Risk of chronic kidney disease in patients with kidney stones-a nationwide cohort study.

BACKGROUND: Chronic kidney disease (CKD) and kidney stones are common in Taiwan; in particular, CKD has a high prevalence but low self-awareness rate. CKD-related risk factors such as diabetes, hypertension, and nephrotoxic drugs are well-known and uncontested; however, kidney stones are relatively less studied and easily overlooked as a risk factor. The objective of this study was to investigate whether kidney stones are a risk factor for CKD. METHODS: We conducted a nationwide population-based matched cohort study to assess the risk of incident CKD in people with kidney stones. Data on incident stones formers in the year 2001-excluding those with a history of CKD-were obtained from Taiwan's National Health Insurance database. Stone formers were matched (1:4) to control subjects according to sex, age, and index date. The total observation period of the study was 10 years, and the primary end-point was the occurrence of CKD. Student's t-test and Chi-squared test were used to compare continuous and categorical data, respectively. Logistic regression was used to calculate the odds ratio of kidney stone patients with incident CKD relative to the control group. Cox proportional hazard regression model was used to obtain the hazard ratio for development of incident CKD among patients with kidney stones. RESULTS: The incidence of CKD in the kidney stone cohort was 11.2%, which was significantly higher than that of the control group (P < .001). Survival analysis showed that the stones cohort was 1.82 times more likely to experience CKD than the controls. Age, sex, hypertension, diabetes mellitus, and hyperlipidemia increased the risk of CKD incidence (1.04, 1.27, 1.55, 3.31, and 1.25 times, respectively). CONCLUSION: Kidney stones are a definite risk factor for CKD; therefore, patients with stones are suggested to undergo regular renal function monitoring and receive appropriate treatment to avoid CKD.

Hospitalization for cancer among radiologists in Taiwan.

BACKGROUND: Population aging and the incremental use of high-tech instruments increase the demand for radiological examinations and treatments in medical services. The exposure of radiologists and other medical workers to medical treatment radiation may thus be increased. OBJECTIVES: The aim of the study was to explore the average number of cancer hospitalizations and use of hospitalization as cancer treatment for radiologists compared with that for family medicine physicians, as well as the trends in the annual average number of cancer hospitalizations among radiologists. METHODS: Research data were obtained from the 2000-2010 Taiwan National Health Insurance Research Database. These samples collected for this study were unbalanced panel data. RESULTS: The average number of cancer hospitalizations for radiologists from 2000 to 2010 ranged between 3.67 and 28.26‰. After controlling the effects of gender, age, hospital accreditation level and year using generalized estimating equations with a binomial distribution and logit link function, our study found that radiologists had non significant higher risk of cancer hospitalizations compared with family medicine physicians. However, the average number of cancer hospitalizations for radiologists showed an annual decline from 2000 to 2010. CONCLUSIONS: Compared with family medicine physicians, radiologists had non significant higher risk of cancer hospitalizations. The data period examined in this study was only 11 years. Considering the numerous new radiological procedures currently in use in modern medical treatments, the health status of medical radiation workers should be continuously monitored in the future.

Mozart K.448 listening decreased seizure recurrence and epileptiform discharges in children with first unprovoked seizures: a randomized controlled study.

BACKGROUND: Increasing numbers of reports show the beneficial effects of listening to Mozart music in decreasing epileptiform discharges as well as seizure frequency in epileptic children. There has been no effective method to reduce seizure recurrence after the first unprovoked seizure until now. In this study, we investigated the effect of listening to Mozart K.448 in reducing the seizure recurrence rate in children with first unprovoked seizures. METHODS: Forty-eight children who experienced their first unprovoked seizure with epileptiform discharges were included in the study. They were randomly placed into treatment (n = 24) and control (n = 24) groups. Children in the treatment group listened to Mozart K.448 daily before bedtime for at least six months. Two patients in the treatment group were excluded from analysis due to discontinuation intervention. Finally, forty-six patients were analyzed. Most of these patients (89.1%) were idiopathic in etiology. Seizure recurrence rates and reduction of epileptiform discharges were compared. RESULTS: The average follow-up durations in the treatment and control groups were 18.6 ± 6.6 and 20.1 ± 5.1 months, respectively. The seizure recurrence rate was estimated to be significantly lower in the treatment group than the control group over 24 months (37.2% vs. 76.8%, p = 0.0109). Significant decreases in epileptiform discharges were also observed after 1, 2, and 6 months of listening to Mozart K.448 when compared with EEGs before listening to music. There were no significant differences in gender, mentality, seizure type, and etiology between the recurrence and non-recurrence groups. CONCLUSIONS: Although the case number was limited and control music was not performed in this study, the study revealed that listening to Mozart K.448 reduced the seizure recurrence rate and epileptiform discharges in children with first unprovoked seizures, especially of idiopathic etiology. We believe that Mozart K.448 could be a promising alternative treatment in patients with first unprovoked seizures and abnormal EEGs. Further large-scaled study should be conducted to confirm the effect. TRIAL REGISTRATION: NCT01892605, date: June-19-2013.

