Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Laparoscopic-assisted versus conventional vaginal hysterectomy for gender-affirming surgery in female-to-male transgender men.","authors":"Huann-Cheng Horng, Ling-Yu Jiang, Tzu-Ya Wang, Wei-Ting Chao, Tzu-Yi Tung, Chia-Kai Wu, Zih-Kai Kao, Chia-Hao Liu","doi":"10.1097/JCMA.0000000000001401","DOIUrl":"10.1097/JCMA.0000000000001401","url":null,"abstract":"<p><strong>Background: </strong>Studies comparing the surgical routes for sex-affirming hysterectomy in female-to-male (FtM) transgender individuals remain limited. This study compared the perioperative outcomes of vaginal total hysterectomy (VTH) and laparoscopic-assisted vaginal hysterectomy (LAVH) in an Asian FtM cohort.</p><p><strong>Methods: </strong>We retrospectively reviewed the data of individuals who were FtM transgender and underwent sex-affirming hysterectomy with bilateral salpingo-oophorectomy at a tertiary referral center between January 2016 and May 2026. Patients who underwent combined major sex-affirming procedures, vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy, or vaginectomy alone were excluded. The perioperative outcomes and complications in the VTH and LAVH groups within 14 days were compared.</p><p><strong>Results: </strong>The study included 132 of 153 screened patients: 89 underwent VTH and 43 underwent LAVH. The baseline characteristics were comparable, although the body mass index (BMI) of the LAVH group was higher. The duration of surgery was significantly longer for the LAVH group than for the VTH group (152.4 ± 78.7 vs 121.2 ± 57.6 minutes; p = 0.024). Immediate postoperative pain at 2 hours was milder after LAVH than after VTH (4.1 ± 0.9 vs 4.6 ± 1.0; p = 0.007), but pain scores were comparable at 24 and 48 hours. Estimated blood loss, hospital stay, Foley catheter duration, and time to first flatus were similar. The overall complication rate was significantly lower in the LAVH group than in the VTH group (18.6% vs 37.1%, p = 0.032). One patient with VTH required conversion to abdominal hysterectomy because of severe adhesions, and one had incomplete bilateral salpingo-oophorectomy.</p><p><strong>Conclusion: </strong>LAVH was associated with fewer perioperative complications and less immediate postoperative pain than VTH, although it required a longer operative time in individuals who were FtM transgender. The improved pelvic visualization and adnexal access afforded by LAVH may offer technical advantages when the pelvic anatomy is challenging. This supports its use as a minimally invasive surgical option for this population.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"627-633"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392772","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":"Association between energy adequacy and clinical outcomes in septic intensive care unit patients stratified by modified Nutrition Risk in the Critically Ill score.","authors":"Pi-Yi Lin, Yu-Tong Yen, Ming-Jen Lu, Han-Shui Hsu","doi":"10.1097/JCMA.0000000000001407","DOIUrl":"10.1097/JCMA.0000000000001407","url":null,"abstract":"<p><strong>Background: </strong>Although malnutrition is common among critically ill patients with sepsis, it is unclear whether early nutritional supplementation is beneficial. We investigated the effects of early calorie and protein delivery in critically ill patients with sepsis.</p><p><strong>Methods: </strong>Adult patients with sepsis who required mechanical ventilation in a surgical intensive care unit (ICU) between January 2021 and December 2022 were enrolled. Nutritional risk in these patients was evaluated using the modified Nutrition Risk in the Critically ill (m-NUTRIC) score. Participants were divided into two groups based on whether they received <50% or ≥50% of their estimated calorie needs within the first 5 days of their ICU stay. The primary outcome was 28-day ICU mortality.</p><p><strong>Results: </strong>Among the 258 participants (195 men and 63 women; mean age, 64.8 ± 13.7 years), within the first 5 days of their ICU stay, 63.2% and 36.8% of the patients received <50% and ≥50% of their estimated calorie needs, respectively. The 28-day ICU mortality rate did not differ significantly between the two groups. Multivariate logistic regression revealed that the use of continuous renal replacement therapy (odds ratio [OR] = 4.07, 95% CI, 1.10-15.09; p = 0.036) and the duration of mechanical ventilation (OR = 1.05, 95% CI, 1.01-1.10; p = 0.020) were independent predictors of 28-day ICU mortality. Providing early nutritional support of ≤50% of the estimated calorie needs did not affect 28-day ICU mortality in these patients ( p = 0.229).