Journal of the Chinese Medical Association : JCMA最新文献

Tinnitus is defined as the perception of sound without an 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: 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: Dysembryoplastic neuroepithelial tumor (DNET) and low-grade astrocytoma (LGA) could present very similar magnetic resonance imaging (MRI) findings. DNET has good seizure control after surgical removal and low malignant potential, while LGA may recur or progress. This study was designed to obtain a 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 to 2024. Individual qualitative and quantitative MRI features were evaluated in both tumors, especially the T2-weighted signal intensity ratio (T2SR), which compared tumor T2-weighted signal with that of normal cerebral white matter. The diagnostic performance of conventional qualitative models, including meaningful qualitative MRI features and combined quantitative model, including T2SR and apparent diffusion coefficient (ADC) values, was evaluated using area under the curve (AUC).

Results: In total, 70 patients (30 DNET, 40 LGA) were included, with a mean age of 23.2 ± 11.3 (15-57) years, including 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%] vs 12 [30.0%], p = 0.049), higher ADC value (2076.2 [53.4] vs 1660.1 [71.9], p < 0.001), and higher T2SR (3.56 ± 0.12 vs 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 the conventional qualitative model (AUC: 0.905 vs 0.727, p = 0.011).

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

Background: Although evidence suggests that levator ani muscle (LAM) entheseal pain is a novel etiology of chronic pelvic pain (CPP), its association with lower urinary tract symptoms (LUTS) remains underexplored. This study examined 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 divided into three groups: an isolated LAM muscular pain, an isolated LAM entheseal pain, and a combined muscle and entheseal pain group. Between-group differences in symptom prevalence and urodynamic parameters were analyzed.

Results: A total of 307 female 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: LAM entheseal pain represents a distinct, clinically palpable entity in CPP. Its urodynamic similarity to myofascial pain suggests that LUTS reflect a shared final pathway of central sensitization rather than peripheral structural dysfunction. Moreover, its unique association with morning stiffness supports a divergent pathophysiology.

Agitation is a frequently occurring and challenging neuropsychiatric symptom of Alzheimer's disease (AD) that substantially affects quality of life, caregiver burden, and healthcare utilization. Nonpharmacological interventions, especially trigger identification, environmental adjustments, and supportive activities, remain the first-line approach for treating agitation. Pharmacological treatment should be considered only when nondrug measures are insufficient or when agitation causes severe distress or safety risks. This consensus integrates evidence up to June 2025, the Taiwan Ministry of Health and Welfare approval status, and expert opinion from Taipei Veterans General Hospital. Among the approved agents, brexpiprazole demonstrated the strongest evidence and most favorable safety profile. Risperidone and aripiprazole are effective, but require careful monitoring for cerebrovascular and extrapyramidal risks. Selected antidepressants, particularly citalopram and agomelatine, should be considered when safety is prioritized. Anticonvulsants, acetylcholinesterase inhibitors, and memantine have limited efficacy and should be reserved for refractory cases. Long-term or routine pharmacological use is not supported by current evidence. Future research should focus on identifying responsive patient subgroups, optimizing dosing strategies, and integrating medications into individualized, multidisciplinary care plans.

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% CI, 1.11-5.30) and cardiovascular mortality and HHFs (hazard ratio: 2.83; 95% CI, 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.

Small-bowel bleeding, accounting for 5% to 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 such as 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.