Music and movement therapy improves quality of life and attention and associated electroencephalogram changes in patients with attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder. Treatments for ADHD include pharmacological and nonpharmacological therapy. However, pharmacological treatments have side effects such as poor appetite, sleep disturbance, and headache. Moreover, nonpharmacological treatments are not effective in ameliorating core symptoms and are time-consuming. Hence, developing an alternative and effective treatment without (or with fewer) side effects is crucial. Music therapy has long been used to treat numerous neurological diseases. Although listening to music is beneficial for mood and cognitive functions in patients with ADHD, research on the effects of music and movement therapy in children with ADHD is lacking. METHODS: The present study investigated the effects of an 8-week music and movement intervention in 13 children with ADHD. The Pediatric Quality of Life Inventory (PedsQL) was used to evaluate changes in participants' quality of life. Conners' Kiddie Continuous Performance Test (K-CPT 2) and the Swanson, Nolan, and Pelham rating scale (SNAP-IV) were used to assess core symptoms. Electroencephalogram (EEG) recordings were analyzed to determine neurophysiological changes. RESULTS: The results revealed that the participants' quality of life increased significantly after the 8-week intervention. Furthermore, the participants' hit reaction times in the block 1 and block 2 tests of K-CPT 2 decreased significantly after the intervention. EEG analysis demonstrated an increase in alpha power and Higuchi's fractal dimension and a decrease in delta power in certain EEG channels. CONCLUSION: Our music and movement intervention is a potential alternative and effective tool for ADHD treatment and it can significantly improve patients' quality of life and attention.

Mozart k.545 mimics mozart k.448 in reducing epileptiform discharges in epileptic children.

Mozart K.448 has been shown to improve cognitive function, leading to what is known as the Mozart Effect. Our previous work reveals positive effects of Mozart K.448 in reducing epileptiform discharges in epileptic children. In this study, we evaluated the effect of Mozart K.545 and compared the effects with those of Mozart K.448 on epileptiform discharges in children with epilepsy. Thirty-nine epileptic children with epileptiform discharges were included in the study. They received electroencephalogram examinations before, during, and after listening to Mozart K.448 and K.545, one week apart, respectively. The frequencies of epileptiform discharges were compared. There was a significant decrease in the frequency of epileptiform discharges during and right after listening to Mozart K.448 and K.545 (reduced by 35.7 ± 32.7% during Mozart K.448 and 30.3 ± 44.4% after Mozart K.448; and 34.0 ± 39.5% during Mozart K.545 and 31.8 ± 39.2% after Mozart K.545). Spectrogrammatic analysis of the two pieces of music demonstrated that both share similar spectrogrammatic characteristics. Listening to Mozart K.448 and K.545 decreased the epileptiform discharges in epileptic children. This suggests that Mozart K.448 is not the only piece of music to have beneficial effects on children with epilepsy. Other music with lower harmonics may also decrease epileptiform discharges in epileptic children.

Increase of urinary concentrations of 8-hydroxy-2'-deoxyguanosine in diesel exhaust emission inspector exposed to polycyclic aromatic hydrocarbons.

