Thymectomy in patients with myasthenia gravis increases the risk of autoimmune rheumatic diseases: a nationwide cohort study.

Objectives: Previous studies have shown myasthenia gravis (MG) and autoimmune rheumatic diseases (ARDs) share common pathogenetic mechanisms. Therefore, the present study investigated the possible relationship between MG and ARDs. Methods: We analysed Taiwanese medical data from the Registry of Catastrophic Illness and identified patients with MG. From the entire general population data of the National Health Insurance Research Database, we randomly selected a comparison cohort that was frequency-matched by age (in 5-year increments), sex, and index date. We analysed the risk of ARDs by using a Cox proportional hazards regression model stratified by sex, age and treatment. Results: In the present study, we enrolled 6478 patients with MG (58.03% women; mean age, 50.55 years) and 25 912 age- and sex-matched controls. The risk of total ARDs was 6.25 times higher in the MG cohort than in the non-MG cohort after adjustment for age and sex. Furthermore, the MG cohort was associated with a significantly higher risk of primary SS (pSS), SLE and other ARD types (adjusted hazard ratios: 15.84 [95% CI: 8.39, 23.91]; 11.32 [95% CI: 5.04, 25.429]; and 4.07 [95% CI: 1.31, 12.62], respectively). The MG cohort who underwent thymectomy had an increased risk of RA, pSS and SLE (adjusted hazard ratios: 4.41; 15.06; and 23.68, respectively). Conclusion: The present nationwide cohort study revealed an association between MG and incident ARDs. The MG cohort who underwent thymectomy had an increased risk of RA, pSS and SLE. Future studies are needed to elucidate the underlying pathogenesis and to translate this into clinical therapeutic options.

Association of migraines with brain tumors: a nationwide population-based study.

BACKGROUND: Several studies examined headaches as a symptom of brain neoplasms. Nevertheless, very few studies attempted to specifically evaluate the role of headaches as a risk factor. This study aimed to investigate the risk of migraine occurrence in the preceding years among patients diagnosed with brain tumors and unaffected controls. METHODS: Data were obtained from the Taiwan National Health Insurance Research Database. In total, 11,325 adults with a first-time brain tumor diagnosis were included as cases, together with 11,325 unaffected matched controls. Each individual was traced in the healthcare claims dataset for a prior diagnosis of migraines. Conditional logistic regressions were performed to calculate the odds ratio (OR) and the corresponding 95% confidence interval (CI) to present the association between brain tumors and having previously been diagnosed with migraines. RESULTS: We found that among patients with and those without brain tumors, 554 (4.89%) and 235 (2.08%) individuals, respectively, were identified as having a prior migraine diagnosis. Compared to unaffected controls, patients with brain tumors experienced an independent 2.45-fold increased risk of having a prior migraine diagnosis. The risks were even higher among men (odds ratio (OR) = 3.04, 95% confidence interval (CI) = 2.29~ 4.04) and after patients who had received a prior migraine diagnosis within 3 years were excluded (OR = 1.91, 95% CI = 1.59~ 2.29). CONCLUSIONS: This is the first report demonstrating the occurrence of brain tumors to be associated with a prior migraine history, for both men and women, in a population-based study.

Association between sudden sensorineural hearing loss and anxiety disorder: a population-based study.

Anxiety disorder (AD) is commonly associated with a number of physical illnesses. No previous study has investigated the association between AD and sudden sensorineural hearing loss (SSNHL). In this study, we investigated the association between prior AD and SSNHL using a population-based dataset in Taiwan. Sampled subjects of this case-control study were retrieved from the Taiwan "Longitudinal Health Insurance Database". We identified 3,522 patients who had a diagnosis of SSNHL as cases and 10,566 age- and gender-matched subjects without SSNHL as controls. A conditional logistic regression was used to calculate the odds ratio (OR) for having previously been diagnosed with AD between cases and controls. We found that of 14,088 patients, 13.4% had a prior AD diagnosis, 17.8 and 11.9% for the SSNHL group and controls, respectively. After adjusting for patient socioeconomic characteristics and comorbid medical disorders, SSNHL patients were more likely to have prior AD than the controls (OR 1.49, 95% confidence interval (CI) 1.34-1.66, p < 0.001). Furthermore, we found that the significant relationship between SSNHL and prior AD decreased with age. The relationship was the most pronounced among those aged ≤44 years, with an adjusted OR of 1.86 (95% CI 1.48-2.33, p < 0.001) for cases compared to controls. We concluded that patients with SSNHL had a higher proportion of prior AD than non-SSNHL-diagnosed controls. Further study is needed to confirm our findings and explore the underlying pathomechanisms.