</p><p><strong>Conclusion: </strong>Achieving at least 50% of the estimated calorie needs within the first 5 days of ICU stay did not improve 28-day ICU survival in this cohort of critically ill patients with sepsis. Further investigations are needed to elucidate whether early nutritional interventions are beneficial for this population.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"634-641"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581842","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 dual role of Ganoderma lucidum polysaccharides in cancer treatment: Meridian tropism-based direct inhibition and immune-mediated modulation.","authors":"Sang-Nguyen-Cao Phan, Wei-Jyun Hua, Li-Lan Liao, Zhi-Hu Lin, Diem-Ngoc-Hong Tran, Mei-Kuang Lu, Tung-Yi Lin","doi":"10.1097/JCMA.0000000000001403","DOIUrl":"10.1097/JCMA.0000000000001403","url":null,"abstract":"<p><p>Ganoderma lucidum, a highly valued medicinal mushroom in Traditional Chinese Medicine (TCM), has a long history of clinical use. Although its immunomodulatory and anticancer properties have been extensively investigated, an integrated framework connecting traditional therapeutic principles with modern molecular pharmacology remains underdeveloped. This review proposes a novel meridian-based pharmacological framework that bridges classical TCM theory with contemporary precision oncology. Specifically, the direct tumor-suppressive effects of G. lucidum polysaccharides (GLPs) across organ-specific malignancies, including lung, liver, hematological, and genitourinary cancers, are systematically examined to explore potential associations between classical meridian tropism and tissue-specific anticancer activity. These organ-targeted effects are further linked to experimentally validated mechanisms, including cell-cycle arrest, apoptosis induction, DNA repair interference, autophagy modulation, inhibition of epithelial-mesenchymal transition, and sensitization to chemotherapy. Beyond their direct tumor-suppressive effects, GLPs also exhibit potent immunomodulatory activities that may enhance cancer immunotherapy. Their roles in regulating systemic immunity and remodeling the tumor microenvironment are highlighted through macrophage reprogramming, dendritic cell maturation, and cytotoxic T-cell activation, together with their potential synergistic interactions with immune checkpoint blockade therapies. By integrating direct tumor suppression with immune-mediated mechanisms within a meridian-based framework, this review provides a comprehensive perspective on the therapeutic potential of GLPs and offers insights to support their future clinical translation in oncology.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"562-577"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392736","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":"Robotic-assisted pancreaticoduodenectomy: Portal vein-first vs artery-first approach.","authors":"Yong-Sian Chen, Yi-Ju Chen, Chia-Man Chou","doi":"10.1097/JCMA.0000000000001406","DOIUrl":"10.1097/JCMA.0000000000001406","url":null,"abstract":"<p><strong>Background: </strong>Robotic pancreaticoduodenectomy (RPD) has emerged as a promising approach for complex pancreatic surgeries. Artery-first approach pancreaticoduodenectomy (AFAPD) prioritizes the early assessment of arterial involvement to improve surgical outcomes. This study compares the clinical, perioperative, and oncological outcomes of AFAPD and traditional portal vein-first pancreaticoduodenectomy (tPD) in patients undergoing RPD.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 151 patients who underwent RPD at a tertiary center in Taiwan from June 2019 to July 2025. Patients were categorized into robotic tPD (n = 81) and AFAPD (n = 70) groups. Propensity score matching (PSM, 1:1) was performed to reduce selection bias. Survival outcomes were analyzed through the Kaplan-Meier method and compared using the log-rank test, and Cox proportional hazards models were employed to estimate hazard ratios with 95% confidence intervals.