PURPOSE: The objectives of this study were to explore the factors influencing urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in diesel engine exhaust emission inspectors (inspectors), the association between polycyclic aromatic hydrocarbons (PAHs) exposure and fine particulate matter (PM(2.5)) levels in diesel exhaust particles (DEPs), and the PAHs exposure levels in diesel vehicle emission inspection stations (inspection stations). METHODS: Twenty-eight inspectors and a control group of thirty-eight individuals matched by age and gender were recruited for this study. Fifteen ambient air samples and eighty-four personal air samples were monitored during 3-day work periods using a repeated-measures study design in each inspection station. Airborne samples were analyzed with a fluorescence detector and by high-performance liquid chromatography. Urinary 8-OHdG was measured in 168 pre- and post-work urine samples from inspectors, and in 38 urine samples from controls. RESULTS: The concentrations of PAHs in DEP(2.5) (PM(2.5) in DEPs) were significantly and positively related to urinary log(10) 8-OHdG levels after adjusting for smoking status and BMI. Statistically, there was a significant correlation between air log(10) PAHs and air log(10) PM(2.5) concentrations in inspectors. Fifteen PAHs compounds within DEP(2.5) revealed the concentrations ranged from 5.18 to 22.93 ng/m(3) in ambient air monitoring and 1.03 to 12.60 ng/m(3) in personal air monitoring. CONCLUSIONS: This study is the first to indicate an association between occupational PAHs exposure from DEP(2.5) at an inspection station and an increased excretion of urinary 8-OHdG in inspectors. In addition, this study also found smoking is not a confounder in inspectors exposed to PAHs in DEP(2.5).

The long-term effect of listening to Mozart K.448 decreases epileptiform discharges in children with epilepsy.

Mozart's Sonata for Two Pianos in D major, K.448 (Mozart K.448), has been shown to improve mental function, leading to what is known as the Mozart Effect. Our previous work revealed that epileptiform discharges in children with epilepsy decrease during and right after listening to Mozart K.448. However, the duration of the effect was not studied. In the study described here, we evaluated the long-term effect of Mozart K.448 on epileptiform discharges in children with epilepsy. Eighteen children with epilepsy whose seizures were clinically well controlled with antiepileptic drugs were included. For each child, EEGs had revealed persistent epileptiform discharges for at least 6 months. These patients listened to Mozart K.448 for 8 minutes once a day before bedtime for 6 months. Epileptiform discharges were recorded and compared before and after 1, 2, and 6 months of listening to Mozart K.448. All of the children remained on the same antiepileptic drug over the 6 months. Relationships between number of epileptiform discharges and foci of discharges, intelligence, epilepsy etiology, age, and gender were analyzed. Epileptiform discharges significantly decreased by 53.2±47.4, 64.4±47.1, and 71.6±45.8%, respectively, after listening to Mozart K.448 for 1, 2, and 6 months. All patients except those with occipital discharges showed a significant decrease in epileptiform discharges. Patients with normal intelligence and idiopathic epilepsy had greater decreases than those with mental retardation and symptomatic epilepsy. Age and gender did not affect the results. We conclude that long-term listening to Mozart K.448 may be effective in decreasing epileptiform discharges in children with epilepsy in a chronologically progressive manner.

Mozart K.448 acts as a potential add-on therapy in children with refractory epilepsy.

Mozart's Sonata for two pianos in D major, K.448 (Mozart K.448), has been shown to improve mental function, leading to what is known as the Mozart effect. Our previous work revealed that epileptiform discharges in children with epilepsy decreased during and immediately after listening to Mozart K.448. In this study, we evaluated the long-term effects of Mozart K.448 on children with refractory epilepsy. Eleven children with refractory epilepsy were enrolled. All of the patients were diagnosed as having had refractory epilepsy for more than 1 year (range =1 year to 6 years 4 months, mean =3 years 11 months) and had been receiving at least two antiepileptic drugs (AED). During the study period, they listened to Mozart K.448 once a day before bedtime for 6 months. Seizure frequencies were recorded 6 months before they started listening to this music and monthly during the study period. All of the patients remained on the same AEDs during the 6-month study period. Frequencies of seizures were compared before and after listening to Mozart K.448. Eight of eleven patients were seizure free (N=2) or had very good responses (N=6) after 6 months of listening to Mozart K.448. The remaining three (27.3%) showed minimal or no effect (effectiveness <50%; unmodified or worsened seizure frequency). The average seizure reduction was 53.6 ± 62.0%. There were no significant differences in seizure reduction with IQ, etiology, or gender. We conclude that Mozart K.448 should be further studied as a potential add-on therapy in the treatment of children with refractory epilepsy.

Risk of insomnia and hypnotics use among emergency physicians.

