Positive association of fasting plasma glucose with bone mineral density in non-diabetic elderly females.

INTRODUCTION: Previous studies involving diabetics have shown different associations between fasting plasma glucose (FPG) and bone mineral density (BMD). The different effects of FPG on BMD are due to varying effects of antidiabetic drugs, glycemic control and diabetic complications in the diabetic patients. It is necessary to identify the association in subjects without diabetes. MATERIALS AND METHODS: A total of 2367 females over 65 were included in this cross-sectional study. Subjects were grouped by FPG quartile. BMD and the prevalence of osteoporosis were compared among different FPG quartiles. Multiple logistic regression was used to analyze the independent contribution of FPG to osteoporosis. RESULTS: Subjects in lower FPG quartile had lower BMD (P < 0.05). Subjects with osteoporosis had a lower FPG than the subjects of osteopenia, and both were lower than subjects with normal bone mass (P < 0.001 for all). Compared with the lowest FPG quartile, subjects in the 3rd and the 4th quartiles have a lower risk of osteoporosis in the lumbar spine (OR 0.77, 95% CI 0.59-0.98; OR 0.76, 95% CI 0.56-0.99, respectively), the total hip (OR 0.72, 95% CI 0.56-0.96; OR 0.75, 95% CI 0.53-0.99, respectively), and the femoral neck (OR 0.73, 95% CI 0.50-0.97; OR 0.71, 95% CI 0.54-0.92, respectively) after adjustment for age, BMI, education, physical activity and menopausal age. CONCLUSION: FPG was positively associated with BMD in non-diabetic elderly females. Low FPG may increase the risk of osteoporosis in the non-diabetic elderly females in China.

Physical activities mediate the correlations between serum creatinine and bone mineral density in Chinese.

BACKGROUND: The relationship between serum creatinine (CR) and osteoporosis under normal renal function and the possible mediating effects mediated by physical activity (PA) are largely unknown. METHODS: A total of 4,137 elderly Chinese subjects were recruited. Three models including different covariates were established. Correlation analysis and multiple linear regression analysis were used to evaluate the relationship between CR and bone mineral density (BMD) and also under different PA pattern. Logistic regression was used to investigate the interaction between CR*PA with osteoporosis. PA was used as a moderating variable to investigate the relationship between CR and BMD. RESULTS: As we expected, the association between CR and BMD remained significant after adjusting covariates in all models. The relationship between CR and BMD showed changeable pattern in case of different physical activity. Specially, the moderating effects of PA on serum creatinine and BMD were significant for all models only in the case of medium physical activity (PA3). CONCLUSIONS: In Chinese elderly under normal renal function, serum CR is positively correlated with BMD, and medium physical activity has mediation effect on such correlation.

Evaluation of plasma cytokine protein array profile: the highlighted PDGF-BB in rheumatoid arthritis.

OBJECTIVES: The cytokines play critical roles in the complex pathogenesis of rheumatoid arthritis (RA), but the specific cytokines are still in need of being discovered. This multi-stage study was performed to identify novel RA cytokines in plasma and further understand the pathological mechanism of the identified cytokines. METHOD: The plasma cytokine protein profile was evaluated by using Human Cytokine Antibody Array 440 in 18 subjects (RA: healthy control = 9:9). Then, enzyme-linked immunosorbent assay (ELISA) was used to validate the highlighted cytokines in 80 subjects (RA: healthy control = 40:40). Further functional experiments on fibroblast-like synoviocytes were performed to identify the pathological mechanisms of the highlighted cytokines for RA. RESULTS: A total of seven significant cytokines have differential expressions between RA patients and controls (fold change (FC) > 2, P value < 0.05). The difference in plasma for the highlighted platelet-derived growth factor (PDGF)-BB was validated in an independent validation sample (P = 0.005). Further, the PDGF-BB obviously promotes cell proliferation of MH7A cell, probably by inhibiting cell apoptosis and accelerating the cell cycle. The PDGF-BB can also promote MH7A cell migration. CONCLUSIONS: This study evaluated the plasma cytokine protein array profile associated with RA and highlighted the importance of PDGF-BB. PDGF-BB has an important role in RA-FLS proliferation and migration. These results suggest that PDGF-BB might contribute to occurrence and development of RA. Key Points • The levels of plasma cytokines were systemically tested using Human Cytokine Antibody Arrays. • The expression difference of PDGF-BB was validated in an independent sample. • PDGF-BB obviously promotes cell proliferation and migration in RA-FLS.

