Journal of the Formosan Medical Association最新文献

Background: Gestational weight gain (GWG) is a modifiable factor influencing maternal and neonatal health. Current GWG guidelines, largely derived from Western populations, may not align with the physiological and sociodemographic characteristics of Asian women. This study examined the associations between GWG and pregnancy outcomes across pre-pregnancy body mass index (BMI) categories in a nationally representative Taiwanese cohort.

Methods: We analyzed 18,970 full-term singleton mother-infant pairs from the Taiwan Birth Cohort Study. GWG was calculated from self-reported pre-pregnancy and delivery weights. BMI was classified using Taiwan's Ministry of Health and Welfare standards: underweight (<18.5 kg/m²), normal weight (18.5-23.9 kg/m²), overweight (24.0-26.9 kg/m²), and obese (≥27.0 kg/m²). Outcomes included low birthweight (LBW), small for gestational age (SGA), large for gestational age (LGA), high birthweight, gestational diabetes mellitus (GDM), gestational hypertension, and pre-eclampsia. Multivariable logistic regression was stratified by BMI and adjusted for maternal age, parity, education, urbanization, and infant sex.

Results: GWG was positively associated with birthweight in all BMI groups. Inadequate GWG was linked to higher risks of LBW, SGA, and maternal complications, particularly in underweight women. Overweight and obese women showed greater tolerance to higher GWG for GDM and gestational hypertension; however, excessive GWG consistently increased pre-eclampsia risk across BMI groups.

Conclusions: Findings highlight the need for BMI-specific GWG recommendations in Taiwan. Among underweight women, insufficient GWG was associated with higher risks of adverse outcomes, suggesting that current GWG targets for this group may warrant re-evaluation, while current guidelines appear adequate for overweight or obese women.

Background: End-stage kidney disease (ESKD) patients on dialysis or post-kidney transplantation (KT) are at high risk of coronavirus disease 2019 (COVID-19).

Method: We retrospectively enrolled ESKD patients on hemodialysis (HD), peritoneal dialysis (PD), and post-KT between January 2020 to December 2022 across eight medical centers in Taiwan. This study analyzed demographics, vaccination coverage, antiviral use, and COVID-19 severity in these patients.

Results: A total of 5950 ESKD patients were analyzed: 3233 (54.3 %) on HD, 1592 (26.8 %) on PD, and 1125 (18.9 %) post-KT. Overall, 83.1 % of patients received at least one dose of vaccine. HD patients had the highest vaccination coverage (89.9 %) but also the highest infection rates (26.2 %), antiviral use (82.4 %), and COVID-19-related mortality (5.3 %). KT recipients had the lowest vaccination coverage (66.8 %) and the highest intensive care unit (ICU) admission (9.3 %), while PD patients had the lowest mortality (0.4 %). Regionally, vaccination was lowest among Northern KT recipients (20.7 %), infection peaked among Eastern HD patients (41.2 %), and severe outcomes were concentrated in Eastern KT recipients, who also had the highest mortality (14.7 %). Logistic regression analysis demonstrated that older age increased the risks of hospitalization and mortality, while vaccination provided a clear dose-dependent protective effect across all outcomes.

Conclusions: Vaccination was associated with reduced hospitalization and death among ESKD patients. HD patients bore the highest infection burden, KT recipients were most vulnerable to severe outcomes, and PD patients had the most favorable prognosis. These finding emphasize the importance of improving vaccine coverage, particularly among KT recipients.

Purpose: Studies exploring changes in fibrosis markers and their predictive performance for histological fibrosis staging after hepatitis C virus (HCV) eradication are limited. The aim of this study was to examine the predictive performance of and exclusionary and confirmatory thresholds for the ELF test, FIB-4 index, APRI, M2BPGi, liver stiffness measurement (LSM) through acoustic radiation force impulse elastography, and the collagen proportionate area (CPA) for each METAVIR fibrosis stage after treatment.

Methods: We examined 280 and 207 patients (3.1 ± 0.3 years) before and after HCV eradication, respectively, of whom 197 underwent paired liver biopsies. Statistical analysis assessed fibrosis markers' predictive performance using AUROC and ROC curves, and their optimal thresholds.

Results: The median ELF, FIB-4, APRI, M2BPGi, LSM, and CPA values for each METAVIR stage and the exclusionary and confirmatory thresholds for dichotomized METAVIR stages decreased after HCV eradication. The areas under the receiver operating characteristic curve (AUROCs) derived for ELF, FIB-4, APRI, M2BPGi, LSM, and CPA for predicting advanced fibrosis (F3-F4) were 0.803, 0.826, 0.784, 0.750, 0.863, and 0.920, respectively, before viral eradication and 0.710, 0.791, 0.766, 0.699, 0.810, and 0.901, respectively, after viral eradication. CPA had the highest AUROCs for predicting significant (F2-F4) and advanced fibrosis (F3-F4) before and after HCV eradication. Most of the fibrosis markers decreased significantly after viral eradication, regardless of METAVIR fibrosis stage changes.

Conclusions: Noninvasive fibrosis markers can be used at a low threshold to determine the stage of liver fibrosis, although their predictive performance decreases after HCV eradication.