This study investigated the risk of insomnia and hypnotics use among emergency physicians. This cross-sectional study recruited physicians working in Taiwanese hospitals in 2015 and the general population as the participants. Data from 1,097 emergency physicians obtained from the National Health Insurance Research Database were grouped into the case group, whereas 14,112 nonemergency physicians and 4,388 people from the general population were categorized into the control groups. This study used logistic regression and conditional logistic regression to compare the risks of insomnia between emergency and nonemergency physicians and between emergency physicians and the general population, respectively. The prevalence of insomnia among emergency physicians, nonemergency physicians and general population was 5.56%, 4.08%, and 1.73%, respectively. Compared with nonemergency physicians and the general population, emergency physicians had a significantly higher risk of insomnia. The proportions of emergency physicians, nonemergency physicians, and general population using hypnotics were 19.96%, 18.24%, and 13.26%, respectively. Among emergency physicians who used hypnotics, 49.77%, 25.57%, and 24.66% used only benzodiazepines, only nonbenzodiazepines, and both benzodiazepines and nonbenzodiazepines, respectively. Nonpharmacological interventions to improve insomnia and reminder of safe use of hypnotics to emergency physicians can serve as references for hospitals in developing health-promoting activities.

Mozart K.448 attenuates spontaneous absence seizure and related high-voltage rhythmic spike discharges in Long Evans rats.

PURPOSE: Recent research has revealed more evidence supporting the positive effects of music on humans and animals. However, evidence of music's effects on improving epilepsy in animals is sparse. This study aimed to clarify the influence of Mozart's music in Long Evans rats, which are characterized by spontaneous absence epilepsy (SAE) and high-voltage rhythmic spike (HVRS) discharges. METHODS: Continuous electroencephalograms comprised of HVRS discharges, and behavioral performance were recorded in Long Evans rats (n=5) before, during, and after exposure to the Mozart's Sonata for Two Pianos in D Major, K.448 (Mozart K.448). The same evaluation was repeated after they had been subjected to daily exposure of the music for 20 days. RESULTS: Seizure frequencies and spontaneous HVRS discharges were reduced in all of the SAE rats during and after music exposure compared with the pre-music stage. The average seizure frequencies were 79.8±24.6, 48±15.2, and 33±12.1/h before, during, and after music exposure, respectively. The average run of spike episodes were 84.6±18.4, 52±17.8, and 36.8±16.9/h before, during, and after music exposure, respectively. The seizure frequencies and related run of spike episodes decreased by 39.8% and 38.5% during, and 58.6% and 56.6% post music exposure, respectively. The average run of spike durations and spike numbers also showed significant decreases (reduction by 47.1%, 47.8% during music and 60.8%, 61.3% post music). After daily music exposure for 20 days, the number of HVRS discharges and seizure frequencies during and after music exposure, however, showed no further accumulative reduction or adaptation effect. These results suggest that Mozart K.448 had a positive short-term effect in attenuating the spontaneous HVRS discharges in Long Evans rats. However, the mechanism needs further investigation.

Parasympathetic activation is involved in reducing epileptiform discharges when listening to Mozart music.

OBJECTIVE: Listening to Mozart K.448 has been demonstrated to improve spatial task scores, leading to what is known as the Mozart effect. Our previous work revealed the positive effects of Mozart K.448 in reducing epileptiform discharges in children with epilepsy. However, the mechanism remains unclear. parasympathetic activation has been shown to help seizure control in many studies. In this study, we investigated the effect of Mozart music on epileptiform discharges and autonomic activity. METHODS: Sixty-four epileptic children with epileptiform discharges were included. They all received electroencephalogram and electrocardiogram examinations simultaneously before, during, and after listening to Mozart K.448 or K.545. The total number of epileptiform discharges during each session (before, during, and after music) were divided by the duration (in minutes) of the session and then compared. Heart rate variability including time and frequency domain analysis was used to represent the autonomic function. RESULTS: The results showed that epileptiform discharges were significantly reduced during and right after listening to Mozart music (33.3 ± 31.1% reduction, p<0.001, during Mozart K.448 and 38.6 ± 43.3% reduction, p<0.001, during Mozart K.545) (28.1 ± 43.2% reduction, p<0.001, after Mozart K.448 and 46.0 ± 40.5% reduction, p<0.001, after Mozart K.545). No significant difference was noticed between the two pieces of music. The reduction was greatest in patients with generalized seizures and discharges. Significant increases in high-frequency (HF), the square root of the mean squared differences of successive RR intervals (RMSSD), the standard deviation of differences between adjacent RR intervals (SDSD), and a decrease in mean beats per minute (bpm) were found during listening to Mozart music. Most of the patients with reduced epileptiform discharges also showed a decreased LF/HF ratio, low-frequency normalized units (LF nu), mean bpm, and an increased high-frequency normalized units (HF nu). CONCLUSIONS: Listening to Mozart music decreased epileptiform discharges in children with epilepsy. The majority of these patients showed an increase in parasympathetic tone during music exposure. SIGNIFICANCE: Our results suggested that Mozart music stimuli induced parasympathetic activation which may be involved in the effect of music in reducing epileptiform discharges and the recurrence rate of seizures.

