Rapid identification of carbapenem-resistant Klebsiella pneumoniae based on matrix-assisted laser desorption ionization time-of-flight mass spectrometry and an artificial neural network model.

BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a clinically critical pathogen that causes severe infection. Due to improper antibiotic administration, the prevalence of CRKP infection has been increasing considerably. In recent years, the utilization of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) has enabled the identification of bacterial isolates at the families and species level. Moreover, machine learning (ML) classifiers based on MALDI-TOF MS have been recently considered a novel method to detect clinical antimicrobial-resistant pathogens. METHODS: A total of 2683 isolates (369 CRKP cases and 2314 carbapenem-susceptible Klebsiella pneumoniae [CSKP]) collected in the clinical laboratories of Taipei Medical University Hospital (TMUH) were included in this study, and 80% of data was split into the training data set that were submitted for the ML model. The remaining 20% of data was used as the independent data set for external validation. In this study, we established an artificial neural network (ANN) model to analyze all potential peaks on mass spectrum simultaneously. RESULTS: Our artificial neural network model for detecting CRKP isolates showed the best performance of area under the receiver operating characteristic curve (AUROC = 0.91) and of area under precision-recall curve (AUPRC = 0.90). Furthermore, we proposed the top 15 potential biomarkers in probable CRKP isolates at 2480, 4967, 12,362, 12,506, 12,855, 14,790, 15,730, 16,176, 16,218, 16,758, 16,919, 17,091, 18,142, 18,998, and 19,095 Da. CONCLUSIONS: Compared with the prior MALDI-TOF and machine learning studies of CRKP, the amount of data in our study was more sufficient and allowing us to conduct external validation. With better generalization abilities, our artificial neural network model can serve as a reliable screening tool for CRKP isolates in clinical practice. Integrating our model into the current workflow of clinical laboratories can assist the rapid identification of CRKP before the completion of traditional antimicrobial susceptibility testing. The combination of MADLI-TOF MS and machine learning techniques can support physicians in selecting suitable antibiotics, which has the potential to enhance the patients' outcomes and lower the prevalence of antimicrobial resistance.

Pest management in future climates: Warming reduces physical weed management effectiveness.

Climate change alters many aspects of weed performance and may also alter the effectiveness of management practices to control pests. Despite this concern, entire categories of widely used management practices, such as physical control, remain understudied in this context. We conducted a field experiment growing the invasive pest musk thistle (Carduus nutans) at ambient and experimentally elevated temperatures. We tested mowing management strategies that varied in the timing of a single mowing event relative to thistles' stem elongation phenology and compared these with an unmowed control. Results from this experiment informed demographic models to project population growth rates for different warming/mowing scenarios. Compared to plants grown under ambient conditions, warmed thistles were more likely to survive the same mowing treatment, flowered earlier in the season, grew to taller heights, and produced more flowering capitula. Proportional reductions in plant height and capitulum production caused by mowing were smaller under warming. Warming did not change the relative ranking of mowing treatments; mowing late in the growing season (2 weeks after individuals first reached a height of 40 cm) was most effective at ambient temperatures and under warming. Warming caused significant increases in projected local population growth rate for all mowing treatments. For invasive musk thistle, warmed individuals outperformed individuals grown at ambient temperatures across all the mowing treatments we considered. Our results suggest that to achieve outcomes comparable to those attainable at today's temperatures, farmers will need to apply supplemental management, possibly including additional mowing effort or alternative practices such as chemical control. We recommend that scientists test management practices under experimental warming, where possible, and that managers monitor ongoing management to identify changes in effectiveness. Information about changes in managed weeds' mortality, fecundity, and phenology can then be used to make informed decisions in future climates.

Proteomic analysis of retinal pigment epithelium cells after exposure to UVA radiation.

