Association of IL-18 gene polymorphisms with clinical aspects of hyperlipidemia in middle-aged and early people in the community.

Hyperlipidemia is notorious for causing coronary artery disease (CAD). IL-18 is a proinflammtory cytokine that contributes to the pathogenesis of CAD. Previous reports have revealed that genetic polymorphism of IL-18 is associated with its expression level as well as the susceptibility to CAD. In the present study, we aim to investigate the relationship between IL-18 single nucleotide polymorphisms (SNPs) and hyperlipidemia in the Han Chinese population in Taiwan. A total of 580 participants older than 30 were recruited from the community. We collected the demographics, self-reported disease histories, and lifestyles. We also assessed the levels of lipid profiles including total cholesterol (CHOL), triglyceride, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol. Two SNPs, rs3882891C/A (intron 5) and rs1946518A/C (promoter -607) of IL-18 were elucidated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. Our results revealed that rs3882891 AA was associated with lower risk of hypercholesterolemia, higher CHOL and LDL-C in subjects (p=0.003, p=0.000 and p=0.005 separately), and rs1946518 CC was associated with hypercholesterolemia, higher CHOL and LDL-C as well (p=0.021, p=0.003 and p=0.001 separately) Furthermore, both SNPs were associated with IL-18 expression level, which was examined by Genotype-Tissue Expression (GTEx) Portal (p=0.042 and 0.016 separately). Finally, the haplotype of IL-18 was subsequently arranged in the order of rs3882891 and rs1946518. The result revealed that the AC haplotype of 2 IL-18 SNPs was also associated with lower risk of hypercholesterolemia, lower levels of CHOL and LDL-C (p=0.01, p=0.001 and 0.003). The current study is the first to report the association between IL-18 SNPs and hyperlipidemia in the Chinese Han population.

High sensitivity C-reactive protein and glycated hemoglobin levels as dominant predictors of all-cause dementia: a nationwide population-based cohort study.

BACKGROUND: Chronic inflammation might play a major role in the pathogenesis linking diabetes mellitus (DM) to cognition. In addition, DM might be the main driver of dementia risk. The purpose of the present study was to evaluate whether inflammation, glycation, or both are associated with the risk of developing all-cause dementia (ACD). METHODS: A nationwide population-based cohort study was conducted with 4113 participants. The data were obtained from the Taiwanese Survey on Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH) in 2007, which was linked with the Taiwan National Health Insurance Research Database (NHIRD). The markers of inflammation, expressed as hs-CRP, and glycation, presented as HbA1c, were measured. High levels of hs-CRP and HbA1c were defined as values greater than or equal to the 66th percentile. Developed ACD was identified based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. RESULTS: During 32,926.90 person-years, 106 individuals developed ACD in up to 8 years of follow-up. The study participants were separated into four categories by the top tertiles of hs-CRP and HbA1c based on the 66th percentile: high levels of both hs-CRP and HbA1c, only high levels of hs-CRP, only high levels of HbA1c, and non-high levels of hs-CRP nor HbA1c. Those who with a high level of only hs-CRP had the higher hazard for developing ACD (adjusted HR = 2.58; 95% CI = 1.29 ~ 5.17; P = 0.007), followed by the group with a high level of only HbA1c (adjusted HR = 2.52; 95% CI = 1.34 ~ 4.74; P = 0.004) and the group with high levels of both hs-CRP and HbA1c (adjusted HR = 2.36; 95% CI = 1.20 ~ 4.62; P = 0.012). Among those aged less than 65 years, hs-CRP was the only significant predictor of ACD risk (P = 0.046), whereas it did not yield any significant result in the elderly. CONCLUSIONS: A higher risk of developing ACD was found not only in patients with high levels of inflammation but also high levels of glycated hemoglobin. Future studies should focus on the clinical implementation of hs-CRP or HbA1c to monitor cognitive deficits.

Receptor for advanced glycation end products in relation to exposure to metal fumes and polycyclic aromatic hydrocarbon in shipyard welders.

Advanced glycation end products (AGE) and the receptor for AGE (RAGE) have been found to be pivotal biomarkers to predict the risk of inflammation and oxidative stress. Limited evidence focuses on the influence of occupational exposure to polycyclic aromatic hydrocarbon (PAH) and metal fumes on AGE and RAGE in shipyard welders. Our aim was to determine the relationships among PAH, metal exposure, and inflammatory biomarkers. From September 1 to December 31, 2017, 53 welding workers (exposed group) and 29 office workers (control group) were enrolled in the study. Comprehensive workups included demographic characteristics, laboratory data, AGE, RAGE, Interleukin-6 (IL-6), tumor necrosis factor-α, PAH, and urinary metal concentrations. RAGE levels were measured by flow cytometric analysis. Urinary 1-hydroxypyrene (1-OHP) was used as a biomarker of exposure to PAH. Several metals were elevated in the personal fine particulate matter (PM2.5) samples, including Mn, Fe, V, Co, Zn, and Cu. The exposed group had significantly higher exposure to PM2.5 (p = 0.015), RAGE (p = 0.020), IL-6 (p = 0.008) than the control group. After adjusting for pertinent variables, there was still a significant and positive association between Ni level and AGE (ß = 0.101; 95% CI, 0.031-0.172). Significant relationship between Cr and Cd levels and RAGE was observed (ß = 0.173; 95% CI, 0.017-0.329; ß = 0.084; 95% CI, 0.011-0.157, respectively). Participants with elevated 1-OHP level had higher odds of high RAGE level in the model 1 (OR = 3.466, 95% CI, 1.053-11.412) and model 2 (OR = 3.454, 95% CI, 1.034-11.536). The RAGE expression of participants was significantly associated with IL-6 levels in the fully adjusted model (ß = 0.294; 95% CI, 0.083-0.732). Our findings highlighted that urinary metal levels and PAH were associated with increased AGE and RAGE formation in shipyard workers. Elevated serum RAGE might induce the production of proinflammatory cytokines and trigger ensuing inflammatory cascades.

