The relationship between resting heart rate and new-onset microalbuminuria in people with type 2 diabetes: An 8-year follow-up study.

AIMS: Microalbuminuria is an indicator of adverse cardiovascular events and chronic kidney disease. Studies have described an elevated resting heart rate as a risk factor for microalbuminuria in people with cardiovascular disease, but none have clarified its role in microalbuminuria development in people with type 2 diabetes. Therefore, this study investigated the relationship between resting heart rate and new-onset microalbuminuria in type 2 diabetes. METHODS: A total of 788 people from a glycaemic control trial in Taiwan were enrolled. Microalbuminuria was defined as a fasting urine albumin-to-creatinine ratio ≥30 mg/g in two consecutive urine tests. Resting heart rate and other covariates were measured at baseline. The quartile of resting heart rates, categorized as <70, 70-74, 75-80 and >80 beats/min, was used for analysis. Cox proportional hazard models were used to evaluate the association between resting heart rate and risk of microalbuminuria. RESULTS: During the follow-up period, 244 people (31%) developed microalbuminuria. Those who developed microalbuminuria had a longer diabetes duration (median = 3.0 vs. 2.0 years, p < 0.001), higher rate of hypertension (77% vs. 66%, p = 0.003), higher rate of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker treatment (50% vs. 38%, p = 0.001) and higher baseline HbA1c level (70 vs. 64 mmol/mol, 8.6 vs. 8.0%, p < 0.001). After adjusting for demographics, metabolic profiles and inflammatory markers, developing microalbuminuria was significantly associated with baseline resting heart rate of 70-74, 75-80 and >80 beats/min (with hazard ratios [95% CI] of 2.05 [1.32, 3.18], 2.10 [1.32, 3.32] and 1.62 [1.01, 2.59], respectively) compared to resting heart rates <70 beats/min. An average increased risk of microalbuminuria for increment of 10 beats/min was about 24% among those with hypertension (with hazard ratios of 1.24 [1.05, 1.47] in the multivariable Cox model). CONCLUSIONS: This prospective cohort study showed that resting heart rate may be an associative risk factor for developing microalbuminuria in type 2 diabetes.

Energy intake at different times of the day: Its association with elevated total and LDL cholesterol levels.

BACKGROUND AND AIMS: This study examined the association between macronutrient intake at different times of the day and blood lipid levels. METHODS AND RESULTS: The study was based on the Nutrition and Health Survey in Taiwan, a cross-sectional study of non-institutionalized and non-pregnant healthy adults (≥19-years-old). A one-day (24 h) dietary recall assessed participants' food intake. Fasting plasma triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol were determined. Low-density lipoprotein (LDL) cholesterol was estimated based on the Friedewald formula. According to the data of eligible subjects (n = 1283), the time of energy intake was categorized into three meal times 0500-0929 (morning), 1130-1329 (noon), and 1730-2029 (evening), along with three snack times 0930-1129 (mid-morning), 1330-1729 (afternoon), and 2030-0459 (night). Energy and macronutrient intake were calculated for the 6 time periods, based on 24 h recall data. An adjusted regression model showed that by transferring 100 kcal intake at night to the morning or noon, LDL cholesterol would be lower by 1.46 (95% CI: 2.42-0.50) and 1.27 mg/dL (95% CI: 2.24-0.30), respectively. Transferring 100 kcal of fat intake at night to earlier periods was associated with a lower LDL cholesterol level, especially transferring to noontime (significantly lower by 5.21 mg/dL, 95% CI: [7.42-2.99]) and evening (significantly lower by 3.19 mg/dL, 95% CI: [6.29-0.08]). CONCLUSIONS: Total cholesterol and LDL cholesterol had the same pattern of association with the timing of energy intake. The study showed that elevated total and LDL cholesterol were positively associated with nighttime energy and fat intake.

Effect of RAGE polymorphisms on susceptibility to and severity of osteoarthritis in a Han Chinese population: a case-control study.