BACKGROUND: Age-related macular degeneration (AMD) is the primary cause of blindness and severe vision loss in developed countries and is responsible for 8.7% of blindness globally. Ultraviolet radiation can induce DNA breakdown, produce reactive oxygen species, and has been implicated as a risk factor for AMD. This study investigated the effects of UVA radiation on Human retinal pigment epithelial cell (ARPE-19) growth and protein expression. METHODS: ARPE-19 cells were irradiated with a UVA lamp at different doses (5, 10, 20, 30 and 40 J/cm2) from 10 cm. Cell viability was determined by MTT assay. Visual inspection was first achieved with inverted light microscopy and then the DeadEnd™ Fluorometric TUNEL System was used to observe nuclear DNA fragmentation. Flow cytometry based-Annexin V-FITC/PI double-staining was used to further quantify cellular viability. Mitochondrial membrane potential was assessed with JC-1 staining. 2D electrophoresis maps of exposed cells were compared to nonexposed cells and gel images analyzed with PDQuest 2-D Analysis Software. Spots with greater than a 1.5-fold difference were selected for LC-MS/MS analysis and some confirmed by western blot. We further investigated whether caspase activation, apoptotic-related mitochondrial proteins, and regulators of ER stress sensors were involved in UVA-induced apoptosis. RESULTS: We detected 29 differentially expressed proteins (9 up-regulated and 20 down-regulated) in the exposed cells. Some of these proteins such as CALR, GRP78, NPM, Hsp27, PDI, ATP synthase subunit alpha, PRDX1, and GAPDH are associated with anti-proliferation, induction of apoptosis, and oxidative-stress protection. We also detected altered protein expression levels among caspases (caspase 3 and 9) and in the mitochondrial (cytosolic cytochrome C, AIF, Mcl-1, Bcl-2, Bcl-xl, Bax, Bad, and p-Bad) and ER stress-related (p-PERK, p-eIF2α, ATF4 and CHOP) apoptotic pathways. CONCLUSIONS: UVA irradiation suppressed the proliferation of ARPE-19 cells in a dose-dependent manner, caused quantitative loses in transmembrane potential (ΔΨm), and induced both early and late apoptosis.

Increased risk of periodontitis among patients with Crohn's disease: a population-based matched-cohort study.

BACKGROUND: Periodontitis is a frequently cited extraintestinal manifestation of Crohn's disease (CD). Despite a plethora of investigations and a recent meta-analysis linking CD and periodontitis, no study has estimated the risk of periodontitis among CD patients with respect to a comparison group nor has any investigation analyzed the effect of CD-specific medications on the risk of periodontitis. The present cohort study compared CD patients and matched subjects without a history of inflammatory bowel disease (IBD) to estimate the effect of CD and CD-specific pharmaceutical prescriptions on the risk of developing periodontitis by leveraging a population-based dataset in Taiwan. METHODS: We sourced 6657 CD patients and 26,628 comparison subjects without a history of IBD from the Taiwan National Health Insurance Database. Cox proportional hazards regressions were used to estimate the risk of subsequent periodontitis by CD status and pharmaceutical prescription during the follow-up period. RESULTS: After adjusting for socioeconomic status (SES), urbanicity, selected medical co-morbidities, and CD-specific pharmaceutical prescriptions, the hazard ratio (HR) for subsequent periodontitis among patients with CD was 1.36 (95% CI = 1.25-1.48) that of comparison subjects. There was not a significant difference in risk between genders or across ages. Steroids (95% CI = 0.66-0.77) appeared to confer a protective effect and Aspirin, Plavix, and Licodin were marginally protective (95% CI = 0.76-0.95). CONCLUSION: This is the first study to report an increased HR for subsequent periodontitis among CD patients when compared to matched comparison subjects without IBD. The protective effect of some pharmaceuticals may suggest that treatment of CD protects against periodontitis.

Increased risk of stroke among patients with Crohn's disease: a population-based matched cohort study.

BACKGROUND: Crohn's disease (CD) is one type of inflammatory bowel disease (IBD) that has been speculated to share prognostic factors with the development of stroke. There is controversial information in the literature regarding the association between CD and stroke. The present cohort study estimated the risk of subsequent stroke among CD patients compared with matched comparison subjects drawn from a population-based dataset in Taiwan. METHOD: This study drew data from the Taiwan National Health Insurance Database to conduct a historical cohort study. The study cohort comprised 3309 CD patients, and the comparison cohort comprised 13,236 subjects without an IBD. Cox proportional hazards regressions were performed to estimate the risk of subsequent stroke during the follow-up period. We also conducted additional analyses stratifying by age group and gender. RESULTS: After adjusting for selected medical co-morbidities and recent prescriptions of selected pharmaceuticals, the hazard ratio (HR) for subsequent stroke among patients with CD was found to be 1.911 (95% confidence interval (CI) = 1.65-2.22) that of comparison subjects. While we did not detect an association between stroke and CD among patients aged 30-40 years, we did detect increased risks for stroke among CD patients aged 40-50 years (HR = 2.29) and those aged over 50 years (HR = 1.88). We also found women (HR = 2.39) to be at a greater risk than men (HR = 1.50). CONCLUSION: This study reports an increased HR for subsequent stroke among CD patients when compared to matched comparison patients without IBD in an Asian population.

