Taichung Armed Forces General Hospital

Abstract Intestinal ultrasound (IUS) is a non‐invasive imaging method used to evaluate bowel wall inflammation and monitor disease activity in inflammatory bowel disease (IBD) patients. Both the European Crohn's and Colitis Organization and the American Gastroenterological Association endorse IUS for monitoring disease activity and identifying complications at the point of care. However, to date, no published data are available regarding the use of IUS for IBD management in Taiwan. Similar to the specificity of IUS in visualizing gut inflammation, immunoglobulin A (IgA) is a key immunoglobulin central to gut mucosal immunity. Recent studies have explored the involvement of IgA in IBD, but the relationship between IgA levels and bowel wall inflammation was unknown. We enrolled 28 IBD patients, including 19 with ulcerative colitis (UC) and 9 with Crohn's disease (CD), from the outpatient clinic of China Medical University Medical Center. All patients underwent IUS between July 2023 and August 2024. Ultrasound scores were based on the Milan ultrasound criteria (MUC) for UC and the bowel ultrasound score (BUSS) for CD. Plasma levels of erythrocyte sedimentation rate, C‐reactive protein (CRP), albumin, IgA, partial Mayo score, and Crohn's disease activity index (CDAI) were collected at baseline, during treatment, and after 52 weeks of advanced therapy (Adalimumab, Vedolizumab, or Tofacitinib). IUS findings were closely correlated with disease activity. In UC, the MUC score was positively correlated with CRP ( R 2 = 0.4888, p < .0001), partial Mayo score ( R 2 = 0.3652, p = .0002), and negatively with albumin levels ( R 2 = 0.3747, p = .0002). In CD, the BUSS score showed a positive correlation with CDAI ( R 2 = 0.2694, p = .0394). Plasma IgA levels were significantly associated with bowel wall thickness (BWT) in both UC and CD ( R 2 = 0.1759, p = .0041). Furthermore, plasma IgA was strongly correlated with the BUSS score ( R 2 = 0.6585, p = .0001) in CD patients. Notably, when BWT exceeded 3.5 mm, plasma IgA levels increased significantly ( p = .0025). These results demonstrate that IUS is an effective tool for monitoring disease activity and evaluating therapeutic responses in IBD patients. Besides, plasma IgA reflects the bowel wall inflammation, particularly in conjunction with IUS.

This study simulated valproic acid (VPA) physiological pharmacokinetics for epilepsy patients via a refined seven-compartmental model. The seven compartments were defined as oral, GI Tract, liver, whole body (WB), cerebrospinal fluid (CSF), kidney, and bladder. A first-order system of seven differential equations was defined according to this specific model and solved by a self-developed program run in MATLAB to evaluate the VPA time-dependent change among compartments. Each compartment's preset dissolving half-life (in hours) was as follows: oral 0.05, GI Tract 0.10, liver 0.5, WB 2.2, CSF 0.8, kidney 1.2, and bladder 0.5, respectively. The derived results were reorganized according to various presets of dissolving half-lives of the liver, WB, CSF, or kidney to analyze the VPA time-dependent changes under various scenarios. Either the liver or WB was the dominant compartment in this model, which mainly controlled the VPA changes. In contrast, others compartments followed the principle of secular equilibrium in the chain decay of radioactive nuclides. Accordingly, the VPA degradation changes in WB ("mother" compartment) mainly affected the VPA changes in other ("daughter") compartments. Thus, the predicted VPA degradation in CSF, kidney, or bladder was always longer than in WB despite its dissolving half-life changes. The predicted results of VPA changes in various compartments were also compared with other studies, and a reasonable agreement was reached on whether the dissolving half-life of the liver or WB ranged from the original 0.2/2.2 to 1.4/0.9 h. The programable capability of this self-developed program allows one to easily modify the primary preset to comply with findings from other studies and has great potential in similar applications.

ObjectiveSialidosis type I (ST‐1) is an autosomal‐recessive, very rare, progressive lysosomal storage disorder caused by pathogenic variants in NEU1. It is clinically characterized by progressive ataxia, myoclonic seizures (MS), bilateral tonic–clonic seizures (BTCS), and distinctive ophthalmological findings. Given the lack of curative options, in this study, we investigated symptomatic treatment strategies, with a particular focus on the efficacy of antiseizure medications (ASMs).MethodsWe describe the clinical course of a patient followed from diagnosis to 18 years of age, and review seven additional cases from our cohort. In parallel, we conducted a narrative review of the literature (PubMed, January 2010–September 2025) to identify published reports containing therapeutic data.ResultsTherapeutic responses were evaluated in a total of 33 cases (8 from our cohort, 25 from published sources). Although available data are insufficient to define standardized treatment guidelines, some ASMs, such as ACZ, PER, LEV, VPA, CZP, and ZNS, demonstrated fairly consistent efficacy in managing MS and BTCS. Sodium oxybate or deep‐brain stimulation may be considered in refractory cases.SignificanceProspective documentation of clinical course and treatment outcomes—ideally through an international registry—is crucial to improve patient care and inform therapeutic strategies.Plain Language SummarySialidosis type I (ST‐1) is a very rare genetic disorder causing movement problems and seizures, with no cure available yet. We followed 8 patients and reviewed 25 published cases to assess treatments focusing on myoclonic seizure (MS) control. Some antiseizure medications showed benefit. However, we have too little data to make clear recommendations. To improve patients' treatment and to choose the most appropriate therapy, it would be important to follow patients over a longer period of time, for example, in an international registry.