</p><p><strong>Results: </strong>After PSM, no significant difference was observed in the baseline characteristics of both groups. In the matched cohort, no significant differences were found between the two groups in terms of operative time (518.5 vs 480.0 minutes, p = 0.269) or estimated blood loss (200 vs 150 mL, p = 0.106). However, compared with the tPD group, the AFAPD group was associated with a significantly lower rate of delayed gastric emptying (DGE, 15.4% vs 36.5%, p = 0.027). Other complications, such as postpancreatectomy hemorrhage (3.8% vs 11.5%, p = 0.289) and abdominal abscess (1.9% vs 7.7%, p = 0.375), showed lower trends in the AFAPD group than in the tPD group but did not reach statistical significance in the matched cohort. The AFAPD group also had a higher incidence of chylous leakage (19.2% vs 7.7%, p = 0.146) than the tPD group. Overall survival was significantly shorter in the AFAPD group than in the tPD group because of the retrospective design of this study and the recent adoption of the AFAPD approach (15.47 vs 36.15 months, p < 0.001).</p><p><strong>Conclusion: </strong>Robotic AFAPD provides perioperative outcomes comparable to those yielded by tPD while significantly reducing DGE. While it has a higher trend of chylous leakage than tPD, it remains a technically superior approach for ensuring early arterial assessment and surgical radicality.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"603-609"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537934","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":"A global perspective on prognosis in acral and nonacral cutaneous melanoma: A systematic review and meta-analysis.","authors":"Chi-Han Huang, Kun-Han Lee, Po-Yu Chu, Cheng-Yuan Li, Tien-Hsiang Wang, Hsu Ma, Yu-Jen Chiu","doi":"10.1097/JCMA.0000000000001408","DOIUrl":"10.1097/JCMA.0000000000001408","url":null,"abstract":"<p><strong>Background: </strong>Acral melanoma (AM) is a rare cutaneous malignancy associated with poor survival. However, prognostic differences between AM and nonacral cutaneous melanoma (NAM) remain unclear. Therefore, we conducted a systematic review and meta-analysis to compare survival outcomes between patients with AM and those with NAM.</p><p><strong>Methods: </strong>PubMed, EMBASE, and the Cochrane Library were comprehensively searched for studies published between January 2000 and December 2025. Studies comparing the 5-year overall survival (OS) and 5-year relapse-free survival (RFS) between AM and NAM were included. Subgroup analyses were performed by disease stage and ethnicity to assess their impact on melanoma prognosis.</p><p><strong>Results: </strong>Twenty studies (18 retrospective and two prospective cohort studies) involving 568 346 patients were included. The meta-analysis demonstrated that AM was associated with significantly lower 5-year OS than NAM (risk ratio [RR]: 0.89; 95% CI: 0.86-0.92; p < 0.00001). In subgroup analyses, compared with NAM, AM was associated with poorer 5-year OS in both stage II (RR: 0.92; 95% CI: 0.88-0.96; p = 0.0003) and stage III disease (RR: 0.85; 95% CI: 0.75-0.96; p = 0.01). Additionally, patients from darker-skinned populations with AM had poorer 5-year OS than those from White populations (RR: 0.89; 95% CI: 0.83-0.95; p = 0.0006).</p><p><strong>Conclusion: </strong>Patients with AM exhibited markedly lower 5-year OS than those with NAM, particularly among patients with stage II and III. Moreover, individuals from darker-skinned populations with AM had poorer survival outcomes than those from White populations.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"610-618"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564281","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":"Effects of insulin and exenatide therapy on glycemic control and β-cell function in patients newly diagnosed with type 2 diabetes and severe hyperglycemia.","authors":"Tsung-Hui Wu, Chin-Sung Kuo, Harn-Shen Chen","doi":"10.1097/JCMA.0000000000001394","DOIUrl":"10.1097/JCMA.0000000000001394","url":null,"abstract":"<p><strong>Background: </strong>To assess the efficacy of short-term insulin therapy compared with exenatide therapy in glycemic control, remission rate, and β-cell function in patients newly diagnosed with type 2 diabetes and severe hyperglycemia.</p><p><strong>Methods: </strong>Patients with newly diagnosed type 2 diabetes and a glycated hemoglobin (HbA1c) level >9% were treated with insulin injections for 10 to 14 days, after which oral glucose tolerance tests (OGTTs) were performed. The patients were randomized in an open-label design to receive either insulin therapy or exenatide therapy for a further 24 weeks. The OGTT was repeated 6 months after randomization to re-evaluate β-cell function and insulin sensitivity. The participants were followed for another year to evaluate long-term glycemic control.