Association between ankylosing spondylitis and chronic periodontitis: a population-based study.

OBJECTIVE: Ankylosing spondylitis (AS) is one type of chronic inflammatory rheumatic disease. It has been suggested that rheumatic diseases may have additional underlying factors in common with chronic periodontitis. However, few studies have addressed the possible link between AS and chronic periodontitis. We undertook the present case-control study to investigate the possible association between AS and chronic periodontitis using a population-based data set in Taiwan. METHODS: We conducted this study by using administrative claims data sourced from the Taiwan National Health Insurance program database. Our study included 6,821 AS patients and 34,105 randomly selected controls. Conditional logistic regression analyses were performed to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for prior chronic periodontitis among AS patients and matched controls. RESULTS: There was a significant difference in the prevalence of prior chronic periodontitis between patients and controls (41.5% versus 25.9%; P<0.001). Conditional logistic regression analysis revealed that patients were more likely than controls to have been previously diagnosed as having chronic periodontitis (adjusted OR 1.84 [95% CI 1.74-1.98]). We further found that patients were only 1.70 (95% CI 1.56-1.89) times more likely than controls to have undergone a gingivectomy or periodontal flap operation (all patients had a history of chronic periodontitis) within the 5 years preceding the index date. After excluding those who had undergone either a gingivectomy or periodontal flap surgery, patients were even more likely than controls to have been previously diagnosed as having chronic periodontitis (adjusted OR 2.04 [95% CI 1.93-2.15]). CONCLUSION: This study detected an association between AS and a prior diagnosis of chronic periodontitis.

Increased risk of stroke among patients with ulcerative colitis: a population-based matched cohort study.

BACKGROUND: The risk of venous thromboembolism (VTE) and the development of atherosclerosis are increased in patients with inflammatory bowel disease (IBD). Ulcerative colitis (UC) is one type of IBD; however, there is controversy in the literature regarding the association between UC and stroke. The present cohort study estimated the risk of subsequent stroke among UC patients compared with that among matched comparison subjects drawn from a population-based data set in Taiwan. METHODS: This investigation analyzed administrative claims data sourced from the Taiwan National Health Insurance Database. Our study consisted of a study cohort comprising 516 UC patients and a comparison cohort of 2,579 subjects without IBD. Cox proportional hazards regressions were performed to estimate the risk of subsequent stroke during the follow-up period. We also conducted additional analyses investigating the risk of subsequent stroke by age group and gender. RESULTS: After adjusting for selected medical co-morbidities and recent prescriptions of selected pharmaceuticals, the hazard ratio (HR) for subsequent stroke among patients with UC was 2.045 (95 % confidence interval (CI) = 1.374-3.043) than that among comparison subjects. While we did not detect an association between stroke and UC among patients aged 30-40 or 40-50 years, we did detect increased risks for stroke among UC patients aged over 50 years (HR = 2.045). We also found the association to remain significant for both men (HR = 2.153) and women (HR = 2.750). CONCLUSIONS: This study detected an increased HR for subsequent stroke among Taiwanese UC patients hen compared to that among matched comparison patients without IBD.

Increased risk of stroke among patients with ankylosing spondylitis: a population-based matched-cohort study.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Although two prior studies detected increased prevalence ratios of cerebrovascular disease among AS patients, the results of the two studies investigating AS and stroke are in conflict. Therefore, the present cohort study set out to estimate the risk of subsequent stroke in AS patients compared with matched controls using a population-based dataset in Taiwan. This investigation analyzed administrative claims data sourced from the Taiwan National Health Insurance Database. Our study consisted of a study cohort comprising 1,479 AS patients and a comparison cohort of 5,916 subjects without AS. Cox proportional hazards regressions were performed to estimate the risk of subsequent stroke during the follow-up period. We also conducted additional analyses investigating the risk of subsequent stroke by gender and pharmaceutical prescription. After adjusting for chronic lower respiratory diseases, type 2 diabetes mellitus, hypertension, hyperlipidemia, renal disease, coronary heart disease, atrial fibrillation, income, and urbanization, compared with comparison patients, the hazard ratio for subsequent stroke among patients with AS was 2.3 (95 % CI 1.9-2.8). We also stratified our results by both gender and pharmaceutical prescription, but did not find a statistically significant difference for the risk of subsequent stroke either between men and women, or between AS patients taking various pharmaceutical regimens and the overall AS population. This is the first study to report an increased hazard ratio for subsequent stroke among AS patients when compared with matched comparison patients without AS.

