Journal of the Chinese Medical Association : JCMA最新文献

Background: Soft contact lenses divide tear film into pre-lens and post-lens layers. This study evaluated whether pre-lens tear film stability, assessed by fluorescein tear breakup time (TBUT) and noninvasive keratograph breakup time (NIKBUT), predicts subjective comfort.

Methods: This single-center prospective study recruited participants aged 20-40 years without ocular diseases. Narafilcon A and verofilcon A contact lenses were used in a crossover design, with participants assigned to wear narafilcon A lenses for one week followed by verofilcon A lenses for another week (Group NV), or the reverse sequence (Group VN). Pre-lens tear film stability was assessed by NIKBUT and fluorescein TBUT on day 1 and day 7. These ocular measurements were correlated with subjective comfort evaluated with Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) after wearing each lens type.

Results: A total of 82 participants (mean age 29.3 ± 3.3 years; 84% female) completed the study. CLDEQ-8 scores were lower with verofilcon A than with narafilcon A (7.09 ± 5.92 vs. 10.21 ± 7.23; p < 0.05). Fluorescein TBUT was consistently longer with verofilcon A than with narafilcon A, both at 15 minutes on day 1 (Group NV: 6.04 vs. 3.80 seconds; Group VN: 7.24 vs. 3.25 seconds) and at 6 hours on day 7 (Group NV: 4.87 vs. 3.03 seconds; Group VN: 5.67 vs. 3.15 seconds). NIKBUT did not differ significantly between the two lenses at either time point. CLDEQ-8 scores negatively correlated with fluorescein TBUT for both lens types (ρ = -0.29 for narafilcon A, p = 0.002; ρ = -0.20 for verofilcon A, p = 0.008).

Conclusion: Verofilcon A provided better subjective comfort compared with Narafilcon A. Fluorescein TBUT, but not NIKBUT, may serve as a complementary assessment for pre-lens tear film stability and subjective comfort, suggesting that fluorescein TBUT offers distinct clinical value in contact lens practice.

Background: Dysembryoplastic neuroepithelial tumor (DNET) and low-grade astrocytoma (LGA) could present very similar MRI findings. DNET have good seizure control after surgical removal and low malignant potential, while LGA may recur or progress This study was designed to obtain more accurate pretreatment diagnosis of DNET and LGA based on MRI findings.

Methods: We retrospectively enrolled patients with pathologically proven DNET and LGA from 2000-2024. Individual qualitative and quantitative MRI features were evaluated in both tumors, especially T2-weighted signal intensity ratio(T2SR), which compared tumor T2-weighted signal with normal cerebral white matter. The diagnostic performance of conventional qualitative models including meaningful qualitative MRI features and combined quantitative model including T2SR and ADC (apparent diffusion coefficient) value was evaluated using area under curve (AUC).

Results: In total, 70 patients (30 DNET, 40 LGA) with mean age of 23.2±11.3(15-57) years and 36 men (51.4%),34 women(48.6%). For individual MRI features, DNET had more FLAIR (fluid attenuated inversion recovery) ring sign [16 (53.3%) versus 12 (30.0%), p = 0.049], higher ADC value [2076.2 (53.4) versus 1660.1(71.9), p<0.001], and higher T2SR (3.56±0.12 versus 2.68±0.63, p < 0.001). The AUC of the T2SR and ADC value was 0.886(0.811-0.962) and 0.824(0.724-0.924), respectively. The combined quantitative model had higher discriminative performance than conventional qualitative model (AUC: 0.905 versus 0.727, p= 0.011).

Conclusion: Our study suggested that quantitative MRI features including T2SR and ADC values enhanced discrimination of DNET and LGA and could potentially serve as complementary imaging marker for improving preoperative diagnostic accuracy.

Background: The lack of specific and immunocompetent gastric cancer models has hindered the exploration of gastric adenocarcinoma (GAC). We constructed a spontaneous and transplantable GAC model using a genetically engineered mouse.