</p><p><strong>Results: </strong>We randomized 40 patients into the insulin group (n = 22) and the exenatide group (n = 18). One patient in the exenatide group withdrew before the intervention, resulting in 22 and 17 patients in the insulin and exenatide groups, respectively. Body weight was significantly higher in the insulin group than in the exenatide group at baseline (75.8 ± 14.3 vs 60.5 ± 12.2 kg, p = 0.011). The mean HbA1c levels were similar between the insulin and exenatide groups at 6 months (6.74 ± 1.12% vs 6.88 ± 0.76%; p = 0.681) and 12 months after randomization (6.62 ± 0.69% vs 7.05 ± 0.72%; p = 0.119). By 1 year after the intervention, the remission rates were 18.2% (n = 4) in the insulin group and 5.9% (n = 1) in the exenatide group ( p = 0.025). The median time to relapse was 6.5 months in the insulin group and 5.0 months in the exenatide group ( p = 0.685). Compared with the exenatide group, the insulin group had better homeostasis model assessment of β-cell function index, insulinogenic index, and total insulin secretion during the OGTT.</p><p><strong>Conclusion: </strong>Insulin therapy may improve β-cell function and reduce remission rates compared with exenatide therapy in patients newly diagnosed with type 2 diabetes and severe hyperglycemia.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"517-524"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254947","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":"Causal effects among hypertension, osteoporosis, and metabolites: A Mendelian randomization study.","authors":"Yiguo Chen, Wei Wang, Xidong Xu, Xiaohua Huang, Bing Wei, Hongliang Jin, Qiyuan Pan, Yang Yang, Zhangyu Wang, Chao Feng, Li Chen, Zhijun Zhao, Yao Su","doi":"10.1097/JCMA.0000000000001397","DOIUrl":"10.1097/JCMA.0000000000001397","url":null,"abstract":"<p><strong>Background: </strong>Studies have examined the connection between blood metabolites, osteoporosis (OP), and hypertension; however, there is not enough data to pinpoint their precise cause.</p><p><strong>Methods: </strong>OP and associated traits served as outcomes, with hypertension serving as the exposure variable. The main methodology was the random-effects inverse variance weighted (IVW) technique. Horizontal pleiotropy and heterogeneity of outcomes were assessed by sensitivity testing. Finally, to find putative mediating metabolites, a two-step Mendelian randomization (MR) analysis was carried out.</p><p><strong>Results: </strong>IVW analysis revealed a substantial negative connection between hypertension and lumbar spine bone mineral density (odds ratio [OR] = 0.961, 95% CI: 0.927-0.997; p < 0.05) and heel bone mineral density (OR = 0.982, 95% CI: 0.971-0.992; p < 0.001), as well as a strong positive correlation with OP (OR = 1.165, 95% CI: 1.067-1.273, p < 0.001). Sensitivity analysis validated the robustness of the results. The blood metabolites (R)-3-hydroxybutyrylcarnitine, 1-(1-enyl-palmitoyl)-GPE (p-16:0), hydroxyasparagine, adenosine 5'-diphosphate (ADP) to 5-oxoproline ratio, sphinganine-1-phosphate levels, and sphingosine-1-phosphate levels showed preliminary suggestive mediating effects on the association between hypertension and decreased bone mineral density in statistics.</p><p><strong>Conclusion: </strong>Our study revealed a positive correlation between hypertension and OP and suggested that blood metabolites may play a mediating role in it. These findings provide clues for a deeper understanding of the potential mechanisms between hypertension and bone health and lay a scientific foundation for exploring targeted intervention strategies in the future.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"544-553"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260975","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":"Reimbursement policy and outcomes after transcatheter aortic valve implantation.","authors":"Wei-Ting Wang, Hsiao-Huang Chang, I-Ming Chen, Hsin-Bang Leu, Tzu-Ting Kuo, Su-Man Lin, Ying-Hwa Chen","doi":"10.1097/JCMA.0000000000001390","DOIUrl":"10.1097/JCMA.0000000000001390","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis. While reimbursement policies significantly expand access, the impact of Taiwan's National Health Insurance (NHI) coverage introduced in February 2021 on patient characteristics and outcomes remains unclear. This study evaluates changes in patient profiles and clinical outcomes before and after NHI reimbursement.</p><p><strong>Methods: </strong>We compared patient profiles, procedural variables, and clinical outcomes, including 30-day complications and 1-year all-cause mortality, cardiovascular death, and rehospitalization for heart failure (HF). Risk was stratified using the Society of Thoracic Surgeons (STS) score.