Onset headache predicts good outcome in patients with first-ever ischemic stroke.

BACKGROUND AND PURPOSE: The study aimed to assess whether onset headache is an ominous sign in patients with first-ever ischemic stroke. METHODS: A large population of ischemic stroke patients was obtained from the Taiwan Stroke Registry. Stroke subtypes were classified by the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. On the basis of the International Classification of Headache Disorders, second version, onset headache was defined as a new headache that developed at the onset of ischemic stroke. Clinical features and impact on stroke outcomes, including in-hospital stroke in evolution, changes in National Institutes of Health Stroke Scale on discharge, and Barthel index and modified Rankin scale ≤6 months after stroke were compared between those with and without onset headache. RESULTS: Among 11 523 patients with first-ever ischemic stroke, 848 had onset headache (7.4%). Patients with specific cause, large-artery atherosclerosis, or cardioembolism were more likely to have onset headache. Patients with onset headache were younger, predominantly female, and more likely to have posterior circulation ischemic lesions. Compared with patients without onset headache, those with onset headache had a lower frequency of stroke in evolution (4.5% versus 6.7%; adjusted relative risk, 0.64; 95% confidence interval, 0.52-0.79), greater improvement in National Institutes of Health Stroke Scale score on discharge (0.08 versus -0.20; P=0.02), higher mean Barthel index scores (86.5±20.0 versus 83.9±23.3; adjusted difference, 1.43; 95% confidence interval, 0.28-2.89), and a lower frequency of modified Rankin scale higher than 2 (27.6% versus 31.5%; adjusted relative risk, 0.85; 95% confidence interval, 0.72-0.95) at 1-month follow-up. There was also a trend for better functional outcome in 3- and 6-month follow-ups. CONCLUSIONS: By adopting standard classification criteria, this large-scale study demonstrated that onset headache was associated with modest but significantly better outcomes after ischemic stroke.

Psoriasis is associated with an increased risk of parkinsonism: a population-based 5-year follow-up study.

BACKGROUND: Few studies have examined the association between autoimmune diseases and parkinsonism. OBJECTIVE: We sought to investigate the risk for parkinsonism during a 5-year follow-up period after a diagnosis of psoriasis using a population-based data set in Taiwan. METHODS: We identified 4885 patients with psoriasis for the study cohort and randomly selected 24,425 patients as a control cohort. Each subject was individually followed up for a 5-year period to identify those who subsequently developed parkinsonism. RESULTS: Stratified Cox proportional hazards regression showed that the adjusted hazard ratio for parkinsonism during the 5-year follow-up period for patients with psoriasis was 1.74 (95% confidence interval 1.35-2.20) that of control patients. Furthermore, the adjusted hazard ratios for parkinsonism within the 5-year follow-up period after the index date for subjects with psoriasis were similar between both sexes (1.78 and 1.66 for men and women, respectively). LIMITATION: Our data set did not provide detailed information on the severity of psoriasis, or individual factors such as cigarette smoking, alcohol consumption, body mass index, and dietary patterns. CONCLUSION: Patients with psoriasis were found to be at a significant risk of parkinsonism during a 5-year follow-up.

Migraine and erectile dysfunction: evidence from a population-based case-control study.

BACKGROUND: This case-control study aimed to estimate the association between erectile dysfunction (ED) and migraines using a nationwide population-based database in Taiwan. METHODS: The data used for this matched case-control study were retrieved from the Taiwan Longitudinal Health Insurance Database 2000. We identified 5763 patients with ED as the cases and randomly selected 17,289 patients as the controls. Conditional logistic regression was used to calculate the odds ratios (OR) for prior migraine between cases and controls. RESULTS: After adjusting for hypertension, diabetes, hyperlipidaemia, renal disease, coronary heart disease, obesity, and alcohol abuse/alcohol dependence syndrome, conditional logistic regression revealed that among ED patients the odds of having been previously diagnosed with migraines was 1.63 (95% CI, 1.39-1.91) that of the control group. This risk was more pronounced in younger groups, with the highest risk being detected among those aged between 30 and 39 years. After adjusting for the above mentioned comorbidities, ED patients aged between 30 and 39 years were found to be at 1.98 (95% CI, 1.67-2.23) times the risk of controls for having been previously diagnosed with migraines. CONCLUSION: We conclude that ED is associated with having been previously diagnosed with migraines, particularly in younger populations.