Gastric cancer (GACA) is a major global health burden, ranking fifth in incidence and third in cancer-related mortality worldwide. Despite growing knowledge of environmental risk factors such as Helicobacter pylori infection, smoking, and alcohol consumption, the role of genetic susceptibility, particularly polymorphisms in matrix metalloproteinase-11 (MMP-11), in GACA pathogenesis remains unclear. We conducted a hospital-based case-control study involving 161 patients with GACA and 483 age- and sex-matched cancer-free controls of Taiwanese ethnicity. Four MMP-11 single nucleotide polymorphisms (SNPs), rs738791, rs2267029, rs738792, and rs28382575, were genotyped using PCR-RFLP and direct sequencing. Logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with a significance threshold of p<0.05. Overall, no significant associations were observed between MMP-11 SNPs and GACA susceptibility. However, the rs28382575 C allele was associated with increased risk (p=0.0377). Stratified analysis revealed that rs738791 CT/TT genotypes were significantly associated with metastasis (p=0.0129). Among smokers and drinkers, rs28382575 CT/CC genotypes conferred elevated risk (smokers: p=0.0027; drinkers: p=0.0153), while rs738792 variant genotypes appeared protective (smokers: p=0.0124; drinkers: p=0.0022). While MMP-11 polymorphisms are not suitable as population-level screening markers for GACA risk, rs738791 and rs28382575 may serve as predictors for metastasis, and rs28382575 and rs738792 as modifiers of gene-environment interaction. Functional validation is warranted to elucidate the biological relevance of these findings in GACA progression.

Vascular leiomyoma (VL; angioleiomyoma) is an uncommon benign tumor arising from smooth muscle cells within the tunica media of blood vessels, typically presenting as solitary, firm nodules. It predominantly occurs in the lower extremities but rarely involves the head and neck region, particularly the auricle. Auricular VLs commonly appear as small, sharply-demarcated nodules that are generally asymptomatic. Nonetheless, a subset of patients may experience episodic pain, which can be elicited or intensified by environmental or mechanical factors including pressure and cold exposure, complicating clinical diagnosis. Due to the nonspecific presentation, auricular lesions are frequently misdiagnosed preoperatively. Definitive diagnosis relies on histological examination. Herein, we present a rare case involving the right auricle, accompanied by a concise review of the relevant literature to enhance clinical awareness, support early diagnosis, and guide appropriate surgical management of this rare entity.

Air medical evacuation for residents of remote islands is expensive yet essential for addressing urgent and critical health conditions. This study aims to identify common referral reasons and quantify the economic impact of such services, with a focus on the potential benefits of implementing preventive medicine and telemedicine to improve medical care accessibility and coverage in these regions. We conducted a retrospective analysis of adult patients who traveled from the Matsu Islands to the Taiwan mainland between January 2016 and June 2022 and divided them into two groups: Emergency Air Medical Transport (EAMT) and non-EAMT. We included both direct medical and non-medical costs, and indirect costs measured by productivity loss due to health conditions. A generalized linear model adjusted for age and gender was employed to estimate average costs per patient. Data were available for 423 participants, with 136 in the EAMT group and 287 in the non-medical evacuation group. The average direct costs were significantly higher in the EAMT group ($12,067, 95% confidence interval [CI] 9,592-15,181) compared to the non-EAMT group ($5,540, 95% CI 4,645-6,608). Transportation costs made up the largest portion of these direct costs, particularly for those requiring EAMT services. The most common referral reasons for EAMT were cardiovascular diseases (27.2%), followed by injuries (21.3%) and general conditions (15.4%). Across all referral reasons, the EAMT group consistently incurred higher average costs compared to the non-EAMT group, with fractures resulting in the highest costs ($21,342, 95% CI 13,794-33,019). The findings highlight the significant financial burden of medical evacuation services in remote islands, particularly for cardiovascular conditions, injuries, and fractures. These results emphasize the need for targeted preventive measures and improved healthcare access to reduce both economic impact and health risks, providing a basis for further cost-effectiveness analysis of future interventions.

Cisplatin, a widely used chemotherapeutic agent, is limited by its poor bioavailability, rapid systemic clearance, and severe side effects. To overcome these limitations, hydroxyapatite-gelatin composite microspheres were developed to improve drug entrapment efficiency (DEE) and provide sustained drug release. Various formulations were prepared by incorporating chitosan either by mixing once or through a sequential coating strategy. By adjusting the loading procedure, the DEE increased from 58% to 99%. The composite microsphere effectively controlled the total drug release duration, extending it from one month to over 5 months. Moreover, the MTT assay demonstrated that all samples effectively inhibited cell growth, with cell viability reduced to less than 20% after 2 weeks of experimentation. These findings demonstrate that the sequential chitosan coating method offers superior drug entrapment and prolonged release compared to mixing chitosan once, exhibiting its potential as a sustained drug delivery system for cancer treatment.