Functional analysis of the short isoform of orf virus protein OV20.0.

UNLABELLED: Orf virus (ORFV) OV20.0L is an ortholog of vaccinia virus (VACV) gene E3L. The function of VACV E3 protein as a virulence factor is well studied, but OV20.0 has received less attention. Here we show that like VACV E3L, OV20.0L encodes two proteins, a full-length protein and a shorter form (sh20). The shorter sh20 is an N-terminally truncated OV20.0 isoform generated when a downstream AUG codon is used for initiating translation. These isoforms differed in cellular localization, with full-length OV20.0 and sh20 found throughout the cell and predominantly in the cytoplasm, respectively. Nonetheless, both OV20.0 isoforms were able to bind double-stranded RNA (dsRNA)-activated protein kinase (PKR) and dsRNA. Moreover, both isoforms strongly inhibited PKR activation as shown by decreased phosphorylation of the translation initiation factor eIF2α subunit and protection of Sindbis virus infection against the activity of interferon (IFN). In spite of this apparent conservation of function in vitro, a recombinant ORFV that was able to express only the sh20 isoform was attenuated in a mouse model. IMPORTANCE: The OV20.0 protein of orf virus (ORFV) has two isoforms and contributes to virulence, but the roles of the two forms are not known. This study shows that the shorter isoform (sh20) arises due to use of a downstream initiation codon and is amino-terminally truncated. The sh20 form also differs in expression kinetics and cellular localization from full-length OV20.0. Similar to the full-length isoform, sh20 is able to bind dsRNA and PKR, inactivate PKR, and thus act as an antagonist of the interferon response in vitro. In vivo, however, wild-type OV20.0 could not be replaced with sh20 alone without a loss of virulence, suggesting that the functions of the isoforms are not simply redundant.

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.

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.

Factors associated with chronic musculoskeletal pain in patients with chronic kidney disease.

BACKGROUND: Chronic musculoskeletal (MS) pain is common in patients with chronic kidney disease (CKD) undergoing haemodialysis. However, epidemiological data for chronic MS pain and factors associated with chronic MS pain in patients with early- or late-stage CKD who are not undergoing dialysis are limited. METHOD: A cross-sectional study to evaluate the prevalence of chronic MS pain and factors associated with chronic MS pain in patients with early- and late-stage CKD who were not undergoing dialysis, was conducted. In addition, the distribution of pain severity among patients with different stages of CKD was evaluated. RESULTS: Of the 456 CKD patients studied, 53.3% (n = 243/456) had chronic MS pain. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, as well as with the calcium × phosphate product levels. In CKD patients with hyperuricemia, chronic MS pain showed a negative, independent significant association with diabetes mellitus as a co-morbidity (odds ratio: 0.413, p = 0.020). However, in the CKD patients without hyperuricemia as a co-morbidity, chronic MS pain showed an independent significant association with the calcium × phosphate product levels (odds ratio: 1.093, p = 0.027). Furthermore, stage-5 CKD patients seemed to experience more severe chronic MS pain than patients with other stages of CKD. CONCLUSION: Chronic MS pain is common in CKD patients. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, and with the calcium × phosphate product levels in early- and late-stage CKD patients who were not on dialysis.

Prescription of psychotropic drugs in patients with chronic renal failure on hemodialysis.

OBJECTIVE: Patients on hemodialysis commonly have comorbid depression and require treatment with psychotropic drugs. This study aimed to investigate the prevalence of the use of psychotropic drugs among patients on hemodialysis and to elucidate the factors associated with use of each class of psychotropic medication. METHODS: This cross-sectional study enrolled 195 hemodialysis patients with a mean age of 58.5 years. Patients were assessed using the Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale, Chalder Fatigue Scale and Short-form Health-related Quality of Life. We analyzed the frequency of psychiatric outpatient department visits within six months prior to interview and psychotropic drugs use within one month prior to interview, including antidepressants, antipsychotics, mood stabilizers, benzodiazepines (BZDs) and hypnotics. RESULTS: Of the 195 patients, 47 (24.1%) fulfilled the DSM-IV criteria for major depressive disorder (MDD). Only 6.4% of patients diagnosed with MDD visited the psychiatry outpatient department within six months prior to interview. Of the total patients, the proportions with use of antidepressants, antipsychotics, mood stabilizers, BZDs and hypnotics were 5.6%, 1.0%, 3.1%, 42.6% and 20.0%, respectively. Having MDD was an independent factor associated with taking antidepressants (adjusted OR = 3.98, p = 0.036) and taking hypnotics (adjusted OR = 2.75, p = 0.011). CONCLUSIONS: Depression is generally undetected or not well-managed among hemodialysis patients in the clinical setting. Only a small proportion of depressed patients received antidepressant treatment. BZDs and/or hypnotics might be exorbitantly prescribed. Clinicians should pay more attention to patients' emotional distress and provide appropriate treatment.