Increased risk of cancer after Bell's palsy: a 5-year follow-up study.

Reactivation of latent herpes simplex virus (HSV) type I or varicella-zoster virus (VZV) has been recognized as the most common pathomechanism underlying Bell's palsy. There is also increased reactivation of HSV or VZV in patients with immunosuppressed states and in cancer patients. The purpose of this study was to investigate the risk for cancer during a 5-year follow-up period after diagnosis of Bell's palsy by using a population-based dataset in Taiwan. We used data from the "Longitudinal Health Insurance Database". We identified 2,618 patients with Bell's palsy as the study cohort and randomly selected 13,090 patients to be used as a comparison cohort. Cox proportional hazards regression was performed to compare the 5-year risk of subsequent cancer between the study and comparison cohorts. We found that the incidence of cancer was 1.55 (95 % CI 1.35-1.78) per 100 person-years for patients with Bell's palsy and 1.09 (95 % CI 1.02-1.18) per 100 person-years for comparison patients. After censoring cases that died from non-cancer causes during the follow-up period and adjusting for urbanization, monthly income, geographic region, and diabetes, the hazard ratio (HR) for cancer during the 5-year follow-up period for patients with Bell's palsy was 1.43 times that for comparison patients (95 % CI 1.22-1.73). There was a particularly increased risk of oral cancer (HR = 2.49; 95 % CI 1.54-4.03) for patients with Bell's palsy compared with the other patients. We conclude that patients with Bell's palsy were at significant risk of cancer during a 5-year follow-up period after diagnosis.

Chronic periodontitis and the subsequent risk of trigeminal neuralgia: a 5-year follow-up study.

AIM: This study set out to explore the possibility that chronic periodontitis (CP) may also be a condition that could potentially result in secondary or symptomatic trigeminal neuralgia (TN) by utilizing a population-based dataset and cohort study design in Taiwan. MATERIALS AND METHODS: We included 110,104 subjects with CP in our study cohort, and randomly selected 110,104 subjects without a history of CP as a comparison cohort. We individually tracked each patient in this study for a 5-year period to identify those who received a subsequent diagnosis of TN. RESULTS: The incidence rate of TN during the 5-year follow-up period was 4.40 (95% CI = 3.87-4.98) per 10,000 person-years for subjects with CP, and 2.60 (95% CI = 2.20-3.05) per 10,000 person-years in comparison subjects. Cox proportional analysis revealed that the adjusted hazard ratio (HR) of TN during the 5-year follow-up period for subjects with CP was 1.65 (95% CI = 1.34-2.03) times higher than that of comparison subjects. However, the study subjects who had undergone a gingivectomy or periodontal flap operation did not have a higher adjusted risk of TN than comparison subjects (HR = 0.93, 95% CI = 0.54-1.61). CONCLUSION: Our study detected a greater risk for TN among patients with CP than matched comparison subjects.

Increased risk of multiple sclerosis following herpes zoster: a nationwide, population-based study.

UNLABELLED: (See the editorial commentary by Corona and Flores, on pages 177-8.) OBJECTIVE: Varicella zoster virus (VZV) has been proposed to be involved in the pathogenesis of multiple sclerosis (MS). However, the epidemiological data regarding the MS occurrence rate following herpes zoster are still scanty. The goal of this study is to investigate the frequency and risk for MS following occurrence of herpes zoster. METHODS: This study used the Taiwan National Health Insurance Research Database. A total of 315,550 patients with herpes zoster were included as the study group, and the control group consisted of 946,650 randomly selected subjects. The stratified Cox proportional hazard regression was performed to calculate the 1-year MS-free survival rate. RESULTS: Of 1,262,200 sampled patients, 29 from the study group (.009%) and 24 from the control group (.003%) had MS during the 1-year follow-up period. After adjusting for monthly income and geographic region, the hazard of MS was 3.96 times greater (95% CI = 2.22-7.07, p < 0.001) for the study group than controls. CONCLUSIONS: Our findings support the notion that occurrence of MS could be associated with herpes zoster attack. We found a significantly higher risk for MS within 1 year of herpes zoster attack compared with the control population.