Exposure assessment of PM2.5 and urinary 8-OHdG for diesel exhaust emission inspector.

Animal studies have shown exposure to diesel exhaust particles (DEPs) to induce production of reactive oxygen species (ROSs) and increase levels of 8-hydroxydeoxyquanosine (8-OHdG). Controversial results have been obtained regarding the effects of workplace exposure on urinary 8-OHdG level. This study assessed concentrations of environmental PM(2.5) in DEP (DEP(2.5)), personal DEP(2.5) and urinary 8-OHdG of diesel engine exhaust emission inspector (inspector) at a diesel vehicle emission inspection station (inspection station). The analysis specifically focuses on the factors that influence inspector urinary 8-OHdG. Repeated-measures study design was used to sample for five consecutive days. A total of 25 environmental PM(2.5) measurements were analyzed at 5 different locations by using a dichotomous sampler, and a total of 55 personal PM(2.5) measurements were analyzed from inspectors by using PM(2.5) personal sampler. During the sampling period, a total of 110 pre- and post-work urine samples from inspectors, and 32 samples from the control group were collected. Following age and sex matching between the inspectors and the control group, levels of urinary 8-OHdG were analyzed. Environmental and personal concentrations of DEP(2.5) were 107.25+/-39.76 (mean+/-SD) and 155.96+/-75.70 microg/m(3), respectively. Also, the concentration of urinary 8-OHdG differed significantly between inspector and control non-smokers, averaging 14.05+/-12.71 and 6.58+/-4.39 microg/g creatinine, respectively. Additionally, urinary 8-OHdG concentrations were associated with diesel exposure after controlling for smoking and cooking at home. Compared with the control group, the inspector displayed significantly increased levels of urinary 8-OHdG. Diesel exhaust is the single pollutant involved in the exposure of DEP(2.5) at the inspection station, as confirmed by the final results.

Pre-implantation genetic diagnosis: a preliminary report of 2 years of experience.

BACKGROUND: Pre-implantation genetic diagnosis (PGD) is defined as making a diagnosis or screening embryos or gametes before implantation. It has the advantage of avoiding repeated spontaneous abortions or therapeutic termination of pregnancy resulting from abnormal embryos. Here, we present our preliminary report of 2 years of experience. METHODS: From March 2001 through October 2002, couples seeking assistance for in vitro fertilization (IVF) were referred for PGD due to chromosomal problems or for aneuploidy screening (PGD-AS). One or two blastomeres were aspirated on day 3 and analyzed using the fluorescent in situ hybridization (FISH) technique. Probes to chromosomes X, Y, and 18 were used for aneuploidy screening and individual specific probes were chosen for chromosomal translocations. Unaffected embryos were transferred on day 5. RESULTS: There were 25 cycles for aneuploid screening (group 1) and four cycles for chromosomal translocation (group 2). In group 1, 73 embryos were biopsied with a successful biopsy/fixation rate of 72.6% and a diagnosis rate of 96.2%. Fifteen unaffected embryos were transferred in 11 cycles, achieving two sets of twins and four singleton pregnancies (implantation rate: 53.3%). In group 2, 27 embryos were biopsied with a successful biopsy/fixation rate of 66.7% and a diagnosis rate of 88.9%. Seven non-affected embryos were transferred in three cycles, resulting in one set of twins (implantation rate: 33.3%). All antenatal amniocentesis confirmed the diagnosis. Post-natal physical examination showed no evidence of major abnormalities. CONCLUSIONS: PGD is an alternative method for having healthy children in selected couples with chromosomal abnormalities. In addition, PGD-AS may increase the implantation rate in infertile couples seeking IVF assistance.