Multi-omics integrative analysis identified SNP-methylation-mRNA: Interaction in peripheral blood mononuclear cells.

Genetic variants have potential influence on DNA methylation and thereby regulate mRNA expression. This study aimed to comprehensively reveal the relationships among SNP, methylation and mRNA, and identify methylation-mediated regulation patterns in human peripheral blood mononuclear cells (PBMCs). Based on in-house multi-omics datasets from 43 Chinese Han female subjects, genome-wide association trios were constructed by simultaneously testing the following three association pairs: SNP-methylation, methylation-mRNA and SNP-mRNA. Causal inference test (CIT) was used to identify methylation-mediated genetic effects on mRNA. A total of 64,184 significant cis-methylation quantitative trait loci (meQTLs) were identified (FDR < 0.05). Among the 745 constructed trios, 464 trios formed SNP-methylation-mRNA regulation chains (CIT). Network analysis (Cytoscape 3.3.0) constructed multiple complex regulation networks among SNP, methylation and mRNA (eg a total of 43 SNPs simultaneously connected to cg22517527 and further to PRMT2, DIP2A and YBEY). The regulation chains were supported by the evidence from 4DGenome database, relevant to immune or inflammatory related diseases/traits, and overlapped with previous eQTLs from dbGaP and GTEx. The results provide new insights into the regulation patterns among SNP, DNA methylation and mRNA expression, especially for the methylation-mediated effects, and also increase our understanding of functional mechanisms underlying the established associations.

Association of Plasma Irisin with Bone Mineral Density in a Large Chinese Population Using an Extreme Sampling Design.

Irisin, a myokine produced by skeletal muscle in response to physical exercise, promotes trans-differentiation of white adipose tissue into brown adipose tissue. Recent evidences suggested that irisin also plays an important role in the control of bone metabolism. This study aimed to ascertain the relationship between plasma irisin and bone mineral density (BMD) in Chinese population by adoption of an extreme sampling method. Based on a large and screened Chinese elderly population (N = 6308), two subgroups with extremely high and low hip BMD were selected for discovery (N = 80, high vs. low BMD = 44:36) and validation (N = 60, high vs. low BMD = 30:30), respectively. Plasma irisin, P1NP, and ß-CTx were measured using commercially available ELISA kits. Other metabolic parameters (e.g., blood glucose, total cholesterol and triglycerides) were collected. Student's t test and Spearman correlation analyses were conducted in SPSS. Significant difference was discovered for plasma irisin between females and age-matched males (N = 80, male vs. female = 42:38, P = 0.002). The plasma irisin levels were significantly higher in high BMD subjects than in low BMD subjects, which was observed in both discovery (P = 0.012) and validation samples (P = 0.022). However, such observation was limited to males only. Further correlation analyses in males showed that plasma irisin was correlated with BMD (r = 0.362, P = 0.025) and triglyceride (r = - 0.354, P = 0.032). Plasma irisin levels were associated with hip BMD in Chinese elderly men. This study represented the first effort of investigating the relationship of plasma irisin and BMD in elderly population. The positive correlation between plasma irisin and BMD hints intrinsic communication between muscle and bone.

The distribution and functional relevance analysis of runs of homozygosity (ROHs) in Chinese Han female population.

Extended homozygosity is a genomic region in which the copies inherited from parents are identical, and has obvious inter-individual differences in length and frequency. Runs of homozygosity (ROHs), regarded as a type of structure variations, may have potential capacity in regulating gene transcription. To learn more about the genome-wide distribution of ROH regions in humans and understand the potential roles, this study applied ROH-based approach to quantify and characterize ROHs in 41 Chinese Han female subjects, and test potential associations between ROHs and mRNA expressions by eQTL analysis to ascertain whether ROHs are relevant to gene transcription in peripheral blood mononuclear cells (PBMCs). 10,884 ROH regions were identified in human genome. The average cumulative length of ROH regions was 217,250 ± 20,241 kb. The number of core segments in each chromosome generally matched the total length of corresponding chromosome, i.e., the longer the chromosome, the more the core segments. Genes located in the core regions of ROH were significantly enriched in multiple basic metabolism pathways. A total of 226 cis-eQTLs and 178 trans-eQTLs were identified. The cis-effect size was mainly concentrated at ± 0.5; and the trans-effect size was mainly concentrated at -1.5 and 1.0. Genes with eQTL effects were significantly enriched in functions related to protein binding, cytosol, nucleoplasm, nuclear membrane, protein binding and citrate metabolic process. This study described comprehensive distributions and characteristics of ROH in Han female Chinese, and recognized the significant role of ROH associated with gene transcription in human PBMC.