Effectiveness and Safety of Clopidogrel vs Aspirin in Elderly Patients With Ischemic Stroke.

OBJECTIVE: To evaluate the risks of recurrent stroke and major bleeding events with clopidogrel and aspirin use among patients aged 80 years or older. PATIENTS AND METHODS: This retrospective cohort study was conducted using the Full Population Data of the Health and Welfare Database in Taiwan. Patients aged 80 years or older who received monotherapy with clopidogrel or aspirin following hospitalization for primary acute ischemic stroke between January 1, 2009, and December 31, 2018, were included. Inverse probability of treatment weighting was used to balance measured covariates between clopidogrel and aspirin users. Measured outcomes included recurrent acute ischemic stroke, acute myocardial infarction, composite cardiovascular events (recurrent stroke or acute myocardial infarction), intracranial hemorrhage, major gastrointestinal tract bleeding, and composite major bleeding events (intracranial hemorrhage or major gastrointestinal tract bleeding). RESULTS: A total of 15,045 patients were included in the study, 1979 of whom used clopidogrel and 13,066 who used aspirin following hospitalization for primary acute ischemic stroke. Clopidogrel use was associated with significantly lower risk of recurrent acute ischemic stroke (hazard ratio [HR], 0.89; 95% CI, 0.83 to 0.96; P=.002), composite cardiovascular events (HR, 0.88; 95% CI, 0.82 to 0.95; P<.001), intracranial hemorrhage (HR, 0.71; 95% CI, 0.56 to 0.90; P=.005), and composite major bleeding events (HR, 0.89; 95% CI, 0.80 to 0.99; P=.04) compared with aspirin use. CONCLUSION: In patients aged 80 years or older with primary acute ischemic stroke, clopidogrel users had lower risks of recurrent stroke and the composite cardiovascular events compared with aspirin users. Clopidogrel users also had lower risks of intracranial hemorrhage and the composite major bleeding events compared with aspirin users.

Polymyalgia rheumatica and the risk of stroke: a three-year follow-up study.

BACKGROUND: Polymyalgia rheumatica (PMR) is a relatively common rheumatic disease, particularly in the elderly. Vasculitis is associated with PMR and theoretically makes such patients susceptible to vascular events such as stroke. This study aims to explore the frequency and risk of stroke among patients with PMR through a population-based case-controlled study. METHODS: The study included 781 patients with PMR from the Taiwan Longitudinal Health Insurance Database between 2001 and 2005. We randomly extracted 3,905 other patients, matched with the study group in terms of sex and age, as a control population. Each subject was individually tracked for a three-year period to identify those who had strokes. Stratified Cox proportional hazard regression was employed to evaluate the risk of stroke, after adjusting for socio-demographic characteristics and comorbidities. RESULTS: We found that 386 out of 4,686 sampled patients (8.24%) had stroke during the three-year follow-up period, including 113 patients with PMR (14.47% of the PMR group) and 273 controls (6.98% of the control group). The stratified Cox proportional hazard regression showed that the adjusted hazard ratio of stroke for patients with PMR was 2.09 times that of controls (95% CI = 1.63-2.66, p <0.001), after adjusting for socio-demographic characteristics and comorbidities. CONCLUSIONS: PMR was associated with a significantly higher risk of stroke in the three-year follow-up period. Physicians should be aware of this potential association in clinical settings.

The Association Between the Use of Cholinesterase Inhibitors and Cardiovascular Events Among Older Patients With Alzheimer Disease.