Association Between Statin Use and the Incidence of Clinically Diagnosed Osteoarthritis: A Nationwide Retrospective Cohort Study in Taiwan.

OBJECTIVE: To investigate the effect of higher cumulative defined daily dose per year (cDDD/y) compared with lower cDDD/y of statin use in the incidence of any joint osteoarthritis (OA). DESIGN: In this population-based retrospective cohort study, patients who were aged ≥40 years were newly initiated on statin therapy between 2002 and 2011, and had a statin prescription for ≥90 days in the first year of treatment were identified from the 2000 Longitudinal Generation Tracking Database. All patients were separated into groups with higher cDDD/y (>120 cDDD/y) and lower cDDD/y (≤120 cDDD/y; as an active comparator) values. Propensity score matching was performed to balance potential confounders. All recruited patients were followed up for 8 years. Marginal Cox proportional hazard models were used to estimate time-to-event outcomes of OA. RESULTS: Compared with lower cDDD/y use, higher cDDD/y use did not reduce the risk of any joint OA (adjusted hazard ratio, 1.07; 95% confidence interval, 0.99-1.14). Dose-related analysis did not reveal any dose-dependent association. A series of sensitivity analyses showed similar results. Joint-specific analyses revealed that statin did not reduce the incidence of knee, hand, hip, and weight-bearing (knee or hip) OA. CONCLUSIONS: Higher cDDD/y statin use did not reduce the risk of OA in this Taiwanese nationwide cohort study. The complexity of OA pathogenesis might contribute to the ineffectiveness of statin. Repurposing statin with its anti-inflammation properties might be ineffective for OA development, and balancing the catabolism and anabolism of cartilage might be a major strategy for OA prevention.

Multidimensional opioid abuse deterrence using a nanoparticle-polymer hybrid formulation.

Misuse of prescription opioid drugs is the leading cause of the opioid crisis and overdose-related death. Abuse deterrent formulations (ADFs) have been developed to discourage attempts to tamper with the formulation and alter the ingestion methods. However, abusers develop complex extraction strategies to circumvent the ADF technologies. For comprehensive deterrence of drug abuse, we develop tannic acid nanoparticles (NPs) that protect encapsulated opioids from solvent extraction and thermal challenge (crisping), complementing the existing formulation strategy to deter injection abuse. Here, we develop a hybrid ADF tablet (NP-Tab), consisting of iron-crosslinked tannic acid NPs encapsulating thebaine (model opioid compound), xanthan gum, and chitosan (gel-forming polymers), and evaluate its performance in common abuse conditions. NP-Tab tampered by crushing and suspended in aqueous solvents forms an instantaneous gel, which is difficult to pull or push through a 21-gauge needle. NPs insulate the drug from organic solvents, deterring solvent extraction. NPs also promote thermal destruction of the drug to make crisping less rewarding. However, NP-Tab releases thebaine in the simulated gastric fluid without delay, suggesting that its analgesic effect may be unaffected if consumed orally as prescribed. These results demonstrate that NP-Tab can provide comprehensive drug abuse deterrence, resisting aqueous/organic solvent extraction, injection, and crisping, while retaining its therapeutic effect upon regular usage.

Increased risk of bladder cancer following diagnosis with bladder pain syndrome/interstitial cystitis.