Relative abundance of mature myostatin rather than total myostatin is negatively associated with bone mineral density in Chinese.

Myostatin is mainly secreted by skeletal muscle and negatively regulates skeletal muscle growth. However, the roles of myostatin on bone metabolism are still largely unknown. Here, we recruited two large populations containing 6308 elderly Chinese and conducted comprehensive statistical analyses to evaluate the associations among lean body mass (LBM), plasma myostatin, and bone mineral density (BMD). Our data revealed that total myostatin in plasma was mainly determined by LBM. The relative abundance of mature myostatin (mature/total) was significantly lower in high versus low BMD subjects. Moreover, the relative abundance of mature myostatin was positively correlated with bone resorption marker. Finally, we carried out in vitro experiments and found that myostatin has inhibitory effects on the proliferation and differentiation of human osteoprogenitor cells. Taken together, our results have demonstrated that the relative abundance of mature myostatin in plasma is negatively associated with BMD, and the underlying functional mechanism for the association is most likely through inhibiting osteoblastogenesis and promoting osteoclastogenesis.

Thyroid Disturbance in Patients with Chronic Hepatitis C Infection: A Systematic Review and Meta-analysis.

BACKGROUND AND AIMS: The involvement of thyroid autoimmunity and dysfunction in patients with chronic hepatitis C virus (HCV) infection before interferon-α (IFN-α) therapy remains controversial. We performed this meta-analysis to evaluate the association of HCV infection with the presence of anti-thyroid antibodies and dysthyroidism. METHODS: A literature search was carried out to collect articles dated up to August 2015 to identify observational studies which compared the prevalence of anti-thyroid antibodies and thyroid dysfunction in IFN-α naïve chronic HCV-infected subjects with non-HCV infected controls. Random-effect or fixed-effect meta-analyses were applied and results reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Twelve studies were included, involving 1,735 HCV-infected and 1,868 non-HCV infected subjects. Pooled anti-thyroid antibody prevalence tended to be higher in HCV-infected subjects. The prevalence of anti-thyroglobulin antibody (TGAb), anti-thyroid peroxidase antibody (TPOAb), anti-thyroid microsomal antibody (ATMA) were 2.40-fold, 1.96-fold and 1.86-fold higher in HCV-infected subjects than in controls, respectively. The prevalence of hypothyroidism also differed by HCV infection status, with a pooled risk of 3.10 (95%CI: 2.19-4.40) in HCV-infected subjects. However, the results did not show a significant difference in the prevalence of hyperthyroidism between the two groups. CONCLUSION: Chronic HCV infection may be an independent risk factor for thyroid disturbance. It is advisable for the clinicians to monitor both thyroid antibodies and function in the course of chronic HCV infection, independent of IFN-α treatment.

Impact of HCV Infection on Diabetes Patients for the Risk of End-Stage Renal Failure.

Both diabetes mellitus (DM) and hepatitis C virus infection (HCVI) are associated with chronic kidney disease (CKD). The aim of this study was to evaluate whether HCVI increases the risk of end-stage renal disease (ESRD) in patients with DM.The National Health Insurance Research database of Taiwan was used to conduct this study. After excluding patients with a prior history of CKD, all patients with a first diagnosis of DM from January 1, 2000 to December 31, 2002 were enrolled. The patients who also had HCVI were defined as index cases (HCV group, n = 9787). A comparison cohort at a 1:1 ratio of random incident patients with DM without HCVI matched by age, sex, age at the diagnosis of DM, duration between the diagnosis of DM and the index date, and various comorbidities through propensity score matching were recruited (non-HCV group, n = 9787). The patients were followed until December 31, 2011.The cumulative incidence rate of developing ESRD was significantly higher in the HCV(+) group than in the non-HCV group (P = 0.008). The incidence rate ratio (IRR) for the risk of ESRD was also significantly higher in the HCV(+) group (IRR: 1.44; 95% CI: 1.09-1.89) than in the non-HCV group, especially for those with a younger age (<50 years; IRR: 2.05; 95% CI: 1.22-3.45) and HCVI within 4 years after the diagnosis of DM (IRR: 1.85; 95% CI: 1.16-2.97). After adjusting for comorbidities in multivariate Cox proportional hazard regression analysis, HCVI (HR: 1.47; 95% CI: 1.11-1.93) was an independent factor for developing ESRD in the patients with DM. After starting dialysis for ESRD, the HCV(+) patients had a similar mortality rate to those without HCVI (P = 0.84).HCVI increases the risk of developing ESRD in patients with DM, especially in younger patients and in those who develop HCVI sooner after a diagnosis of DM.