Recent studies have revealed that the inflammatory process plays a role in the pathogenesis of osteoarthritis (OA). The S100 family and receptor for advanced glycation end products (RAGE) participate in regulating inflammation, even in the production of matrix metalloproteinases (MMPs). MMP-1 degrades cartilage, which may result in OA development. Moreover, polymorphisms in RAGE, S100A8, and MMP-1 have a marked effect on ligand binding and transcription regulating. In this study, we investigated the potential genetic contribution of the RAGE, S100A8, and MMP-1 genes to OA. We performed a matched case-control association study and genotyped OA patients and healthy controls, who were analyzed by polymerase chain reaction-restriction fragment length polymorphism assays. A total of 207 patients were diagnosed with knee OA and underwent total knee replacement. The control group included 207 individuals who had standard X-rays of the knee joints to confirm K/L < 2 and were matched by age and gender. Single-nucleotide polymorphisms in RAGE (-429T/C, -374T/A, and 557G/A), S100A8 (rs3795391A/G), and MMP-1 (-1607 1G/2G, -755G/T, and -519A/G) were evaluated. RAGE -374T/A, S100A8 rs3795391A/G, MMP-1 -1607 1G/2G, -755G/T, and -519A/G showed no significant difference between OA patients and healthy controls. RAGE -429T/C and 557G/A showed a significant association between OA patients and healthy controls (P = 0.016 and 0.047, respectively). In haplotype analyses, no RAGE and MMP-1 haplotypes showed associations with OA. Our results suggest that the investigated polymorphism in the RAGE gene play a role in OA in the Han Chinese population.

Skeletal muscle mass and risk of death in an elderly population.

BACKGROUND AND AIM: Body mass index (BMI) has a U-shaped relationship with mortality among the elderly, in contrast to the general adult population. Skeletal muscle mass may be more appropriate than BMI for classifying mortality risk among the elderly. We investigated the relationship between skeletal muscle mass and mortality among elderly Chinese persons. METHOD AND RESULTS: A total of 1512 elderly from the Nutrition and Health Survey in Taiwanese Elderly (1999-2000) was enrolled, and the survival status was followed using data from the National Death Registry. The skeletal muscle mass index (SMMI) was calculated by dividing skeletal muscle mass by height in meters squared. The Cox proportional hazard model was used to estimate the association between SMMI and mortality. During the follow-up (average time: 7.9 years), one-third elderly died (n = 506) by any cause and 25% of them was cardiovascular mortality (ICD-9-CM: between 390 and 459). The total mortality and cardiovascular mortality were 4.23 and 1.07 per 100 person-years. Elderly participants with the lowest SMMI had the highest total mortality and cardiovascular mortality among the four quartiles (6.72, 3.76, 3.25 and 3.50 per 100 PY for total mortality; 1.81, 0.76, 0.87, 0.93 for cardiovascular mortality). Those with a low (1st quartile) SMMI had a 2-fold increase in total mortality (1.96; 1.63-2.35) and cardiovascular mortality (2.16; 1.51-3.08) risk compared to those with a normal [2nd, 3rd, or 4th quartile] SMMI. CONCLUSIONS: The threshold relationship between SMMI and mortality is contrast to the reverse J-shaped relationship between BMI and total mortality. Therefore, skeletal muscle mass measurement may be considered with a high priority to identify elderly individuals with a high mortality risk.

Hyperuricemia and incident atrial fibrillation in a normotensive elderly population in Taiwan.

BACKGROUND AND AIM: Atrial fibrillation (AF) is an important cardiovascular disease in the elderly. The association between hyperuricemia and AF is unclear. Therefore, we aimed to investigate the prospective relationship between uric acid and development of AF in a nationally representative cohort of elderly people. METHODS AND RESULTS: A total of 1485 elderly people (age ≥ 65 yrs) from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were without AF on "electrocardiography" at baseline. Incident AF events (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM: 427.31) were identified using data from the National Health Insurance Dataset. Hyperuricemia was defined as levels of uric acid >7.0 mg/dL in men and 6.0 mg/dL in women. A Cox proportional hazards model was used to evaluate the association between hyperuricemia and incident AF. The follow-up period was from 1999 to 2000 to 2008. During the follow-up period (median: 9.16 yrs), 90 AF events occurred (44 in men and 46 in women). Older age, elevated systolic blood pressure, being an ex-smoker, and high uric acid were positively associated with incident AF. Hyperuricemia was positively associated with incident AF in normotensive (age-adjusted hazard ratio (HR): 2.65 and 95% confidence intervals: 1.05-6.69), but not in (1.20:0.74-1.94) hypertensive individuals (systolic blood pressure ≥130 or diastolic blood pressure ≥85 or using hypertensive medicine). A significant association between hyperuricemia and AF (3.78; 1.24-11.59) remained after adjusting for other potential confounders among normotensive older persons. CONCLUSION: Hyperuricemia is associated with the development of AF in elderly people with normal blood pressure.