</p><p><strong>Results: </strong>We analyzed 467 patients undergoing TAVI at a tertiary referral center between May 2010 and April 2024. Patients were divided into pre-reimbursement (n = 258) and post-reimbursement (n = 209) groups. Reimbursement was associated with a shift toward higher-risk patients, reflected by an increase in median STS scores (5.9%-7.2%, p = 0.002) and a greater proportion of patients with STS scores ≥8% (44.0% vs 31.8%, p = 0.019). Post-reimbursement patients had a higher prevalence of dialysis (17.7% vs 7.6%, p = 0.001) and more commonly underwent valve-in-valve TAVI for degenerated bioprosthetic valves (8.4% vs 2.7%, p = 0.007). Despite this higher-risk profile, hospital stay was significantly shorter post-reimbursement (7.0 vs 12.0 days, p < 0.001). Valve Academic Research Consortium-3 (VARC-3) defined 30-day outcomes were similar, except for reduced acute kidney injury in post-reimbursement patients (1.0% vs 6.6%, p = 0.021). One-year mortality was unchanged, but HF rehospitalization decreased significantly (2.9% vs 8.1%, p = 0.017). After multivariable adjustment, high STS risk (≥8%) independently predicted worse 1-year outcomes.</p><p><strong>Conclusion: </strong>In this single-treatment group experience, NHI reimbursement in Taiwan expanded TAVI access to higher-risk patients without compromising short- or mid-term mortality, and was associated with reduced heart failure readmission, especially among high-risk patients.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"525-533"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966311","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":"Reply to: \"Incidence of Jarisch-Herxheimer reaction after syphilis treatment and the role of awareness effect\".","authors":"Hung-Chin Tsai","doi":"10.1097/JCMA.0000000000001396","DOIUrl":"10.1097/JCMA.0000000000001396","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"555"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254945","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":"Endoscopic variceal ligation versus cyanoacrylate injection for acute variceal bleeding from the cardia to the lesser curvature.","authors":"Yu-Fu Chen, Tsung-Chieh Yang, Ping-Han Hsieh, Yu-Jen Chen, Hsiao-Sheng Lu, Kuei-Chuan Lee, Hui-Chun Huang, Jiing-Chyuan Luo, Ming-Chih Hou","doi":"10.1097/JCMA.0000000000001393","DOIUrl":"10.1097/JCMA.0000000000001393","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend endoscopic variceal ligation (EVL) and endoscopic cyanoacrylate injection (ECI) for esophageal and fundal variceal bleeding, respectively. However, the optimal strategy for treating acute variceal bleeding (AVB) from the cardia to the lesser curvature remains undefined. This study compared the efficacy of EVL and ECI for AVB in this region.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with AVB from the cardia to the lesser curvature treated with EVL or ECI. Varices were classified as type 1 gastroesophageal varices-cardiac varices (GOV1-CVs; 0-2 cm below the gastroesophageal junction) or conventional GOV1s (2-5 cm below). Outcomes, including 5-day treatment failure, 6-week rebleeding, and 6-week survival, were compared using Kaplan-Meier analysis. Independent predictors of rebleeding and mortality were identified via Cox regression and subgroup analyses by variceal location.</p><p><strong>Results: </strong>We enrolled 129 patients (EVL: 59; ECI: 70) between 2006 and 2024. Both modalities achieved high hemostasis rates, with no significant differences in 5-day treatment failure (3.4% vs 4.3%; p = 1.000), 6-week rebleeding (10.2% vs 12.9%; p = 0.630), or 6-week survival (76.3% vs 77.1%; p = 0.956). On multivariable analysis, portal vein thrombosis (hazard ratio [HR]: 5.4; p = 0.020) and clinically significant bleeding (HR: 4.4; p = 0.016) predicted 6-week rebleeding, whereas Child-Pugh class C (HR: 4.3; p < 0.001) and creatinine >1.3 mg/dL (HR: 2.5; p = 0.024) predicted 6-week mortality. EVL demonstrated lower 6-week rebleeding than ECI for GOV1-CVs (9.8% vs 40.0%, p = 0.011), but not GOV1s ( p = 0.408). In the GOV1-CVs subgroup, EVL (HR: 0.2; p = 0.030) was the only independent predictor of rebleeding.</p><p><strong>Conclusion: </strong>EVL and ECI demonstrated comparable efficacy for AVB from the cardia to the lesser curvature. Notably, EVL is superior to ECI in reducing 6-week rebleeding in GOV1-CVs, supporting EVL as the preferred approach and underscoring the importance of precise variceal classification.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"497-507"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229811","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}