Outcomes of catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis.

AIMS: Over the past decade, catheter ablation (CA) has become an established therapy for symptomatic atrial fibrillation (AF). Atrial fibrillation is common in hypertrophic cardiomyopathy (HCM) patients, and restoring sinus rhythm is of great clinical benefit to them. Therefore, we conducted a systematic review and meta-analysis of the available data to evaluate the effectiveness and safety of CA for AF in patients with HCM. METHODS AND RESULTS: Six databases were searched to identify studies describing outcomes of CA of AF in HCM patients with a mean follow-up of ≥12 months after the index procedure. The following data were extracted: (i) single-procedure success, (ii) multiple-procedure success, and (iii) drug-free success. Fifteen studies involving 531 patients were included. Single-procedure freedom from atrial arrhythmia at the latest follow-up was 45.5% [95% confidence interval (CI): 34.8-56.2%]. With multiple procedures, the final success rate was 66.1% (95% CI: 55.3-76.9%) overall, 71.8% (95% CI: 61.6-82.0%) in paroxysmal AF, and 47.5% (95% CI: 36.0-59.0%) in non-paroxysmal AF. Without anti-arrhythmic drugs (AADs), single-procedure success rate at latest follow-up was 32.9% (95% CI: 21.7-41.1%); after multiple procedures, this raised to 50.4% (95% CI: 39.2-61.6%). The incidence of serious periprocedural complications was acceptable [5.1% (95% CI: 2.8-9.6%)]. Substantial heterogeneity (I(2)> 50%) was noted in the above groups. CONCLUSIONS: Catheter ablation of AF in patients with HCM is feasible, although more repeat procedures and AAD are needed to prevent AF recurrence.

[Serum carbohydrate antigen-125 levels in patients with bronchiectasis].

OBJECTIVE: To evaluate the level of serum carbohydrate antigen-125(CA125) and its related factors in patients with bronchiectasis. METHODS: The clinical data of 504 patients with bronchiectasis in Zhejiang Putuo People's Hospital from June 2009 to June 2014 were collected in the study.The patients were divided into CA125 elevated group and CA125 normal group according to serum CA125 level,and the differences of serum CA125,age,gender, white blood cell(WBC),C-reactive protein(CRP), blood glucose and other test indicators were compared between two groups. RESULTS: There were 276 patients including 117 male and 159 female with elevated serum CA125.Their mean age was(66.3±13.1)years and the mean level of CA125 was(83.70±43.87) U/mL. There were 228 patients including 84 male and 144 female with normal CA125 levels. Their mean age was(67.5±10.5) years and the mean level of CA125 was(20.68±9.67)U/mL.The peripheral blood WBC in patients with CA125 elevated group[(10.08±5.68)×10(9)/L] was significantly higher than that in CA125 normal group[7.73±3.46)×10(9)/L], the difference was statistically significant(P<0.05).The medium of CRP level in patients with CA125 elevated group[22.98(3.18~196.88)mg/L] was significantly higher than that in CA125 normal group[6.34(0.50~97.66)mg/L](P<0.05). Correlation analysis showed that CA125 was positively correlated with WBC and CRP(P<0.05). Stepwise regression analysis showed that CRP was the only independent prognostic factors of CA125. Paired t test showed the presence of CA125 serum in patients with bronchiectasis had a significant difference between before and after anti-infection therapy(P<0.05). CONCLUSION: The serum levels of CA125 rise in patients with bronchiectasis,while it decrease after anti-infection therapy.CRP is an independent associated factor of serum CA125 level.