AIMS: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a prevalent disorder that may contribute to bladder cancer (BC). This cohort study set out to investigate the association between IC/BPS and BC by using a population-based dataset. METHODS: The data for this study were sourced from the Taiwan National Health Insurance program. The case cohort comprised 7,562 patients with IC/BPS, and 22,686 randomly selected subjects were used as a comparison cohort. A Cox proportional hazards regression model (stratified by age group, geographic location, urbanization level, and the index year) was constructed to estimate the risk of subsequent BC following a diagnosis of IC/BPS. We also ran the analysis utilizing an alternative comparison cohort composed of patients with urinary incontinence (UI). RESULTS: In the study sample of 30,248 patients, 96 patients (0.32%) received a diagnosis of BC during the 3-year follow-up period; 48 (0.63% of patients with IC/BPS) were from the study cohort; and 48 (0.21% of patients without IC/BPS) were from the comparison cohort. The incidence rate of BC was 2.12 (95% CI: 1.58-2.78) per 1,000 person-years in patients with IC/BPS and 0.70 (95% CI: 0.52-0.92) per 1,000 person-years in comparison patients. Cox proportional analysis revealed that the adjusted HR for BC during the 3-year follow-up period for patients with IC/BPS was 2.95 (95% CI: 1.97-4.41) that of comparison subjects. When performing the analysis with the alternative UI comparison cohort, the adjusted HR for BC was 1.96 (95% CI: 1.14-3.39). CONCLUSIONS: This investigation detected a novel association between BC and prior IC/BPS.

Traumatic brain injury increases the risk of female urinary incontinence.

AIMS: According to our knowledge, no study has attempted to explore the risk of urinary incontinence (UI) after traumatic brain injury (TBI). This study aimed to examine the relationship between TBI in Taiwanese women and their risk of developing UI. METHODS: The study was based on 2,416 female patients newly diagnosed with TBI together with 12,080 matched enrollees without a history of TBI as a comparison group. All patients were tracked for a 1-year period from their index date to identify those who developed subsequent UI. The stratified Cox proportional hazards models were performed to compute the risk of UI between groups. RESULTS: Of 14,496 patients, 104 (4.30%) from the TBI group and 192 (1.59%) from the comparison group had a diagnosis of UI during the follow-up period. The incidence rate of UI was 4.50 (95% CI: 3.69-5.43) per 100 person-years in patients with TBI and 1.62 (95% CI: 1.40-1.86) per 100 person-years in patients without TBI. The stratified Cox proportional analysis showed that after adjusting for socioeconomic status, obesity, hypertension, diabetes, and hysterectomy, the increased UI risk of patients with TBI persisted at about the same level as in the unadjusted analysis (hazard ratio = 2.78; 95% CI = 2.16-3.53). In addition, although patients with severe and moderate TBI had higher incidence rates of UI than patients with mild TBI, the difference did not reach a statistically significant level (P = 0.090). CONCLUSIONS: Our results suggest that an increased risk of UI exists at the first year follow-up in patients with a TBI diagnosis.

Increased risk of depressive disorder following diagnosis with bladder pain syndrome/interstitial cystitis.

AIM: Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic pain syndrome of unknown etiology that primarily affects women. Using a longitudinal follow-up design, this study aimed to examine the risk of depressive disorder (DD) among women with BPS/IC compared to the general population during a 1-year period following their diagnosis. METHOD: This study used data from the Taiwan "Longitudinal Health Insurance Database." A total of 832 patients with BPS/IC were included in the study group and 4,160 matched non-BPS/IC enrollees were included as the comparison group. Each patient (n = 4,992) was individually tracked for a 1-year period to identify those who subsequently received a diagnosis of DD. Cox proportional hazards regressions (stratified by age group and the index year) were used to estimate the risk of subsequent DD following a diagnosis of BPS/IC. RESULTS: We found that during the 1-year follow-up, the incidence rate of DD was 4.69 (95% CI: 3.38-6.34) per 100 person-years in patients with BPS/IC and 0.94 (95% CI: 0.68-1.27) per 100 person-years in comparison patients. The hazard ratio (HR) of DD during the 1-year follow-up period for patients with BPS/IC was 5.06 (95% CI: 3.21-7.96, P < 0.001) that of comparison patients after adjusting for patient monthly income, geographic location, and urbanization level. The adjusted HR for DD associated with BPS/IC was 10.33 for patients aged between 40 and 49 (95% CI: 3.68-29.04). CONCLUSION: Our study demonstrated that there is an increased risk for being diagnosed with DD during the first year subsequent to being diagnosed with IC/PBS.

A case-control study on the association between rheumatoid arthritis and bladder pain syndrome/interstitial cystitis.

