BACKGROUND:Sarcopenic obesity (SO) is a clinical and functional condition defined by the coexistence of obesity and sarcopenia. This study investigated the prevalence, incidence, and determinants of SO among Taiwanese older adults using the 2025 Asia-Oceania consensus. METHODS:Data were analyzed from 1048 participants (aged≧65 years) in the Taichung Community Health Study for Elders (TCHS-E). Questionnaires with basic information were conducted. Participants were categorized into healthy, possible SO, and SO groups based on body mass index, waist circumference, body composition including muscle mass and body fat percentage by DXA/BIA, and physical function. Comparisons of baseline characteristics between sexes and across different sarcopenic obesity (SO) status transitions were performed using the Chi-square test. Logistic regression identified risk factors for 1-year status changes. RESULTS:The baseline prevalence of SO was 2.0%, with women showing higher rates than men (2.6% vs. 1.5%, p < 0.001). The 1-year incidence of SO and possible SO was 1% and 3%, respectively. In fully adjusted models, hypertension (OR = 3.67, 95% CI: 1.26-10.66) and diabetes (OR = 4.01, 95% CI: 1.07-15.12) were independent predictors of SO deterioration. Conversely, regular exercise (OR = 0.46 in age/sex-adjusted models) and higher education were protective factors promoting improvement. Cognitive impairment also correlated with unfavorable SO trajectories. CONCLUSIONS:While the 1-year incidence of SO is relatively low, female sex, advanced age, and cardiometabolic comorbidities significantly increase deterioration risk, whereas exercise and education serve as protective factors, highlighting the need for tailored, multidimensional prevention strategies.
Background Respiratory syncytial virus (RSV) is increasingly recognized as a cause of severe respiratory illness in adults, especially the elderly and those with comorbidities. However, data on outcomes and risk factors for severe disease in this population remain limited. Methods We retrospectively analyzed 123 adult patients diagnosed with RSV infection at a tertiary center in Taiwan from 2015 to 2023. Clinical characteristics, laboratory data, detection of other pathogens, clinical course and outcome were reviewed. Multivariable logistic regression identified risk factors for severe RSV infection, including ICU admission and 30-day mortality. Results The mean age was 55.7 years; 50% were aged ≥60 years and 13% were ≥75 years. ICU admission occurred in 17%, with significant associations to viral coinfection and elevated C-reactive protein (CRP). Thirty-day mortality was 13%, and overall in-hospital mortality was 18%, all among patients with comorbidities. Independent predictors of 30-day mortality included late elderly (aOR 24.2, p = 0.03), high CRP > 11.5 mg/dL (aOR 16.4, p = 0.005) and thrombocytopenia < 34,103/μL (aOR 11.4, p = 0.01). Conclusion Advanced age (≥75 years), high CRP, and severe thrombocytopenia are key predictors of mortality in adults RSV patients. These findings highlight the need for targeted prevention strategies, including vaccination, in high-risk populations.
Clonal hematopoiesis (CH), defined by the age-related expansion of hematopoietic stem cells harboring somatic driver mutations, has emerged as a novel and clinically relevant contributor to atherosclerotic cardiovascular disease (ASCVD). Once considered primarily a precursor to hematologic malignancy, CH is now recognized as a systemic pro-inflammatory state linking somatic evolution to cardiovascular pathology. Epidemiological studies consistently demonstrate that CH is independently associated with increased risks of coronary artery disease, heart failure, aortic stenosis, and cardiovascular mortality. Mechanistically, CH-associated mutations—most commonly in DNMT3A, TET2, and ASXL1—reprogram immune cells toward a pro-inflammatory phenotype, characterized by activation of the NLRP3 inflammasome and increased cytokine production, thereby promoting endothelial dysfunction, atherogenesis, and adverse cardiac remodeling. These insights have catalyzed the development of targeted therapeutic strategies, particularly anti-inflammatory interventions, as well as approaches aimed at modulating clonal expansion and leveraging cardiometabolic agents. Clinically, incorporation of CH genotype and clonal burden into risk assessment may refine cardiovascular risk stratification and guide personalized prevention strategies. In this review, we summarize current evidence on the biological mechanisms linking CH to ASCVD, its clinical implications across cardiovascular phenotypes, and emerging therapeutic approaches. Collectively, CH represents a paradigm shift toward inflammation-driven precision cardiology.