Clinical implications and outcome prediction in chronic hemodialysis patients with lower serum potassium×uric acid product.

BACKGROUND: The aims of this study were to evaluate correlations between serum potassium (S[K]) and uric acid (S[UA]) in hemodialysis patients and to determine whether lower levels of both S[K] and S[UA] were associated with poor long-term prognoses in these patients. METHODS: A cohort of 424 maintenance hemodialysis patients (58±13 years of age; 47% male; 39% with diabetes) from a single center were divided into tertiles based on the product of S[K]×S[UA] (K×UA): Group 1: low K×UA: n=141; Group 2: median K×UA: n=141; and Group 3: high K×UA: n=142. The longest observation period was 60 months. RESULTS: S[K] showed a positive linear correlation with S[UA] (r=0.33; p<0.001). In multivariate logistic regression analysis, Group 1 was characterized by hypoalbuminemia (odds ratio [OR]=0.20, 95% confidence interval (CI)=0.11-0.35) and lower levels of normalized protein catabolism [nPCR] (OR=0.10, 95%CI=0.05-0.22) and phosphate levels (OR=0.41, 95%CI=0.33-0.51). In contrast, Group 3 was associated with higher nPCR (OR=6.07, 95%CI=2.93-12.50) and albumin levels (OR=2.12, 95% CI=2.12-7.00). Compared to the reference (Group 1), the hazard ratio (HR) for long-term mortality was significantly lower in Groups 2 (HR=0.65, 95%CI=0.43-0.99) and 3 (HR=0.56, 95%CI=0.36-0.89). In multivariate Cox proportional analysis, the risk of mortality decreased by 2% (HR=0.98; 95%CI=0.96-0.99) per 1 unit increase in K×UA product. CONCLUSION: Hemodialysis patients with lower S[K] and [UA] levels were characterized by hypoalbuminemia and lower nPCR, and they were associated with a long-term mortality risk.

Precedent fluctuation of serum hs-CRP to albumin ratios and mortality risk of clinically stable hemodialysis patients.

BACKGROUND: A high sensitivity C-reactive protein to albumin ratio (hs-CRP/Alb) predicts mortality risk in patients with acute kidney injury. However, it varies dynamically. This study was conducted to evaluate whether a variation of this marker was associated with long-term outcome in clinically stable hemodialysis (HD) patients. METHODS: hs-CRP/Alb was checked bimonthly in 284 clinically stable HD outpatients throughout all of 2008. Based on the "slope" of trend equation derived from 5-6 hs-CRP/alb ratios for each patient, the total number of patients was divided into quartiles--Group 1: ß≦ -0.13, n = 71; group 2: ß>-0.13≦0.003; n = 71, group 3: ß>0.003≦0.20; and group 4: ß>0.20, n = 71. The observation period was from January 1, 2009 to August 31, 2012. RESULTS: Group 1+4 showed a worse long-term survival (p = 0.04) and a longer 5-year hospitalization stay than Group 2+3 (38.7±44.4 vs. 16.7±22.4 days, p<0.001). Group 1+4 were associated with older age (OR = 1.03, 95% CI = 1.01-1.05) and a high prevalence of congestive heart failure (OR = 2.02, 95% CI = 1.00-4.11). Standard deviation (SD) of hs-CRP/Alb was associated with male sex (ß = 0.17, p = 0.003), higher Davies co-morbidity score (ß = 0.16, p = 0.03), and baseline hs-CRP (ß = 0.39, p<0.001). Patients with lower baseline and stable trend of hs-CRP/Alb had a better prognosis. By multivariate Cox proportional methods, SD of hs-CRP/alb (HR: 1.05, 95% CI: 1.01-1.08) rather than baseline hs-CRP/Alb was an independent predictive factor for long-term mortality after adjusting for sex and HD vintage. CONCLUSION: Clinically stable HD patients with a fluctuating variation of hs-CRP/Alb are characterized by old age, and more co-morbidity, and they tend to have longer subsequent hospitalization stay and higher mortality risk.

Methadone maintenance treatment programme reduces criminal activity and improves social well-being of drug users in China: a systematic review and meta-analysis.

