Journal of the Formosan Medical Association最新文献

Background: Urinary tract infection (UTI) is among the most prevalent bacterial infections globally, particularly impacting elderly populations in emergency departments (EDs). This study aimed to develop and validate an ED-specific risk score predicting in-hospital mortality for elderly patients with UTI.

Methods: Using data from the MIMIC-IV-ED database, we enrolled patients aged 65 or older with confirmed UTI admitted to wards or ICUs. Variables were selected through stepwise logistic regression using Bayesian Information Criterion in the derivation cohort (70 %), and dichotomized by optimal cut-offs identified by Youden's index. A point-based scoring system was developed from regression coefficients. Internal validation was performed on a separate validation cohort (30 %) assessing discrimination (AUC), calibration, and clinical utility using decision curve analysis.

Results: Among 2391 patients, 160 (6.7 %) experienced in-hospital mortality. The EARL-UTI score included five variables: age >83 years, Emergency Severity Index <2, red cell distribution width >15.7 %, albumin <2.9 g/dL, and lactate >2.4 mmol L^-1. Scores ≥4 predicted a mortality rate of 29.9 % compared to 4.5 % in lower-scoring groups, with sensitivity and specificity of 59.6 % and 93.1 %, respectively, and a negative predictive value of 95.5 %. Validation cohort performance remained consistent (AUC 0.73), and the model outperformed established risk scores.

Conclusions: The EARL-UTI score provides an easily implemented bedside tool for rapid identification of elderly ED patients at high risk for in-hospital mortality, potentially guiding early intervention and resource allocation decisions. Future prospective multicenter studies are necessary to confirm its clinical impact and generalizability.

Background: Taiwan was endemic for hepatitis A virus (HAV) before the 1980s. Following the introduction of a targeted vaccination program and improved hygiene, the prevalence of HAV significantly declined. In 2018, nationwide HAV vaccination for infants was implemented. We aimed to assess the current seroprevalence under the coverage of universal hepatitis A vaccination.

Methods: A nationwide cross-sectional survey was conducted between 2019 and 2021, including 4717 participants aged 1-60 years. Anti-HAV IgG levels were measured, and vaccination records were reviewed. Geographic and age-specific differences in HAV seroprevalence were analyzed.

Results: The seroprevalence of anti-HAV exhibited a bimodal distribution, with the lowest rates observed in individuals aged 31-35 years (7.14 %) and peaks among those under 2 years (89 %) and those over 56 years (89.5 %). Eastern Taiwan, where a targ eted vaccination program was implemented for more than 20 years before the introduction of universal vaccination, had a higher seroprevalence compared to non-eastern regions (47.9 % vs. 27.9 %, P < 0.0001). Children born after 1995 in eastern Taiwan had higher seropositivity due to the early vaccination program, while children born after 2017 showed similar rates across all regions, reflecting the success of nationwide universal immunization. Receiving two or more doses of HAV vaccine conferred higher seropositivity than one dose (98.5 % vs. 90.11 %, P = 0.001).

Conclusion: The HAV vaccination program significantly increased seroprotection against HAV in children and young adults. The universal immunization conducted recently reduced the age and geographic disparities in HAV prevalence. Two or more doses of HAV vaccines may provide better protection.

Background: Sarcopenia, characterized by progressive muscle/function loss, is prevalent in chronic kidney disease (CKD), associated with adverse outcomes. Identifying factors influencing its progression in end-stage kidney disease (ESKD) is essential for targeted interventions. This study aimed to determine key factors for incident or persistent sarcopenia risk status in ESKD patients.

Methods: We prospectively enrolled ESKD patients on chronic hemodialysis in 2020, collecting clinical, anthropometric, laboratory, and physical function data. Screening for sarcopenia status was assessed at baseline and one year later, using the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire. Primary outcome was persistent or incident SARC-F-defined sarcopenia. Risk factors were analyzed using multiple regression models.

Results: Among 146 patients (60.8 ± 11.9 years; 66.4 % male), 26 (17.8 %) had incident or persistent SARC-F-defined sarcopenia. They were older, had more comorbidities (diabetes, peripheral vascular disease, stroke), lower albumin and potassium levels, and higher baseline SARC-F scores and frailty. Regression analyses considering demographic/physical data, comorbidity, and medications identified advanced age (odds ratio (OR) 1.079, 95 % confidence interval (CI) 1.024-1.138) and prior stroke (OR 7.346, 95 % CI 1.227-43.97) as significant risk factors. After incorporating laboratory markers, baseline SARC-F, and frailty status, only prior stroke (OR 18.522, 95 % CI 2.278-150.6) and higher baseline SARC-F scores (OR 2.422, 95 % CI 1.676-3.501) were associated with increased risk.

Conclusions: Our findings highlight a subgroup of ESKD patients at an elevated risk of SARC-F-defined sarcopenia persistence or development, including prior stroke and poorer baseline sarcopenia screening results.

This study investigated speech perception skills in children with speech sound disorders (SSDs). Previous research has reported inconsistent findings regarding perceptual deficits in children with SSDs, prompting further investigation into the nature and extent of these difficulties. The present study focused on subtypes of SSDs in preschool children and evaluated their perception of consonants and lexical tones. Seventy Mandarin-speaking children aged 5;0 - 5;11 participated, including 24 children with developmental SSDs (DEV-SSDs), 22 children with non-developmental SSDs (NONDEV-SSDs), and 24 typically developing peers. Children with NONDEV-SSDs were classified as exhibiting more non-developmental speech errors. Computerized speech discrimination and identification tasks were used to assess consonant and lexical tone discrimination and categorical perception abilities. The results indicated that the DEV-SSDs exhibited speech perception skills comparable to those of their typically developing counterparts. In contrast, the NONDEV-SSDs showed significant deficits in both discrimination and identification tasks, with additional difficulties in categorizing speech sounds, indicating underlying phonological processing challenges. These findings highlight the importance of incorporating speech perception assessment and training into intervention programs for the subgroup of children with SSDs, especially for children with more non-developmental speech errors (NONDEV-SSDs).

Parkinson's disease (PD) is the fastest-growing neurological disorder worldwide, largely driven by the aging global population, and poses major challenges in clinical management due to progressive disability, the emergence of symptoms insufficiently controlled by current therapies, and treatment-related complications. In this Review, we revisit the definition of PD beyond its clinical manifestations, emphasizing the evolving framework of biological classification. We examine advances in genetics and explore the structural and physiological roles of α-synuclein, with particular attention to post-translational modifications, their contributions to neurodegeneration, and the existence of disease-specific α-synuclein strains that underlie pathological propagation. We highlight recent progress in diagnostic technologies, including seed amplification assays and PET tracers for pathological α-synuclein detection, as well as updates in MRI-based imaging and digital biomarkers to support early detection and differentiation of PD from atypical parkinsonian syndromes. Finally, we review the current therapeutic landscape, encompassing pharmacological therapies, surgical approaches such as deep brain stimulation, and emerging neuromodulation strategies, including adaptive deep brain stimulation, transcranial magnetic stimulation, and focused ultrasound. Together, these strategies will bridge the gap to transform both the understanding and clinical care of PD in the coming decade.