OBJECTIVE: To evaluate the association between the use of cholinesterase inhibitors (ChEIs) and incident cardiovascular events (CVEs) among older patients with Alzheimer disease (AD). PATIENTS AND METHODS: This retrospective cohort study was conducted with a new-user design and active-comparator design. The data source was the 2005-2014 Full Population file from the Health and Welfare Database in Taiwan. Patients were included if they were aged 50 years or older and had been diagnosed with AD between January 1, 2006, and December 31, 2010. The association between ChEI use and the risk of CVEs was investigated in patients with AD. Among the ChEI users, the risk of CVEs was further compared between patients with different cumulative doses and different ChEI treatment strategies. The propensity score method, which included matching and inverse probability of treatment weighting, was used to balance the potential confounders. A Cox proportional hazards model with competing risks was used to estimate the hazard ratio of CVEs. RESULTS: The study included 6070 patients with AD. After covariate adjustment, ChEI users had a significantly lower risk of CVEs than nonusers (hazard ratio, 0.57; 95% CI, 0.51 to 0.62). Among ChEI users, patients with a high cumulative dose had a significantly lower risk of CVEs than those with a low cumulative dose (hazard ratio, 0.82; 95% CI, 0.70 to 0.96). CONCLUSION: The use of ChEIs was associated with a decreased risk of incident CVEs among patients with AD. The cardioprotective effect of ChEIs showed a dose-response relationship.

Increased risk of stroke after adhesive capsulitis: a population-based study.

BACKGROUND AND PURPOSE: No previous study has described the association between stroke and previous adhesive capsulitis (AC). This study aims to investigate the risk of stroke after AC with a population-based database. METHOD: Records for 10 935 with a principal diagnosis of AC and 32 805 randomly selected controls were collected between 2000 and 2003. The log-rank test was performed to analyze the differences in accumulated stroke-free survival rates between the 2 groups. Cox proportional hazard regressions were performed to calculate the longitudinal hazard of stroke. RESULTS: During the follow-up period, 575 patients from the study group (5.3%) and 1201 from the comparison group (3.7%) had strokes. The crude hazard ratio for stroke for patients with AC was 1.46-times greater than for controls (95% CI, 1.32-1.62; P<0.001), and the adjusted hazard ratio was 1.22 (95% CI, 1.06-1.40; P=0.002). CONCLUSIONS: Our study demonstrates increased prevalence and risk of stroke after AC. Further study is needed to confirm our findings and explore underlying mechanisms.

Increased risk of Guillain-Barré Syndrome following recent herpes zoster: a population-based study across Taiwan.

BACKGROUND: Guillain-Barré syndrome (GBS) has been sporadically reported to be associated with herpes zoster reactivation. However, the risk for developing GBS after herpes zoster reactivation remains unknown. This study aimed to establish epidemiological profiles regarding the frequency and risk for GBS following herpes zoster. METHODS: We extracted 315,595 patients with herpes zoster from a nationwide health registry in Taiwan during the period 2003-2005 and also randomly selected 946,785 matched control subjects. Each participant was individually tracked for 2 months from their index ambulatory care visit to identify those who developed GBS. Stratified Cox proportional hazard regressions were conducted to analyze the difference in the risk of GBS for patients with and without herpes zoster. RESULTS: Of the sample of 1,262,380 patients, 92 (0.01%) presented with GBS during the 2-month follow-up period, 78 from the study group (0.025% of the herpes zoster patients) and 14 from the comparison group (0.001% of patients without herpes zoster). Regression revealed that the adjusted hazard of GBS during the follow-up period was 18.37 times greater (95% confidence interval, 10.22-33.01 times greater; P < .001) for patients with herpes zoster than for those without. Furthermore, we found that patients who developed GBS after herpes zoster were more likely to have prior infection, compared with the likelihood of herpetic patients who did not develop GBS. CONCLUSIONS: The risk for GBS is significantly increased among people who have experienced a recent herpes zoster attack, compared with the risk of a matching population.

Tuberculosis and the risk of ischemic stroke: a 3-year follow-up study.

BACKGROUND AND PURPOSE: The aim of this study is to estimate the risk of ischemic stroke during a 3-year follow-up period after a tuberculosis diagnosis using a nationwide, population-based study and a retrospective cohort design. METHOD: The study cohort comprised 2283 patients who had received treatment for tuberculosis, except tuberculosis of the meninges and central nervous system, between 2000 and 2003; 6849 randomly selected subjects comprised the comparison cohort. Cox proportional hazard regressions were performed as a means of comparing the 3-year ischemic stroke-free survival rate between these 2 cohorts. RESULTS: Of the 9132 sampled patients, 392 (4.3%) experienced ischemic stroke during the 3-year follow-up period, including 136 (6.0% of the tuberculosis patients) from the study cohort and 256 (3.7%) from the comparison cohort. After adjusting for patient age, gender, hypertension, diabetes, coronary heart disease, hyperlipidemia, malignancy, monthly income, and the geographical region and urbanization level of the community in which the patient resided, the hazard ratio of ischemic stroke for tuberculosis patients was 1.52-times (95% CI, 1.21-1.91; P<0.001) higher than for comparison patients. CONCLUSIONS: We conclude that patients with a tuberculosis diagnosis are at an increased risk for ischemic stroke but not hemorrhagic stroke in the next 3 years. Further research is necessary to investigate these findings in tuberculosis-endemic areas.