AIM: While bladder pain syndrome/interstitial cystitis (BPS/IC) has been suggested by a number of studies to have autoimmune character, no population-based study to date has been conducted investigating its association with rheumatoid arthritis (RA). This study aimed to examine the association between IC/BPS and having previously been diagnosed with RA. METHODS: We conducted this study by using administrative claims data sourced from the Taiwan National Health Insurance Database. Our study included 9,269 cases with BPS/IC and 46,345 randomly selected controls. Conditional logistic regression was performed to calculate the odds ratio (OR) for the association between previously diagnosed RA and IC/BPS. RESULTS: RA was found among 202 (2.2%) cases and 504 (1.12%) controls. Conditional logistic regression analysis suggested that when compared with controls, the OR for prior RA among cases was 1.66 (95% CI = 1.47-1.87, P < 0.001) after adjusting for diabetes, hypertension, coronary heart disease, obesity, hyperlipidemia, chronic pelvic pain, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, depression, panic disorder, migraine, sicca syndrome, allergy, endometriosis, asthma, overactive bladder, tobacco use disorder, and alcohol abuse. Additionally, BPS/IC was consistently and significantly associated with a previous diagnosis of RA regardless of prescription drug use; the OR for prior RA among groups prescribed ≤1 type of disease-modifying antirheumatic drug (DMARD), two types of DMARDs, and ≥3 types of DMARDs or TNF-alpha inhibitor when compared to controls were 1.49 (95% CI = 1.28-1.72), 1.91 (95% CI = 1.38-2.68), and 2.36 (95% CI = 1.77-3.17), respectively. CONCLUSIONS: There is an association between RA and BPS/IC after adjusting for socio-demographic characteristics and medical co-morbidities.

Reflux esophagitis increased the risk of bladder pain syndrome/interstitial cystitis: a 3-year follow-up study.

AIMS: Reflux esophagitis (RE) is a common disease which has been recognized to be associated with several medical co-morbidities. However, the association between RE and bladder pain syndrome/interstitial cystitis (BPS/IC) is still unknown. The present study aimed to explore the association between these two diseases. METHODS: We identified 8,962 female patients who had received a diagnosis of RE as the study cohort. We randomly selected 44,810 subjects to be included as the comparison cohort. Each patient in this study was individually tracked for a 3-year period to identify those who subsequently received a diagnosis of BPS/IC. Cox proportional hazards regressions were carried out to estimate the 3-year risk of BPS/IC following a diagnosis of RE. RESULTS: The incidence of BPS/IC following a diagnosis of RE was 4.3% during the follow-up period for all subjects. The incidence rate of BPS/IC was 2.38 [95% confidence interval (CI): 2.21-2.57] per 100 person-years in patients with RE, and 1.24 (95% CI: 1.18-1.30) per 100 person-years in controls. Cox proportional analysis indicated that the hazard ratio (HR) of BPS/IC for patients with RE was 2.00 (95% CI = 1.82-2.20, P < 0.001) that of controls. The adjusted HR of BPS/IC for patients with RE was 1.40 (95% CI = 1.27-1.55, P < 0.001) after taking age group, urbanization level, and medical comorbidity into consideration. CONCLUSION: We found that patients with RE were at a higher risk than with comparison patients for having been subsequently diagnosed with BPS/IC during longitudinal follow-up.

Increased risk of diabetes following perianal abscess: a population-based follow-up study.

PURPOSE: It remains unclear whether perianal abscess is a prediabetes condition or the initial presentation of type 2 diabetes. Using a population-based dataset, this study aimed to explore the risk of type 2 diabetes following perianal abscess. METHODS: We used data sourced from the Longitudinal Health Insurance Database 2000. In total, there were 1,419 adult patients with perianal abscess in the study group and 7,095 randomly selected subjects in the comparison group. Stratified Cox proportional hazards regressions were carried out to evaluate the association between being diagnosed with perianal abscess and receiving a subsequent diagnosis of diabetes within 5 years. RESULTS: Of the total 8,514 sampled subjects, the incidence rate of diabetes per 100 person-years was 1.87 (95 % confidence interval (CI) = 1.74-2.01); the rate among patients with perianal abscess was 3.00 (95 % CI = 2.60-3.43) and was 1.65 (95 % CI = 1.52-1.79) among comparison patients. Stratified Cox proportional hazards analysis revealed that patients with perianal abscess were more likely to have received a diagnosis of diabetes than comparison patients (hazard ratio = 1.80, 95 % CI = 1.50-2.16, p < 0.001) during the 5-year follow-up period after censoring cases that died from nondiabetes causes and adjusting for patient geographic location, urbanization level, monthly income, hypertension, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome at baseline. CONCLUSIONS: Our results suggest that patients with perianal abscess have a higher chance of contracting type 2 diabetes mellitus within the first 5 years following their diagnosis.