OBJECTIVE: Methadone maintenance treatment (MMT) has been implemented in China since 2004 and has expanded into a nationwide programme. This study aims to evaluate changes in social functioning, family relations and drug-related criminal behaviour among MMT clients in China. DESIGN: Systematic review and meta-analysis. METHODS: Both English and Chinese literature databases, including PubMed, Chongqing VIP Chinese Science and Technology Journals Database (CQVIP), China National Knowledge Infrastructure (CNKI) and Wanfang Data, were comprehensively searched over the period 2004-2014 for studied indicators. Study selection, quality assessment and data extraction were conducted according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) Statement. Meta-analyses were conducted using Comprehensive Meta-Analysis Biostat software. RESULTS: Thirty-eight articles were included in this review (1 in English and 37 in Chinese). The self-reported arrest rate decreased from 13.1% (95% CI 9.1% to 18.5%) at baseline to 3.4% (95% CI 1.5% to 7.7%) and 4.3% (95% CI 1.6% to 11.4%) after 6 and 12 months of MMT intervention, respectively. The rate of drug selling decreased from 7.6% (95% CI 3.8% to 14.8%) at baseline to 1.9% (95% CI 0.6% to 6.2%) and 3.0% (95% CI 1.0% to 8.9%) after 6 and 12 months of intervention, respectively. Similarly, the rates of selling sex for drugs and drug-related crime decreased from 5.3% (95% CI 2.4% to 11.1%) and 9.9% (95% CI 6.8% to 14.2%) at baseline to 1.1% (95% CI 0.5% to 2.3%) and 3.4% (95% CI 2.5% to 4.5%) at 6 months, then to 0.8% (95% CI 0.3% to 1.9%) and 3.4% (95% CI 0.8% to 13.1%) at 12 months after treatment initiation, respectively. In contrast, the rate of employment of clients and the proportion of clients having a good relationship with their family increased substantially from 26.4% (95% CI 22.9% to 30.1%) and 37.9% (95% CI 32.0% to 44.2%) to 41.6% (95% CI 36.6% to 48.0%) and 59.6% (95% CI 48.1% to 70.2%) at 6 months, then to 59.8% (95% CI 52.4% to 66.8%) and 75.0% (95% CI 69.0% to 80.2%) at 12 months after treatment initiation, respectively. CONCLUSIONS: MMT has significantly reduced criminal activity, and improved employment rate and social well-being, of clients of the MMT programme. MMT is an effective measure to help drug users to resume societal and familial functions in China.

Sex difference for urologic malignancy risk in uremic patients after kidney transplantation: a population-based study.

BACKGROUND: High urologic malignancy incidence has been reported in end-stage renal disease (ESRD) patients, especially of female sex. This study was undertaken to evaluate whether female recipients still carry an aggravated risk of this malignancy after kidney transplantation (KT). METHODS: The claims data from the Bureau of National Health Insurance of Taiwan were used for analysis. All KT recipients who developed urologic malignancy from January 1, 1999, to December 31, 2007 (n = 2,245) were enrolled in this study. By means of propensity score, a database of 1:4 ratio random incident ESRD patients with matched age, sex, comorbidity rates, and dialysis to index date was used as control (non-KT group, n = 8,980). The last observation period ended on December 31, 2008. RESULTS: The cumulative urologic malignancy incidence rate was significantly higher in female recipients after KT than their female ESRD counterparts without KT (P < 0.001). This gap became more prominent approximately 2 years after transplantation. No similar trend was detected in male KT patients (P = 0.13). Incidence rate ratio of urologic malignancy was significantly higher in female recipients (incidence rate ratio, 2.13; 95% confidence interval [95% CI], 1.53-2.97) than in their male counterparts (incidence rate ratio, 1.43; 95% CI, 0.90-2.25). From multivariate Cox proportional hazard regression tests, female (hazards ratio, 2.10; 95% CI, 1.52-2.95) but not male sex (hazards ratio, 1.47; 95% CI, 0.93-2.32) was determined to be an independent factor for the development of urologic malignancy after KT. After acquiring this malignancy, KT recipients did not have any advantage in cumulative survival compared to ESRD patients without KT (P = 0.07). CONCLUSION: Compared to males, female recipients tended to have a significantly higher urologic malignancy risk after KT.

