Journal of the Formosan Medical Association最新文献

Background: Ethanol ablation (EA) has been proposed as a first-line treatment modality for recurrent symptomatic cystic thyroid nodules following initial aspiration. The efficacy of EA can be compromised when the initial nodule volume exceeds 10 mL. This study assessed the efficacy of single-session EA in managing thyroid cysts with an initial volume of ≥10 mL.

Methods: This retrospective study included 70 patients, stratified into three groups on the basis of initial nodule volume: Group 1 (≥10, <20 mL), Group 2 (≥20, <40 mL), and Group 3 (≥40 mL). Primary outcomes were the volume reduction ratio (VRR) and therapeutic success rate (VRR >50%) at the 6-month follow-up post-EA. Secondary outcomes included improvements in symptom scores, cosmetic grades, and identification of factors influencing VRR.

Results: The median VRR at the 6-month was 94.8% (interquartile ranges: 88.3-98.1%), with a therapeutic success rate of 90%. Significant improvements were observed in nodule volume, symptom scores, and cosmetic grades (all p < 0.001). Nodules ≥40 mL had poorer symptom scores and cosmetic grades compared to nodules with volumes of ≥10 mL and <20 mL (p < 0.05), though VRR differences were not significant (p = 0.944). Solid portions and nodule vascularity negatively impacted VRR (p = 0.001 and p = 0.002).

Conclusion: Single-session EA effectively reduces volume and improves symptoms and cosmetic outcomes for cystic thyroid nodules ≥10 mL, though larger, solid, and vascular nodules may require tailored treatment strategies.

Background: Pregnant women with inflammatory bowel disease frequently experience suboptimal perinatal outcomes. One Taiwanese study conducted from 2001 to 2003 revealed higher risks of preterm birth and low birth weight in infants born to mothers with ulcerative colitis. With the advancement in disease management, we aim to investigate the pregnancy and perinatal outcomes of Taiwanese mothers with inflammatory bowel disease between 2004 and 2018.

Methods: We integrated data from Taiwan's Maternal and Child Health Database, Birth Reporting Database, National Health Insurance Database, and Catastrophic Illness Registry from 2004 to 2018. Mothers with inflammatory bowel disease were identified using International Classification of Diseases codes and the Catastrophic Illness Registry and matched 1:10 with healthy pregnant women based on the year of childbirth and maternal age. Statistical analyses involved chi-squared tests and conditional logistic regression models.

Results: A total of 3,059,647 births were recorded, of which 146 were born to mothers with IBD (126 to those with ulcerative colitis and 20 to those with Crohn's disease). We observed no significant differences in stillbirths, preterm births, cesarean deliveries, low birth weights, small- or large-for-gestational-age newborns, or Apgar scores between the mothers with inflammatory bowel disease and the controls. Hypertensive disorders of pregnancy were less prevalent in the inflammatory bowel disease group (4.1% vs 13.6%; P = 0.001). Subgroup analysis revealed consistent outcomes in both ulcerative colitis and Crohn's disease, across socioeconomic status, and disease duration.

Conclusion: Pregnancy and perinatal outcomes are comparable in Taiwanese women with inflammatory bowel disease and matched healthy counterparts. While no statistically significant differences were observed, the limited statistical power for certain outcomes warrants cautious interpretation. These findings highlight the need for further investigation in larger cohorts or pooled datasets to explore small but potentially clinically meaningful differences.

Background: Early language and motor development may influence cognitive function in a cascading manner later in life. This study aimed to explore the impact of language and motor plasticity during toddlerhood and early preschool years on intelligence in late preschool, with an additional consideration of the influence of ASD and ADHD diagnoses.

Methods: We retrospectively collected medical chart from 423 children aged 2-5 years (316 boys and 107 girls; mean age at Time 1: 3.49 ± 0.98 years), who participated in an early intervention program at a medical center in Northern Taiwan. Language and motor development along with demographic information were assessed during the initial evaluation (Time 1). These assessments were repeated, and intelligence was measured at the follow-up (Time 2). A generalized linear model was used for the data analysis.

Results: Receptive language developmental change was the strongest predictor of lower intelligence quotient (IQ) scores, followed by gross, expressive language, and fine motor developmental changes (all p < 0.01). Children with catch-up receptive or expressive language or gross or fine motor development had better IQ outcomes than those with persistent delay (all p < 0.001). There were no ASD-by-developmental type or ADHD-by-developmental type interactions predicting IQ.

Conclusion: Better plasticity in language and motor abilities during toddlerhood and early pre-school years was associated with better intelligence in the late pre-school years. The importance of early and effective interventions for language and motor development has been highlighted.

Alzheimer's disease (AD) is a major global health burden whose diagnosis has shifted from syndromic assessment to a biologically grounded framework anchored in biomarkers. This review traces the evolution of diagnostic criteria, highlights the complementary roles of amyloid positron emission tomography (PET), tau PET, and fluid biomarkers, and discusses the growing clinical utility of blood-based tests-especially phosphorylated tau assays-with performance approaching that of cerebrospinal fluid (CSF) and PET measures. We also examine how the advent of disease-modifying anti-amyloid therapies has accelerated biomarker-guided pathways for patient selection, prognosis, and monitoring. Finally, we outline ethical issues surrounding preclinical diagnosis and survey future directions, including artificial intelligence (AI), neuroinflammation and synaptic markers, and personalized therapies. Collectively, these developments represent progress toward a precision-medicine model for AD, though major barriers to equitable and clinically meaningful implementation remain.