Methods: We generated a tamoxifen-inducible CRISPR-based Anxa10-CreERT2 mouse line and crossed it with the KrasG12D/+ and Tp53R172H/+ strains to develop Anxa10-CreERT2; KrasG12D/+; Tp53R172H/+ mice on a C57BL/6J background. Tamoxifen and N-methyl-N-nitrosourea were administered to induce in situ tumor development. An orthotopic gastric tumor was confirmed by histological analysis and positron emission tomography/computed tomography. A transplantable mouse-derived allograft (MDA) model and stable GAC cell line (ST-YC19) were subsequently established using MDA. The malignant characteristics and drug responses were evaluated.

Results: Spontaneous GAC had a 100% incidence within 2.5 months, was predominantly of the intestinal type, and presented essential molecular features of the CIN subtype. The ST-YC19 GAC cell line derived from MDAs exhibited an aggressive phenotype, robust tumorigenic potential, peritoneal dissemination, and distant metastasis. This model showed limited sensitivity to anti-programmed death-1 immunotherapy.

Conclusion: We successfully established a spontaneous GAC model and its corresponding cell line in C57BL/6J mice, enabling a comprehensive investigation of tumor progression, metastasis, therapeutic response, and resistance mechanisms in vivo. This model represents a valuable platform for advancing precision medicine in gastric cancer.

Background: Emerging evidence implicates levator ani muscle (LAM) entheseal pain as a novel etiology, yet its association with lower urinary tract symptoms (LUTS) remains underexplored. This study investigates the urodynamic manifestations of LUTS in patients with LAM entheseal pain.

Methods: In this retrospective cohort, women with chronic pelvic pain (CPP) and LUTS underwent standardized palpation and were stratified into three groups: isolated LAM muscular pain, isolated LAM entheseal pain, and combined muscular and entheseal pain. Symptom prevalence and comprehensive urodynamic parameters were compared across groups.

Results: A total of 307 patients were enrolled. Enthesis-related pain groups exhibited significantly higher prevalences of urinary symptoms, including urinary frequency (muscle pain, n = 81 vs. entheseal pain, n = 32 vs. combined pain, n = 194: 82.7% vs. 87.5% vs. 85.1%, p = 0.011), residual urinary sensation (46.9% vs. 65.6% vs. 63.4%, p < 0.001), and painful bladder symptoms (45.7% vs. 59.4% vs. 61.9%, p < 0.001). Additionally, these groups demonstrated significantly higher rates of pain-related comorbidities, including bearing-down sensation (33.3% vs. 37.5% vs. 49.0%, p < 0.001), dysmenorrhea (22.2% vs. 25.0% vs. 35.1%, p < 0.001), irritable bowel syndrome (29.6% vs. 32.4% vs. 44.3%, p < 0.001), and systemic myofascial pain (28.4% vs. 40.6% vs. 52.6%, p < 0.001). However, direct comparison between isolated muscular and entheseal pain groups revealed no significant differences in LUTS or pain comorbidities, whereas combined pain group demonstrated the highest symptom prevalence. Notably, no significant intergroup differences were observed in urodynamic parameters.

Conclusion: This study demonstrates that LAM entheseal pain represents a distinct, clinically palpable entity in CPP. The inability of urodynamic evaluation to distinguish it from myofascial pain suggests that associated LUTS may reflect a shared final pathway of central sensitization rather than peripheral structural dysfunction. Its association with morning stiffness further supports a divergent pathophysiology.

Background: Disease‑modifying therapy for heart failure with preserved ejection fraction (HFpEF) remains limited. The Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial demonstrated the benefits of disease‑modifying therapy and outlined the eligibility criteria for this treatment. The present study investigated how often treatment eligibility changes after hospitalization for acute decompensation and whether eligibility at discharge influences 1‑year outcomes.

Methods: This single-center observational cohort study included adults hospitalized for acute HFpEF (left ventricular ejection fraction ≥ 50%) between January 2020 and December 2022. Elevated N‑terminal pro‑B‑type natriuretic peptide and structural heart disease (left atrial enlargement or left ventricular hypertrophy) indicated predischarge DELIVER eligibility. Eligibility was reassessed in event‑free survivors at 1-year follow-up. Primary (all-cause mortality) and secondary (cardiovascular mortality and hospitalization for heart failure [HHF]) outcomes were analyzed over a 1-year period. Kaplan-Meier and Cox analyses with stepwise adjustment were performed.