Comparison of the impact of "fast decline" in residual renal function and "initial anuria" on long-term outcomes in CAPD patients.

BACKGROUND: Residual renal function (RRF) is pivotal to long-term outcomes, while rapid RRF decline (RRFD) is associated with mortality risk for continuous ambulatory peritoneal dialysis (CAPD) patients. This study was conducted to compare the impact of "initial anuria" and rapid RRFD on the long-term prognosis of CAPD patients. METHOD: According to the timing of anuria and the slope of RRFD, a total of 255 incident CAPD patients were divided into 3 groups. For the "anuria" group, anuria was detected from CAPD initiation and persisted for > 6 months (n = 27). Based on the median of the RRFD slope, the other 228 non-anuric patients were divided into a "slow decliner" group (n = 114), and a "rapid decliner" group (n = 114). The maximal observation period was 120 months. RESULTS: Logistic regression tests indicated that the "anuria" group was associated with previous hemodialysis > 3 months (odds ratio [OR]: 8.52, 95% confidence interval [CI]: 3.12 - 23.28), and female (OR: 0.29, 95% CI: 0.09 - 0.90), while the "fast decliner" group with higher Davies co-morbidity scores (DCS) (OR: 1.52; 95% CI: 1.08 - 2.14), body mass index (BMI) (OR: 1.12; 95% CI: 1.04 - 1.21), and male (OR: 1.12; 95% CI: 1.04 - 1.21). After adjusting for DCS, the "fast decliner" group (hazard ratio [HR]: 0.37; 95% CI: 0.17 - 0.80) showed a better outcome than that of the "anuria" group (reference = 1). Both baseline RRF (ß = -0.24; p < 0.001) and DCS (ß = -3.76; p < 0.001) showed inverse linear correlations to the slope of RRFD. From the Cox proportional analyses, higher baseline RRF (HR: 0.92; 95% CI: 0.88 -.97) and higher slope of RRFD (slower decline in RRF) (HR: 0.90; 95% CI: 0.85 - 0.96) were independent factors for less mortality risk in patients with DCS = 0. However, only a higher slope of RRFD (HR: 0.97; 95% CI: 0.94 - 0.99) was significant for better survival in CAPD patients with DCS > 0. CONCLUSION: Compared to the baseline RRF, CAPD patients with co-morbidities that rapidly deteriorate RRFD are more crucially associated with long-term mortality risk.

[Value of quality of life evaluation in prognosis of chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the quality of life in patients with chronic obstructive pulmonary disease (COPD) by COPD Assessment Test (CAT) and Body Mass Index, Airflow Obstruction, Dyspnea, Exercise Capacity Index (BODE). METHODS: One hundred patients with stable COPD admitted in Putuo People's Hospital were recruited in the study. CAT and BODE index were measured for each patient.The deaths and frequency of exacerbations were recorded during 3-year follow-up period,and the correlation between CAT and BODE in evaluating COPD prognosis was analyzed. RESULTS: There were 28, 30, 29 and 13 patients with CAT score of 1, 2, 3 and 4, respectively; while there were 31, 29, 28 and 12 cases with BODE scores of 1, 2, 3 and 4. CAT scores were well correlated with BODE evaluation in terms of overall score and scores of 4 items (r= -0.237, -0.772, 0.789, -0.767, 0.888, respectively, Ps<0.05). COPD exacerbation incidence and mortality increased with the increasing CAT levels. The rank sum test showed that there were no significant differences between CAT and BODE index in the frequency of acute exacerbation(P<0.05); and in the death toll, the difference was not significant(1 group Χ2=0.919, 2 group Χ2=0.001, 3 group Χ2=0.177,4 group Χ2=0.322, Ps>0.05). CONCLUSION: CAT is relevant to BODE in evaluating incidence of exacerbation and mortality for patients with COPD and CAT is more easily to be applied.

End-stage renal disease after hypertensive disorders in pregnancy.