Pitfalls of CT for deep neck abscess imaging assessment: a retrospective review of 162 cases.

OBJECTIVES: To investigate the diagnostic value of contrast-enhanced computed tomography (CT) for the prediction of deep neck abscesses in different deep neck spaces and to evaluate the false-positive results. METHOD: We retrospectively analysed the clinical charts, CT examinations, surgical findings, bacteriology, pathological examinations and complications of hospitalised patients with a diagnosis of deep neck abscess from 2004 to 2010. The positive predictive values (PPV) for the prediction of abscesses by CT scan in different deep neck spaces were calculated individually on the basis of surgical findings. RESULTS: A total of 162 patients were included in this study. All patients received both intravenous antibiotics and surgical drainage. The parapharyngeal space was the most commonly involved space. The overall PPV for the prediction of deep neck abscess with contrast-enhanced CT was 79.6%. The PPV was 91.3% when more than one deep neck space was involved but only 50.0% in patients with isolated retropharyngeal abscesses. In the false-positive group, cellulitis was the most common final result, followed by cystic degeneration of cervical metastases. Five specimens taken intra-operatively revealed malignancy and four of these were not infected. CONCLUSIONS: There are some limitations affecting the differentiation of abscesses and cellulitis, particularly in the retropharyngeal space. A central necrotic cervical metastatic lymph node may sometimes also mimic a simple pyogenic deep neck abscess on both clinical pictures and CT images. Routine biopsy of the tissue must be performed during surgical drainage.

Berberine reduces leukocyte adhesion to LPS-stimulated endothelial cells and VCAM-1 expression both in vivo and in vitro.

Leukocyte adhesion to endothelium plays a critical initiating role in inflammation. Berberine, an anti-inflammatory natural compound, is known to attenuate lipopolysaccharide (LPS)-induced lung injury and improve survival of endotoxemic animals with mechanism not fully clarified. This study investigated the effects of berberine on the LPS-induced leukocyte-endothelial cell adhesion both in vivo and in vitro. We first established an animal model to observe the in vivo LPS-induced adhesion of leukocytes to the endothelium of venules in the lung tissue dose-dependently. Pretreatment of LPS-stimulated rats with berberine for 1 h reduced the leukocyte-endothelium adhesion and vascular cell adhesion molecule-1 (VCAM-1) expression in lung. Pretreatment of LPS-stimulated vascular endothelial cells with berberine also dose-dependently decreased the number of adhered THP-1 cells and VCAM-1 expression at both RNA and protein levels. Berberine was further confirmed to inhibit the nuclear translocation and DNA binding activity of LPS-activated nuclear factor-kappa B (NF-kappa B). These data demonstrated an additional molecular mechanism for the profound anti-inflammatory effect of berberine.

Extraordinary transmittance in three dimensional crater, pyramid, and hole-array structures prepared through reversal imprinting of metal films.

We used a reversal imprinting-in-metal (RIM) process to fabricate various three-dimensional (3D) metal structures under low pressure. Molds featuring different shapes were used to pattern various subwavelength metal structures, including pyramidal, hole-array, and crater-like structures. Refractive index matching and cavity effects both enhanced the degree of transmission of these structured metal films. The crater-like structure appears to be a promising material because of the unique properties imparted by the elongated and gradually tapering spacing of its cavities. From both near-field simulations and experimentally obtained optical spectra, we found that the cavity effect in the crater-like structure led to significantly enhanced transmission of the optical intensity. Thus, this RIM process allows the ready fabrication of various two- and three-dimensional metallic structures for use in surface plasmon-based devices.

Using direct nanoimprinting to study extraordinary transmission in textured metal films.