Association of acute myocardial infarction with sudden sensorineural hearing loss: a population-based case-control study.

OBJECTIVE: Although the etiology of sudden sensorineural hearing loss (SSNHL) remains unknown, there is increasing evidence suggesting an underlying cardiovascular pathomechanism. This study set out to explore a possible association between acute myocardial infarction (AMI) and having previously been diagnosed with SSNHL by using a population-based dataset with a case-control design. METHODS: In this study, we utilized administrative claims data from the Taiwan National Health Insurance program to identify 48,674 cases with AMI and to randomly select 243,370 controls. Conditional logistic regression was used to explore the association between AMI and having previously been diagnosed with SSNHL. RESULTS: Of the sampled patients, 1,313 (0.4%) had been diagnosed with SSNHL within 5 years before the index date; 340 (0.75% of the cases) were from the cases and 974 (0.4% of controls) were from the controls. After adjusting for patient geographic region, monthly income, hypertension, diabetes, hyperlipidemia, and coronary heart disease, conditional logistic regression analysis (conditioned on sex, age group, urbanization level, and index date) revealed that the odds ratio for prior SSNHL in patients with AMI was 1.50 (95% CI 1.30-1.70; p < 0.001) that of controls. We found that the adjusted odds ratio of prior hospitalization for the treatment of SSNHL for cases was 2.11 (95% CI 1.65-2.69; p < 0.001) times that of controls. CONCLUSIONS: This study identified a novel association between AMI and prior SSNHL. The results of this study highlight a need for clinicians dealing with SSNHL patients to be alert to their risk of subsequent AMI.

Association between obstructive sleep apnoea and chronic periodontitis: a population-based study.

AIM: This study set out to explore the association between obstructive sleep apnoea (OSA) and prior chronic periodontitis (CP) by utilizing a population-based data set with a case-control design in Taiwan. MATERIALS AND METHODS: We included 7673 subjects with OSA as cases, and randomly selected 21,963 subjects without a history of OSA as controls. We performed conditional logistic regression analyses to explore the association between OSA and having been previously diagnosed with CP. RESULTS: There was a significant difference in the prevalence of prior CP between cases and controls (33.8% versus 22.6%, p < 0.001). Conditional logistic regression analysis suggested that the odds ratio of prior CP for cases was 1.75 (95% CI = 1.68-1.88) times greater than that of controls after adjusting for monthly income and geographical location, as well as hypertension, diabetes, coronary heart disease, hyperlipidaemia, obesity, tobacco use disorder, and chronic obstructive pulmonary disease and alcohol abuse. CONCLUSION: Our study detected an association between OSA and a prior diagnosis of CP.

Association of bladder pain syndrome/interstitial cystitis with urinary calculus: a nationwide population-based study.

INTRODUCTION AND HYPOTHESIS: Although one prior study reported an association between bladder pain syndrome/interstitial cystitis (BPS/IC) and urinary calculi (UC), no population-based study to date has been conducted to explore this relationship. Therefore, using a population-based data set in Taiwan, this study set out to investigate the association between BPS/IC and a prior diagnosis of UC. METHODS: This study included 9,269 cases who had received their first-time diagnosis of BPS/IC between 2006 and 2007 and 46,345 randomly selected controls. We used conditional logistic regression analysis to compute the odds ratio (OR) and its corresponding 95 % confidence interval (CI) for having been previously diagnosed with UC between cases and controls. RESULTS: There was a significant difference in the prevalence of prior UC between cases and controls (8.1 vs 4.3 %, p < 0.001). Conditional logistic regression analysis revealed that cases were more likely to have been previously diagnosed with UC than controls (OR = 1.70; 95 % CI = 1.56-1.84) after adjusting for chronic pelvic pain, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, depression, panic disorder, migraine, sicca syndrome, allergy, endometriosis, and asthma. BPS/IC was found to be significantly associated with prior UC regardless of stone location; the adjusted ORs of kidney calculus, ureter calculus, bladder calculus, and unspecified calculus when compared to controls were 1.58 (95 % CI = 1.38-1.81), 1.73 (95 % CI = 1.45-2.05), 3.80 (95 % CI = 2.18-6.62), and 1.83 (95 % CI = 1.59-2.11), respectively. CONCLUSIONS: This work generates the hypothesis that UC may be associated with BPS/IC.