OBJECTIVE: The purpose of this study was to determine the long-term postpartum risk of end-stage renal disease in women with hypertensive disorders in pregnancy. Although most women with hypertensive disorders in pregnancy recover after delivery, some may experience acute renal failure. STUDY DESIGN: We searched Taiwan's National Health Insurance Research Database to identify women with hypertensive disorders in pregnancies and deliveries between 1998 and 2002. All cases were followed for a maximum of 11 years (median, 9 years; interquartile range, 7.79-10.02 years) to estimate the incidence of end-stage renal disease; Cox regression analysis that was adjusted for potential confounding was used to determine the relative risk. RESULTS: Of the 13,633 women with hypertensive disorders in pregnancy, 46 experienced end-stage renal disease. Women with hypertensive disorders in pregnancy had a risk of end-stage renal disease that was 10.64 times greater than did women without them (95% confidence interval [CI], 7.53-15.05). The risk was highest in women with a history of preeclampsia superimposed on chronic hypertension (hazard ratio, 44.72; 95% CI, 22.59-88.51). Women with gestational hypertension had a higher risk of end-stage renal disease than did women without hypertensive disorders in pregnancy (hazard ratio, 5.82; 95% CI, 2.15-15.77). CONCLUSION: Women with hypertensive disorders in pregnancy have a higher risk of postpartum end-stage renal disease, regardless of which type of hypertensive disorder they have. Women with a history of hypertensive disorders in pregnancy are encouraged to have regular postpartum checkups, especially of renal function.

Increased risk of mortality among haemodialysis patients with or without prior stroke: a nationwide population-based study in Taiwan.

BACKGROUND & OBJECTIVES: Patients with prior stroke (PS) undergoing chronic dialysis are at a high risk of mortality. However, little is known about the cumulative risk and survival rate of dialysis patients with long-term follow up. The aim of this study was to assess risks for mortality between patients with and without PS undergoing chronic haemodialysis (HD). METHODS: The Taiwan National Health Insurance Research Database (NHRI-NHIRD-99182) was used and all adult patients (≥18 yr) with end stage renal disease (ESRD) who started maintenance HD between January 1, 1999, and December 31, 1999, were selected. The patients were followed from the first reported date of HD to the date of death, end of dialysis or December 31, 2008. A Cox's proportional hazard model was applied to identify the risk factors for all-cause mortality. RESULTS: Among 5672 HD patients, 650 patients (11.5%) had PS. A higher proportion of stroke history at baseline was found in men (52.8%) and those aged ≥ 55 yr (80.9%). After adjusting for age, sex and other covariates, the patients with PS were found to have a 36 per cent increased risk of mortality compared to those without PS (HR 1.36, 95% CI: 1.22-1.52). The cumulative survival rates among HD patients without PS were 96.0 per cent at the first year, 68.4 per cent at the fifth year, and 46.7 per cent at the ninth year, and 92.9, 47.3 and 23.6 per cent, respectively, in those with PS (log-rank: P<0.001). INTERPRETATION & CONCLUSIONS: Our findings showed that PS was an important predictor for all-cause mortality and poor outcome in patients undergoing chronic HD.

Long-term survival and predictors for mortality among dialysis patients in an endemic area for chronic liver disease: a national cohort study in Taiwan.

BACKGROUND: Patients with end-stage renal disease (ESRD) are at a higher risk for chronic hepatitis, liver cirrhosis (LC) and mortality than the general population. Optimal modalities of renal replacement therapy for ESRD patients with concomitant end-stage liver disease remain controversial. We investigated the long-term outcome for chronic liver disease among dialysis patients in an endemic area. METHODS: Using Taiwan's National Health Insurance claim data (NHRI-NHIRD-99182), We performed a longitudinal cohort study to investigate the impact of comorbidities on mortality in dialysis patients. We followed up 11293 incident hemodialysis (HD) and 761 peritoneal dialysis (PD) patients from the start of dialysis until the date of death or the end of database period (December 31, 2008). A Cox proportional hazards model was used to identify the risk factors for all-cause mortality. RESULTS: Patients receiving PD tended to be younger and less likely to have comorbidities than those receiving HD. At the beginning of dialysis, a high prevalence rate (6.16 %) of LC was found. Other than well-known risk factors, LC (hazard ratio [HR] 1.473, 95 % CI: 1.329-1.634) and dementia (HR 1.376, 95 % CI: 1.083-1.750) were also independent predictors of mortality. Hypertension and mortality were inversely associated. Dialysis modality and three individual comorbidities (diabetes mellitus, chronic lung disease, and dementia) interacted significantly on mortality risk. CONCLUSIONS: LC is an important predictor of mortality; however, the effect on mortality was not different between HD and PD patients.