Hyperthyroidism and risk of ischemic stroke in young adults: a 5-year follow-up study.

BACKGROUND AND PURPOSE: Case reports or case series have reported the association between hyperthyroidism and cerebrovascular disease. However, hyperthyroidism has never been considered as a potential risk factor for stroke in young people. The aim of the present study is to estimate the risk for ischemic stroke among hyperthyroidism patients aged 18 to 44 years during a 5-year period after the diagnosis of hyperthyroidism as compared to a cohort of patients without hyperthyroidism during the same period. METHODS: A total of 3176 patients with hyperthyroidism were included as the study cohort and 25 408 patients without hyperthyroidism were included as comparison cohort. Each patient was individually tracked for 5 years from their index ambulatory visit to identify those in whom ischemic stroke developed. Cox proportional hazard regressions were performed to compute the 5-year stroke-free survival rate between these 2 cohorts. RESULTS: Of the total sample of 28 584 patients, 198 patients (0.7%) had ischemic strokes during the 5-year follow-up period (31 [1.0% of the hyperthyroidism patients] from the study cohort and 167 [0.6% of comparison patients] from the comparison cohort). After adjusting for the patient's age, gender, income, level of urbanization, hypertension, diabetes, atrial fibrillation, hyperlipidemia, coronary heart disease, and whether they were using antiarrhythmics, the hazard of having ischemic stroke during the 5-year follow-up period was 1.44-times greater (95% CI, 1.02-2.12; P=0.038) for patients with hyperthyroidism than for patients in the comparison cohort. CONCLUSIONS: We conclude that hyperthyroidism is associated with an increased risk for ischemic stroke among young adults.

Reflux esophagitis and the risk of stroke in young adults: a 1-year population-based follow-up study.

BACKGROUND AND PURPOSE: Reflux esophagitis (RE) is the most common manifestation of gastro-esophageal reflux disease with esophageal injury. To the best of our knowledge, there has been no specific study to evaluate the risk of stroke after diagnosis of RE in young adults. This study aims to evaluate the risk of stroke among RE patients aged 18 to 50 years during a 1-year period after diagnosis of RE compared to a cohort of non-RE patients during the same period. METHODS: This study used the Taiwan Longitudinal Health Insurance Database 2005. A total of 2340 RE patients were included as the study cohort and 11 700 non-RE patients were included as the comparison cohort. Each patient was individually tracked for 1 year from the index ambulatory visit to identify those in whom stroke developed. RESULTS: Out of the sample of 14 040 patients, 78 patients (0.56%) had strokes develop during the 1-year follow-up period: 22 from the study cohort (0.94% of the RE patients) and 56 from the comparison cohort (0.48% of patients without RE). Patients with RE were 1.68-times more likely to have strokes develop (95% confidence interval, 1.03-2.76) than patients in the comparison cohort during the follow-up period after adjusting for patients' medical comorbidities, such as hypertension, diabetes, coronary heart disease, renal disease, heart failure, and hyperlipidemia, as well as their demographic differences, such as the level of urbanization of their communities, monthly income, and geographical location. CONCLUSIONS: We conclude that RE is associated with an increased risk of subsequent stroke in young adults.

Prevalence and Risk Factors of Sensory Symptoms in Diabetes Patients in Taiwan.

