Yuan's General Hospital

Cardiometabolic disorders, such as diabetes, hypertension, dyslipidemia, retinopathy, and non-alcoholic fatty liver disease, present significant health challenges globally. Recent evidence suggests that sesame (Sesamum indicum L.) supplementation may offer beneficial effects in modulating various cardiometabolic risk factors, although findings from clinical trials have been inconsistent. This meta-analysis aims to systematically assess the effects of sesame supplementation on multiple cardiometabolic parameters, including lipid profiles, blood pressure, glycemic control, liver enzyme levels, inflammatory biomarkers, body weight, and body mass index (BMI), with the goal of evaluating its potential as an adjunctive therapy for clinical retinopathy. A comprehensive literature search was conducted across multiple databases through July 2025 to identify randomized controlled trials (RCTs) that compared sesame supplementation with placebo or active controls on cardiometabolic outcomes. Pooled effect sizes were calculated using a random-effects model. A total of 10 studies involving 441 participants were included in the meta-analysis. Sesame supplementation significantly reduced both systolic and diastolic blood pressure. Improvements were also observed in glycemic control, with reductions in fasting blood glucose and HbA1c levels. Further-more, sesame intake was associated with a significant reduction in liver enzyme levels, particularly alanine aminotransferase (ALT). Subgroup analyses revealed that the effects did not increase with longer durations of sesame supplementation. This meta-analysis provides evidence supporting the beneficial effects of sesame supplementation in improving various cardiometabolic risk factors. Incorporating sesame products into dietary strategies may offer a promising adjunctive intervention for managing cardiometabolic disorders and retinopathy associated with these disorders.

Background/Objectives: The rising prevalence of dementia presents significant emotional, psychological, and economic challenges for families. Dementia-friendly communities (DFCs) aim to alleviate these burdens by fostering social inclusion and mutual support for people with dementia (PWD) and their caregivers. This study explores the social network structures within DFCs in rural Taiwan, utilizing social network theory as its framework. Methods: A qualitative design was employed, involving semi-structured interviews with eleven participants, including eight caregivers and three case managers. Data were analyzed using grounded theory. Results: The results indicate that the DFC social network is grounded in reciprocal relationships and mutual support between families, workplaces, and neighborhoods. Durability depends on stable relationships, sustained support systems, and the preservation of local culture. Cultural alignment and engagement reduce stigma and foster understanding, while diverse activities strengthen social bonds and participation. Conclusions: The study highlights the importance of government policy, infrastructure, and public awareness in sustaining dementia-friendly environments. The results offer valuable insights for enhancing community design and policy to better support PWD and their families.

ABSTRACTMetabolic dysfunction‐associated steatotic liver disease (MASLD) is an increasingly prevalent chronic liver condition that can progress to severe complications such as metabolic dysfunction‐associated steatohepatitis (MASH). Despite its growing burden, there are no reliable non‐invasive biomarkers for tracking disease progression. In this study, we established a murine MASLD/MASH model using a high‐fat diet and chemical (CCl4) induction. We analyzed serum‐derived extracellular vesicles (EVs) at 14 and 28 weeks to identify stage‐specific proteomic signatures. Proteomic profiling of circulating EVs revealed key proteins associated with disease progression, including cathepsin B (Ctsb) and prosaposin (Psap) in early MASLD, and coagulation factor XIII A chain (F13a1) and polymeric immunoglobulin receptor (Pigr) in early MASH. The significant and severe MASH stages notably enriched Psma2, Psmb3, and Psmb5. These findings suggest EV‐associated proteins may be promising non‐invasive biomarkers for differentiating MASLD/MASH stages and guiding clinical monitoring.

ABSTRACTOsteosarcoma is one of the most prevalent malignant tumors in pediatric cancer, with survival rates remaining stagnant for over a decade, particularly among patients with metastatic disease. Thus, identifying novel therapeutic targets is critical for improving clinical outcomes. The ATG4 family (ATG4A, ATG4B, ATG4C, and ATG4D) encodes proteases essential for autophagy, a process implicated in cancer progression and drug resistance. However, the role of ATG4 proteins in osteosarcoma remains unclear. This study showed that silencing ATG4 family members using small interfering RNA (siRNA) induced G1‐phase cell cycle arrest and promoted cell death in osteosarcoma cells. Among them, ATG4D knockdown significantly impaired cell migration and invasion. Consistently, stable knockdown of ATG4D via short hairpin RNA (shRNA) reduced cell motility and tumorsphere formation. Moreover, ATG4D depletion enhanced autophagic markers, including LC3B‐II puncta and p62 protein levels, and sensitized osteosarcoma cells to starvation and chemotherapy‐induced cell death. In vivo, osteosarcoma cells harboring ATG4D‐targeting shRNA exhibited reduced tumor growth and elevated apoptosis in xenografted mice compared to control cells. Clinically, ATG4D protein expression was elevated in osteosarcoma tissues compared to normal bone cells, with higher levels correlating with poor overall survival, particularly in patients older than 10 years or with tumors located in the lower limbs. These findings suggest that ATG4D may serve as a potential diagnostic biomarker and therapeutic target for osteosarcoma.