In this paper, we describe a thermal embossing imprint method, which we name "nano-imprinting in metal" (NIM), for patterning metal films with a variety of profiles. Metal films exhibiting either perforated hole-arrays or corrugated structures with various surface morphologies can be fabricated rapidly. The SPR phenomenon allowed energy coupling to the other side of the textured metal film, causing a dramatic increase in the transmission. As a technique for readily controlling the working wavelength and transmittance, the NIM method has great potential for application in various optoelectronic devices.

Brachial-ankle vs carotid-femoral pulse wave velocity as a determinant of cardiovascular structure and function.

Carotid-femoral pulse wave velocity (cf-PWV) is a validated marker of arterial stiffening over the central arteries. Brachial-ankle pulse wave velocity (ba-PWV) integrates the mechanical properties from both the central and peripheral arteries and may be more representative than cf-PWV as arterial load for left ventricle (LV). We compared ba-PWV with cf-PWV for the association of cardiovascular structure and function in 320 subjects with various degrees of abnormality in cardiac structure and function. ba-PWV (by oscillometric technique) and cf-PWV (by tonometric technique) were measured simultaneously, and were highly correlated (r=0.79, P<0.001). Both ba-PWV and cf-PWV were significantly correlated with LV mass, but the correlation was better with ba-PWV (r=0.29 vs r=0.22, P=0.0219). While ba-PWV and cf-PWV were similarly significantly correlated with LV end-systolic elastance and mitral E/A ratio, ba-PWV had better correlation with isovolumic relaxation constant (r=0.34 vs r=0.27, P=0.0202) than cf-PWV. In addition, the correlation was also significantly stronger with ba-PWV than with cf-PWV for other indices of arterial stiffness, including carotid incremental modulus (r=0.59 vs 0.50, P=0.0013), effective arterial elastance (r=0.41 vs r=0.33, P=0.0081) and carotid augmentation index (r=0.38 vs r=0.32, P=0.0368). In conclusion, ba-PWV correlates better with LV mass and diastolic function and other indices of arterial function than cf-PWV, probably because ba-PWV encompasses a greater territory of arterial tree than cf-PWV.

Using colloidal lithography to fabricate and optimize sub-wavelength pyramidal and honeycomb structures in solar cells.

The external quantum efficiency of solar cells can be improved by using texturing pyramid- and honeycomb-like structures with minimum reflection. In this study, we investigated the reflection properties of texturing structures through rigorous coupled-wave analysis and the three-dimensional finite-difference time domains (FDTD) method to analyze close-packed texturing structures. We also demonstrate a simple method-combining sub-wavelength-scale monolayer and bilayer polystyrene spheres with a one-step reactive ion etching process-to fabricate optimized pyramid- and honeycomb-shaped antireflection structures, respectively. Thus, sub-wavelength pyramidal and honeycomb-like structures displaying low reflectance were obtained readily without the need for any lithography equipment.

A Point-based Mortality Prediction System for Older Adults with Diabetes.

The mortality prediction models for the general diabetic population have been well established, but the corresponding elderly-specific model is still lacking. This study aims to develop a mortality prediction model for the elderly with diabetes. The data used for model establishment were derived from the nationwide adult health screening program in Taiwan in 2007-2010, from which we applied a 10-fold cross-validation method for model construction and internal validation. The external validation was tested on the MJ health screening database collected in 2004-2007. Multivariable Cox proportional hazards models were used to predict five-year mortality for diabetic patients ≥65 years. A total of 220,832 older subjects with diabetes were selected for model construction, of whom 23,241 (10.5%) died by the end of follow-up (December 31, 2011). The significant predictors retained in the final model included age, gender, smoking status, body mass index (BMI), fasting glucose, systolic and diastolic blood pressure, leukocyte count, liver and renal function, total cholesterol, hemoglobin, albumin, and uric acid. The Harrell's C in the development, internal-, and external-validation datasets were 0.737, 0.746, and 0.685, respectively. We established an easy-to-use point-based model that could accurately predict five-year mortality risk in older adults with diabetes.

Detection of a phase transition in red cell membranes using positronium as a probe.