Background Intravascular large B-cell lymphoma (IVLBCL), a rare but increasingly recognized aggressive extranodal B-cell lymphoma, often presents with diagnostically challenging manifestations. Three prediction scores—the Kameda, Okayama, and St. Marianna scores—have recently been proposed to guide the use of random skin biopsy (RSB) for diagnosing IVLBCL, but none have undergone external validation. Methods We retrospectively included 86 consecutive patients aged ≥15 years with suspected IVLBCL who underwent RSB between May 2013 and June 2024. The outcome of interest was a positive RSB for IVLBCL lesions. We evaluated the 2-risk-group classification measures and the 3-risk-group model performance. Results Fourteen patients (16%) had a positive RSB. Although the St. Marianna score had the best 3-risk-group model performance, both the Okayama and St. Marianna scores achieved 100% sensitivity and negative predictive value in the 2-risk-group classification. The Kameda score rarely stratified patients as high risk, resulting in limited predictive performance. In settings where missed diagnoses are considered more harmful than unnecessary biopsies, the 2-risk-group classification and the 3-risk-group model of each score performed similarly. Conclusion The St. Marianna score or Okayama scores may help reducing unnecessary biopsies without missing IVLBCL diagnoses in settings similar to our cohort. These results should be validated locally before routine clinical use.
Background Emergency rooms (ER) are frequently the gateway for older adults seeking acute medical care. The Identification of Seniors at Risk (ISAR) tool is a brief screening instrument intended to identify older people at risk for adverse health outcomes. However, its predictive value for short-term hospital returns remains unclear. We aimed to determine the predictive value of the ISAR questionnaire for ultra-short-term adverse outcomes, namely 3-day ER revisits and 3-day readmissions, in older adults in Taiwan. Methods This prospective study included patients aged ≥65 years who visited the ER of a community hospital in Taiwan in 2021 and 2022. ISAR screening was performed by trained nurses. The outcome variables were 3-day ER revisits and 3-day readmissions. The main predictor variables included total ISAR score (≧2vs.≦1) and individual ISAR items. Covariates included age, gender, triage level, arrival method, pain score, observation time and disease category. Results Of 9697 eligible patients, 3039 (31.3%) underwent ISAR screening. ISAR-screened patients had a higher rate of both 3-day ER revisits and readmission (6.2% vs. 4.7%, p < 0.001; 1.7% vs. 0.9%, p = 0.001). Of the individual ISAR questions, the item “recent hospitalization within 6 months” was significantly associated with both 3-day ER revisits and readmission (OR = 1.852 and OR = 2.290), respectively. The accuracy was 88.1% and 91.6%, respectively. Conclusion The single item “recent hospitalization within 6 months” can be an independent risk indicator. Emergency triage should prioritize this specific question for short-term risk stratification.
BACKGROUND:Herpes zoster is a skin disorder with a lifetime prevalence of 30%. Sng reflects a somatosensory response to tissue acidosis and is proposed as a symptom in herpes zoster. However, its prevalence and clinical significance in herpes zoster remain unclear. We examined the prevalence and temporal pattern of sng, and its associations with pain and itch. METHODS:A total of 137 adults with acute-phase herpes zoster were consecutively enrolled. The primary outcome was the prevalence of sng at baseline and at weeks 2, 4, and 12. Secondary outcomes included numeric rating scale (NRS) scores for sng, pain, and itch, correlations among these symptoms, and the association of baseline sng with subsequent pain and itch. RESULTS:At baseline, 49.6% of patients reported sng, rarely as an isolated symptom but usually with pain and itch. Of 105 sng(+) myotomes, 20 (19.05%), 15 (14.29%), 11 (10.48%), and 11 (10.48%) were located on the back, chest, head, and waist, respectively. Sng severity was strongly correlated with pain severity in affected myotomes (r = 0.6712, p < 0.0001), but not with itch severity (r = -0.0329, p = 0.7388). Both the prevalence and severity of sng decreased over time. Furthermore, baseline sng NRS was correlated with pain and itch at week 12 (r = 0.48, p < 0.01; r = 0.40, p = 0.02). CONCLUSION:Sng is common in herpes zoster, typically coexisting with pain and affecting axial myotomes. Its severity declines over time but may be associated with persistent pain and itch.