p-Cresyl sulfate (PCS), a gut-derived uremic toxin with proinflammatory and cytotoxic effects, has been implicated in cardiovascular injuries among patients with chronic kidney disease (CKD). Aortic stiffness (AS), assessed by carotid–femoral pulse wave velocity (cfPWV), is a recognized predictor of cardiovascular risk. This study investigated the association between serum PCS levels and AS in patients with nondialysis-dependent CKD. In total, 165 patients with nondialysis-dependent CKD were enrolled. Clinical data and fasting blood samples were collected. Arterial stiffness (AS) was assessed bilaterally by measuring carotid–femoral pulse wave velocity (cfPWV) on both the left and right sides. A value above 10 m/s was considered indicative of increased stiffness. Serum PCS levels were quantified using high-performance liquid chromatography–mass spectrometry. Fifty patients (30.3%) had AS. The AS group was significantly older and had higher diabetes prevalence, systolic blood pressure, fasting glucose, urinary protein-creatinine ratio, and PCS levels than the control group. In the multivariate analysis, both PCS (odds ratio [OR]: 1.097; 95% confidence interval [CI]: 1.024–1.175; p = 0.008) and age (OR: 1.057; 95% CI: 1.025–1.090; p < 0.001) were independently associated with AS. In conclusion, elevated serum PCS and older age were independently associated with AS. Thus, PCS is a potential early marker of vascular damage in CKD.

Background and Objectives: Peripheral arterial disease (PAD) is a severe manifestation of atherosclerosis that disproportionately affects patients with chronic kidney disease (CKD) stages 3-5, resulting in a higher prevalence in this group. Currently, it is challenging to detect early PAD in this patient population. This study investigated the association between serum endocan levels and PAD based on the ankle-brachial index (ABI) in non-dialysis patients with CKD stages 3-5. Materials and Methods: Specimens of blood and baseline demographic characteristics were gathered from a total of 164 patients presenting with stages 3-5 CKD, who were not receiving dialysis. We used a commercially available oscillometric technique to ascertain ABI values for our participants, and used a common and well-established threshold for defining low ABI, known to be associated with PAD: ABI values < 0.9. Endocan levels in patients' serum samples were measured by using enzyme-linked immunosorbent assays. Results: A total of 24 out of 164 people (14.6%) showed lower-than-normal ABIs. Compared to the group with normal ABIs, the individuals with low ABIs had more of the following conditions: diabetes mellitus (DM, p = 0.030), urine protein-to-creatinine ratio (p = 0.031), serum C-reactive protein concentrations (p = 0.037), and serum endocan levels (p < 0.001). After adjusting for variables significantly correlated with PAD by multivariate logistic regression analysis, age (odds ratio [OR]: 1.097, 95% confidence interval [CI]: 1.038-1.159, p = 0.001), DM (OR: 3.437, 95% CI: 1.053-11.225, p = 0.041), and serum endocan concentration (OR: 1.098, 95% CI: 1.042-1.157, p = 0.001) were identified as independent predictors of PAD in patients with CKD stages 3-5. Conclusions: Elevated serum endocan levels were found to be independent correlates of PAD in non-dialysis patients with CKD stages 3 through 5.

An 8-week regimen of glecaprevir/pibrentasvir is recommended for treatment-naïve patients with chronic hepatitis C (CHC). In alignment with the Taiwanese government's objective to eliminate hepatitis C by 2025, this study aimed to provide real-world evidence on the use of this regimen in treatment-naïve patients with chronic kidney disease (CKD) by using data from the Taiwan Association for the Study of the Liver HCV Registry (TACR). CKD was defined by an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 or higher with proteinuria persisting for over 3 months. Patients were categorized as having early CKD (eGFR ≥45 mL/min/1.73 m2) or pre-end-stage renal disease (pre-ESRD) (eGFR <45 mL/min/1.73 m2). Among 1072 patients who received at least one dose of the regimen, 1054 had available data for assessing sustained virologic response at 12 weeks posttreatment (SVR12). The overall SVR12 rate was 99.6%, with rates of 99.7% for pre-ESRD patients and 99.6% for early CKD patients. Subgroup analysis showed 100% efficacy for genotype 3 and dyslipidemia, 99.5% for diabetes, 99.4% for cardiovascular disease, 96.9% for a history of cerebral vascular accident, and 95.5% for patients with a history of drug injection or HIV co-infection. Adverse events were reported in 16.8% of patients, with 0.8% experiencing serious events, and only two cases were treatment-related. Renal function significantly improved, with overall eGFR increasing from 39.2 to 41.9 mL/min/1.73 m2. Early CKD patients showed an eGFR rise from 53.5 to 57.1, while pre-ESRD patients improved from 27.1 to 29.2 at SVR12. The study concluded that the 8-week regimen is highly effective, well-tolerated, and associated with significant renal function improvement in treatment-naïve CHC patients with both early CKD and pre-ESRD.