Positron lifetimes in human red cell ghost membranes have been measured as a function of temperature from 3 degrees C to 25 degrees C. A marked sudden change in the ortho-positronium annihilation rate was found at 16-18 degrees C during the heating cycle and at 18-20 degrees C in the cooling cycle. Such sudden change of microenvironment in the membranes sensed by ortho-positronium is attributed to the sudden change of water diffusion rate through the membranes which is a consequence of the sudden change in free volume, or fluidities in the lipid layers.

Experimental verification of the effects of optical wavelength on the amplitude of laser generated ultrasound in polymer-matrix composites.

Laser ultrasound is now integrated into the manufacturing process of some of the most modern aircraft for the inspection of composite parts. Unfortunately, for some material and process combinations, laser-ultrasound suffers from a lack of sensitivity. In laser-ultrasound generation, optical penetration depth plays a very important role. It was shown that changing the generation wavelength from the 10.6 microm of the CO2 laser to the 3-4 microm range can significantly improve generation efficiency. In this paper, ultrasonic displacements are compared to measurements of optical penetration depth in different polymer-matrix composites. Ultrasonic waves were generated using an optical parametric oscillator operating in the 3.0-3.5 microm band and optical penetration depth spectra were evaluated using quantitative photoacoustic spectroscopy. The relative amplitudes of the generated ultrasonic waves track closely the optical penetration depth spectra. These results experimentally demonstrate the importance of optical penetration in the laser-ultrasound generation process.

Osteoid osteoma in the talar neck: a report of two cases.

This article describes two cases of juxta-articular osteoid osteoma of talar neck. Both patients were initially treated as having ankle sprains or arthritis before diagnosis of osteoid osteoma. A high index of suspicion and appropriate imaging studies are important to make an early diagnosis of this disorder. Once diagnosis is confirmed, en bloc resection and autogenous bone graft can cure the disorder.

Craniofacial growth changes of Mongolian children with normal occlusion from 8 to 12 years.

The purpose of this study is to quantify the changes of craniofacial skeleton in Mongolian children born in Taiwan. They had normal occlusion and pleasing profiles, received no previous orthodontic treatment, and were aged 8 to 12 years. The subjects included 24 boys and 24 girls from whom lateral cephalograms were taken for the study. After measurements and statistical analysis, the findings in this investigation indicated the following: 1. Although the growth of the mandible showed forward and upward rotation, the growth pattern of craniofacial portion from ages 8 to 12 was stable with no significant difference in angular measurements. Nevertheless, there were significant differences in linear measurements. The linear dimensions exhibited a gradual increase with age for both boys and girls. This fact should be considered in the diagnosis and treatment plan for young patients under 12 years old with anteroposterior discrepancies. 2. There was a considerable degree of sexual dimorphism with boys showing greater angles in the maxilla-mandibular relationship and greater late skeletal and dental changes. Most of the changes in various parameters occurred earlier in girls, and in boys these changes were distributed more evenly over the entire period of study.

Early contribution of arterial wave reflection to left ventricular relaxation abnormalities in a community-dwelling population of normotensive and untreated hypertensive men and women.

We examined the contribution of arterial wave reflection to early abnormalities in left ventricular relaxation, whether this association was modified by gender or hypertension and the role of reflected wave timing and amplitude. We studied a cohort of normotensive and untreated essential hypertensive Taiwanese participants (675 men, 601 women, mean age 52 years). Doppler flow and applanation tonometry were performed to assess carotid-femoral pulse wave velocity (PWV) and augmentation index (AI). Diastolic parameters including the ratio between the peak velocity of early and late diastolic mitral inflow (E/A), E-deceleration time and left atrial (LA) diameter were measured by echocardiography. In multivariate models predicting E/A, women were more likely to have lower E/A than men (ß=-0.08, P<0.001). AI was significantly associated with lower E/A in both men (ß=-0.09, P=0.005) and women (ß=-0.12, P<0.001) independent of PWV. Inclusion of AI in the overall model reduced the gender difference in E/A by 61% and rendered it nonsignificant. There was a significant interaction between AI and hypertension (P=0.02). The inverse association between AI and E/A was significant only in normotensive men and women, and only for the amplitude but not timing of the reflected wave. In conclusion, the contribution of wave reflection to left ventricular diastolic dysfunction was independent of arterial stiffness, more pronounced in normotensive individuals and explained a significant portion of the gender difference in diastolic function.