Background Previous research links frailty to cognitive decline, but the relationship between frailty and motoric cognitive risk syndrome (MCR), a dementia precursor, is underexplored. Methods This study used CHARLS data with 3388 participants aged ≥45. Data from 2011 to 2012, 2013, and 2015 were analyzed to examine the relationship between frailty index (FI), total FI, and changes in FI (△FI) with MCR risk. Nine machine learning models were built using baseline FI to predict MCR risk, and changes in frailty status over time were assessed for their impact on MCR risk. Results By follow-up end, 127 participants (3.74%) developed MCR. Higher baseline FI, total FI, and △FI were associated with increased MCR risk. Restricted cubic splines (RCS) showed a linear relationship between FI and MCR risk (p > 0.05). Trend regression analysis confirmed a significant upward trend in MCR risk (P < 0.05), with odds ratios of 1.434 (1.195, 1.721), 1.766 (1.450, 2.151), and 1.278 (1.081, 1.511) for different FI categories. Logistic regression and GBDT models had AUC > 0.6, indicating baseline FI showed modest predictive performance associated with MCR. Participants transitioning from robust to frail/pre-frail showed higher MCR prevalence, while those regaining robustness from frailty showed lower MCR prevalence. Remaining pre-frail or improving to robust status also associated with reduced MCR occurrence compared to progressing from pre-frailty to frailty. Conclusion This study highlights the crucial associations of frailty with MCR. Early detection and intervention in frailty might be promising targets for mitigating MCR development and potentially linked to dementia prevention.
Background Invasive fungal rhinosinusitis (IFRS) represents a severe infection associated with high morbidity and mortality, particularly among patients with predisposing factors such as diabetes mellitus or recent coronavirus disease 2019 (COVID-19). This study aimed to describe the clinical features and therapeutic outcomes of IFRS in a tertiary care setting in Vietnam. Methods We conducted a descriptive study of 49 adult patients diagnosed with IFRS at the Hospital for Tropical Diseases in Ho Chi Minh City between January 2022 and December 2025. Data on demographics, comorbidities, clinical presentation, imaging, histopathology, and outcomes were analyzed. Results The median age was 60 years, and 55.1% of the patients were male. Diabetes mellitus (77.6%) was identified as a significant underlying condition. Common clinical manifestations included craniofacial pain (89.8%) as well as orbital swelling and proptosis (67.3%). Imaging studies demonstrated frequent involvement of the maxillary sinus (73.5%) and ethmoid sinus (67.3%), with orbital invasion observed in 55.1% of patients. Histopathological examination revealed the presence of Mucorales in 55.1% of cases and Aspergillus-like filamentous fungi in 40.8%. All patients underwent surgical intervention and received systemic antifungal therapy. There were four fatal cases during the induction phase; notably, all deceased patients exhibited acute IFRS with intracranial invasion. Conclusion IFRS predominantly affects individuals with diabetes mellitus and those with a history of COVID-19 in Vietnam. Mucorales is the leading pathogen. Given the rapid progression and risk of intracranial invasion, early diagnosis based on clinical suspicion and a multidisciplinary management strategy are vital for reducing mortality.
BACKGROUND:Whether extending treatment duration and using high-dose esomeprazole can improve the efficacy of sequential therapy as second-line treatment for Helicobacter pylori (H. pylori) infection remains uncertain. We aimed to compare the efficacy and tolerability of optimized 14-day sequential therapy (ST14) and 10-day bismuth quadruple therapy (BQ10), both containing high-dose esomeprazole, as second-line treatment after failure of standard triple therapy. METHODS:In this multicenter, open-label, randomized trial conducted at six hospitals in Taiwan, adult patients (≥20 years) with confirmed H. pylori infection who failed first-line standard triple therapy were randomly assigned to receive ST14 or BQ10. Both regimens included esomeprazole 40 mg twice daily. The primary outcome was eradication rate assessed by ^13C-urea breath test using intention-to-treat (ITT) and per-protocol (PP) analyses. Secondary outcomes included adverse events, treatment adherence, and short-term changes in metabolic parameters. Antibiotic resistance and 23S ribosomal RNA mutations were assessed in available isolates. CLINICALTRIALS:gov: NCT03208426. RESULTS:A total of 155 patients were randomized (ST14, n = 76; BQ10, n = 79). Eradication rates were significantly lower with ST14 than with BQ10 in both ITT analysis (60.5% vs. 87.3%, P < 0.0001) and PP analysis (62.2% vs. 98.6%, P < 0.0001). ST14 was associated with fewer adverse events than BQ10 (39.5% vs. 62.0%, P = 0.008), while treatment adherence was high and comparable between groups. The eradication rate of ST14 was 80% in strains harboring 23S ribosomal RNA mutations and 99% in those without mutations (P < 0.0001). No clinically meaningful differences in metabolic parameters were observed at 8 weeks. CONCLUSIONS:BQ10 provides superior eradication efficacy compared with ST14 as second-line treatment for H. pylori infection, despite higher rates of adverse events. Sequential therapy with high-dose esomeprazole should not be used empirically as second-line therapy.