Results: Of 385 patients (mean age: 83.7 ± 13.9 years; men, 53%), 79.2% were DELIVER‑eligible at discharge. Within 1 year, 41.7% of patients who were initially ineligible became eligible, and 85.4% of patients who were eligible remained eligible. The main factor contributing to these changes was progressive left atrial dilatation. Follow-up assessments revealed 35, 20, and 68 HHFs, cardiovascular deaths, and all-cause deaths, respectively. Although eligible patients exhibited high rates of crude 1-year mortality (hazard ratio: 2.43; 95% confidence interval: 1.11-5.30) and cardiovascular mortality and HHFs (hazard ratio: 2.83; 95% confidence interval: 1.13-7.09) than did ineligible patients, no differences in event-free survival rates were observed after adjustment for age, sex, and comorbidities.

Conclusion: Although most patients with decompensated HFpEF met the DELIVER criteria, 41.7% of initially ineligible patients became eligible after 1 year. However, no differences were observed in the adjusted 1-year rate of all-cause mortality or cardiovascular mortality and HHFs.

Tinnitus is defined as the perception of sound without external stimulus. It is classified as a subjective phenomenon described as ringing, buzzing, or hissing in the ears. Tinnitus often co-occurs with migraine, as both conditions originate from disturbances of the central nervous system, specifically the auditory and trigeminal nerve pathways. The overlap in populations and pathophysiological similarities between tinnitus and migraine provide strong evidence for overlap between the conditions and a shared potential for therapy. Calcitonin-gene-related peptide (CGRP) medications are a recent development in migraine treatment that have proven to be effective prophylactic agents. CGRP medications work by blocking CGRP's inflammatory role in migraine formation, a physiological process that may also be involved in the loudness of tinnitus. This narrative review aims to provide an overview of the role of CGRP in migraine and tinnitus and discuss managing CGRP and central sensitization as a potential therapeutic role in tinnitus.

Background: This study aimed to establish a targeted fetal next-generation sequencing (NGS) panel and evaluate its diagnostic yield in sonographically normal fetuses.

Methods: A retrospective analysis was conducted on 1,820 cases of sonographically normal fetuses who underwent fetal NGS targeted panel testing, based on parental requests, between June 2021 and June 2023.

Results: Among the 1,820 cases analyzed, 833 cases (45.8%) showed no anomalies, 893 cases (49.1%) were identified with abnormal carrier statuses, and 94 cases (5.2%) exhibited pathogenic condition. The most frequently identified condition was glucose-6-phosphate dehydrogenase (G6PD) deficiency, with hemizygous mutations observed in 35 cases. This was followed by homozygous pathogenic variants in the GJB2 gene, identified in 19 cases. Additionally, 83 cases exhibited G6PD gene mutations, and 344 cases were identified as carriers of GJB2 gene variants. Other notable findings included 15 cases of familial hypercholesterolemia, 5 cases of Noonan syndrome, and 2 cases of osteogenesis imperfecta. Rare disorders identified were Wilson's disease, cystic fibrosis, Cockayne syndrome, and ototoxic hearing loss, each occurring in a single case.

Conclusion: The study demonstrated that the fetal NGS targeted panel yielded critical findings in 5.16% of sonographically normal fetuses, emphasizing its potential in prenatal diagnostics. Effective screening requires careful variant selection and detailed pre- and post-test genetic counseling to ensure clinical relevance and informed decision-making for parents.

Small bowel bleeding, accounting for 5-10% of gastrointestinal bleeding episodes, presents a distinct diagnostic challenge due to the organ's length and anatomical complexity. Over recent years, the management of small bowel bleeding has significantly evolved, driven by advancements in both diagnostic and therapeutic technologies. This Taiwan association for the study of intestinal diseases (TASID) practical consensus integrates local epidemiology, up-to-date diagnostic advances including early small bowel capsule endoscopy, and emerging treatments for vascular lesions like angiodysplasia. This practical consensus is divided into four major parts, including: I. terminology regarding small bowel bleeding and differential diagnosis II, evaluation of suspected small bowel bleeding III. endoscopy for small bowel bleeding and IV. medical treatment. Clinicians should be equipped to identify common causes of small bowel bleeding, understand the advantages and limitations of various evaluation methods, and apply a stepwise, evidence-based approach in managing these patients.