Background: Diabetic sensory neuropathy has rarely been studied in the Asian populations. This study investigated the prevalence and risk factors of sensory symptoms (SS) in the Taiwanese diabetes patients. Methods: A total of 1,400 diabetes patients received a health examination together with a structured questionnaire interview for three categories of abnormal sensation of numbness or tingling pain, electric shock, and skin thickness sensation on seven anatomical sites on upper limbs and six sites on lower limbs. Prevalence of SS was defined using nine different criteria, with the least stringent criterion of "any positive symptom on at least 1 site" and the most stringent criterion of "any positive symptom on at least bilateral and symmetrical 2 sites involving the lower limb." Logistic regression was used to estimate the odds ratios and their 95% confidence interval for SS by the different definitions. Fasting plasma glucose and hemoglobin A1c were entered in separate models to avoid hypercollinearity. Results: The prevalence of SS was 14.4 and 54.0% when using the most stringent and least stringent criterion, respectively. Women consistently had a significantly higher prevalence than men did. Among the three categories of symptoms, numbness or tingling pain was the most common, and fingers and toes were the most commonly involved anatomical sites. For any symptoms, 37.1% of the patients had any symptoms on the upper limbs and 41.7% had any symptoms on the lower limbs. Female sex, diabetes duration, hemoglobin A1c, and hypertension were associated with SS in all models. Conclusions: Taiwanese diabetes patients may have a high prevalence of SS if a structured questionnaire is used for screening. Female sex, diabetes duration, hemoglobin A1c, and hypertension are associated with SS.

Associations between Attention-Deficit/Hyperactivity Disorder and Ocular Abnormalities in Children: A Population-based Study.

Purpose: Attention-deficit/hyperactivity disorder (ADHD) was reported to be associated with disturbances in the prefrontal circuitry and seems to be associated with dysfunctions of eye motility. This study aimed to explore associations between ADHD and ocular abnormalities, including amblyopia, hypermetropia, astigmatism, and heterotropia, using a large, nationwide population-based dataset in Taiwan.Methods: We retrieved our sample for this cross-sectional study from the Taiwan National Health Insurance Research Database. In total, 116,308 children with ADHD were selected as the study group and 116,308 randomly selected children without ADHD as the comparison group. We used conditional logistic regression analyses to examine the odds ratios (ORs) of amblyopia, hypermetropia, astigmatism, and heterotropia between children with and those without ADHD.Results: We found that children with ADHD had significantly higher prevalences of amblyopia (1.6% vs. 0.9%, p< .001), hypermetropia (2.4% vs. 1.3%, p < .001), astigmatism (0.2% vs. 0.1%, p < .001), and heterotropia (1.1% vs. 0.5%, p < .001) than children without ADHD. The ORs of amblyopia, hypermetropia, astigmatism and heterotropia for children with ADHD were 1.89 (95% confidence interval (CI) = 1.76 ~ 2.05), 1.82 (95% CI = 1.68 ~ 1.92), 1.73 (95% CI = 1.34 ~ 2.16), and 2.01 (95% CI = 1.82 ~ 2.21) compared to children without ADHD.Conclusions: The findings suggest that ADHD is associated with ocular abnormalities, including amblyopia, hypermetropia, astigmatism, and heterotropia.

Reduction of AHI1 in the serum of Taiwanese with probable Alzheimer's disease.

OBJECTIVE: The development of blood-based biomarkers for early diagnosis and treatment of Alzheimer's disease (AD) is desirable. In AD model mouse brain and neuronal cells, Abelson helper integration site-1 (AHI1) protein is reduced. AHI1 facilitates intracellular amyloid precursor protein (APP) translocation to inhibit amyloidogenic pathology of AD, and thus may be an AD biomarker. METHODS: This study was conducted among 32 AD patients and 54 healthy control (HC) subjects. AHI1-related protein levels from initially collected serum samples in each group were screened using Western blotting. The protein concentrations of AHI1 and amyloid-ß (Aß), peptide(s) derived from APP, from all serum samples were analyzed using ELISA. RESULTS: In AD serum, AHI1 and a large truncated C-terminal APP fragment were significantly reduced. The average concentrations of serum AHI1 and Aß in AD were significantly lower than those in HC. Notably, AHI1 concentration in HC serum was decreased in an age-dependent manner, while it was consistently low in AD serum and had no correlation with Aß or mini-mental state examination score. The receiver operating characteristic analysis on all subjects demonstrated an area under curve (AUC) value of 0.7 for AHI1 on AD diagnosis, while the AUC increased to 0.82 on the subjects younger than 77 years old, suggesting a good diagnostic performance of serum AHI1 for AD especially at relatively young age. CONCLUSION: An early event of AHI1 reduction in the body of AD patients was observed. Serum AHI1 may be valuable for early diagnosis of AD.