGFR decline trajectories did not change significantly following DAA therapy.</p><p><strong>Conclusion: </strong>An in-hospital referral program for T2DM patients is feasible for HCV microelimination, using CKD staging as a practical risk stratifier. Despite DAA renal safety, diabetes-associated kidney damage may drive post-cure renal progression, necessitating continuous metabolic management.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"593-602"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}