Does dementia increase risk of thrombolysis?: a case-control study.

BACKGROUND: Dementia represents a potential challenge when thrombolysis is a treatment option. In this study, we assess the impact of dementia on the rate of intracerebral hemorrhage (ICH) and hospital mortality associated with acute ischemic stroke (AIS) in patients treated with thrombolysis. METHODS: A cohort of patients with AIS was identified from the National Inpatient Sample database for the years 2000 to 2007. Vascular and degenerative types of dementia were identified by the International Classification of Diseases-9-CM codes. A matched random sample without dementia was selected from a pool of those with AIS and treated with thrombolysis. RESULTS: In this analysis, 35,557 patients with diagnosis of dementia were included; 207 (0.56%) received thrombolysis. In-hospital mortality (17.48% vs 8.63%) and ICH (5.80% vs 0.38%) were higher in the thrombolysis group (p < 0.0001) compared to those who did not receive thrombolysis. Multivariate analysis showed that thrombolysis was associated with increased hospital mortality (odds ratio [OR] 16.15; 95% confidence interval [CI] 8.54-30.53) and ICH (OR 2.80; 95% CI 1.82-4.32). Compared to a matched population of patients without dementia treated with thrombolysis (n = 621), those who had dementia and were treated with thrombolysis had similar risks of ICH (5.80% vs 4.51%, p = 0.45) and mortality (17.39% vs 14.49%, p = 0.31) rates. With thrombolysis, ICH remained a predictor of mortality for both dementia and control groups (OR 2.25; 95% CI 1.02-4.99). CONCLUSION: The administration of thrombolysis for AIS in patients with dementia was not associated with increased risk of ICH or death compared to the counterparts without dementia. ICH remained as predictor of mortality.

Obesity pandemic, correlated factors and guidelines to define, screen and manage obesity in Taiwan.

The prevalence of obesity and associated chronic diseases has increased rapidly in Taiwan. Data from three consecutive Nutrition and Health surveys in Taiwan show that obesity prevalence has tripled for elementary school boys and doubled for girls since 1993-1996. About one-third of boys (15.5% and 14.7% for overweight and obesity, respectively) and one-quarter of girls were either overweight (14.4%) or obese (9.1%) in 2001-2002. For adults, obesity prevalence rates defined by body mass index > or = 27 kg m(-2) increased from 10.5% in men and 13.2% in women in the 1993-1996 survey, to around 17% in 2005. Prevalence of overweight was around 20% in 1993-1996 for both men or women, and increased to 30% in 2005 for men. No change was found in women. The underprivileged regions usually had higher prevalence of obesity and associated diseases. Scientific bases for Taiwan obesity definition are set out together with the screening and management plans. High-calorie intake was associated with obesity in young children (grades 1-2), but not in older children and adults. Physical inactivity and sedentary lifestyle-related variables were associated with obesity in men and older boys. In addition, good dietary quality was associated with a lower risk of obesity independent of energy intake in elderly Taiwanese. More research is needed to find effective determinants and public health measures for obesity, and concerted efforts are required to combat this rising health problem.

Condylar resorption during active orthodontic treatment and subsequent therapy: report of a special case dealing with iatrogenic TMD possibly related to orthodontic treatment.

A 28-year-old female underwent orthodontic treatment for approximately 22 months. During the later stages of this treatment, the patient reported right shoulder and neck-muscle pain. In addition, temporomandibular joint disorder (TMD) with a 'clicking' sound during mastication commenced 5 months prior to treatment completion. Specific medication to deal with these symptoms was suggested by medical specialists, as were some stress-relief methods, although the pain still progressed, and subsequent clinical and radiographical examinations were undertaken by another orthodontist. Right mandibular condylar resorption was observed from both the panorex and temporomandibular joint (TMJ) radiographs. No clinical signs of rheumatic disease were observed, although bruxism was noted. Following the termination of the orthodontic treatment by the second practitioner, the patient was treated with splint therapy 1 month subsequent to which, the previous symptoms of pain in the shoulder and neck, and the clicking sound during mastication had subsided. During the 14-month period of splint therapy and follow-up, new bone growth in the right condyle was observed from radiographs.