Chronic kidney disease stage is a modulator on the association between high-sensitivity C-reactive protein and coronary vasospastic angina.

The prevalence of coronary vasospasm and also the factors associated with coronary vasospasm in CKD is still unclear. In this cross-sectional study of 859 consecutive CKD patients with angina pectoris received coronary catheterization, we evaluated the factors associated with coronary vasospasm. Patients with vasospasm were older and had higher peripheral blood white cell counts, higher peripheral blood monocyte cell counts, higher haemoglobin levels, higher hs-CRP levels, and lower levels of serum creatinine than patients without vasospasm. The results of multivariate logistic regression analysis revealed that peripheral blood monocyte count and hs-CRP level were independently associated with coronary vasospasm in patients with stage 1 CKD. Only peripheral blood monocyte count but not hs-CRP was independently associated with coronary vasospasm in patients with stages 2 and 3 of CKD. In conclusion, peripheral blood monocyte count is independently associated with coronary vasospasm in patients with stage 1-3 CKD, whereas hs-CRP is only independently associated with coronary vasospasm in patients with stage 1 CKD.

Developmental Trajectories and Predictors of Incident Dementia among Elderly Taiwanese People: A 14-Year Longitudinal Study.

The aim of this study was to identify dementia trajectories and their associated predictors among elderly Taiwanese people over a 14-year period using a nationwide representative longitudinal study. This retrospective cohort study was performed using the National Health Insurance Research Database. Group-based trajectory modeling (GBTM) was used to distinguish the specific trajectory groups of incident dementia during 2000-2013. All 42,407 patients were classified by GBTM to identify the trajectory of incident dementia, which included high- (n = 11,637, 29.0%), moderate- (n = 19,036, 44.9%), and low-incidence (n = 11,734, 26.1%) groups. Those diagnosed with hypertension (adjusted odds ratio [aOR] = 1.43; 95% confidence interval [CI] = 1.35-1.52), stroke (aOR = 1.45, 95% CI = 1.31-1.60), coronary heart disease (aOR = 1.29, 95% CI = 1.19-1.39), heart failure (aOR = 1.62, 95% CI = 1.36-1.93), and chronic obstructive pulmonary disease (aOR = 1.10, 95% CI = 1.02-1.18) at baseline revealed tendencies to be classified into high-incidence groups in dementia risk. The results from a 14-year longitudinal study identified three distinct trajectories of incident dementia among elderly Taiwanese people: patients with cardiovascular disease risk factors and cardiovascular disease events tended to be classified into high-incidence dementia groups. Early detection and management of these associated risk factors in the elderly may prevent or delay the deterioration of cognitive decline.

Association between cold dialysis and cardiovascular survival in hemodialysis patients.

BACKGROUND: Higher cardiovascular mortality has been noted in patients with chronic kidney disease (CKD). CKD patients are also known to have impaired energy expenditure but the role of energy expenditure in cardiovascular disease is not yet known. Furthermore, the association between cold dialysis (CD) and clinical outcomes in hemodialysis patients is unclear. METHODS: This was a single-center retrospective cohort study consisting of two groups: a CD group with dialyzate temperature <35.5 °C and a standard dialysis (SD) group with dialyzate temperature between 35.5 and 37 °C. The end points of the study were overall mortality, cardiac mortality and non-cardiac mortality. The study analyzed the associations between dialyzate temperature and long-term survival in CD and SD groups. Propensity score analysis was used to control for intergroup baseline differences. RESULTS: Baseline characteristics of both groups were similar. Kaplan-Meier analysis showed that CD was significantly associated with a lower risk for overall mortality (P = 0.006) and cardiac mortality (P = 0.023) but not for non-cardiac mortality or infectious mortality. After multivariate Cox regression analysis, adjusting for propensity scores and other possible confounding factors, CD remained a significant beneficial factor for overall mortality (P = 0.030) and cardiac mortality (P = 0.034). CONCLUSION: Our studies show that CD is significantly and independently associated with a lower risk for overall mortality and cardiac mortality.

Comparison of the validity of the Chinese versions of the Hypomania Symptom Checklist-32 (HCL-32) and Mood Disorder Questionnaire (MDQ) for the detection of bipolar disorder in medicated patients with major depressive disorder.

OBJECTIVE: The sensitivity and specificity of the Chinese versions of the Hypomania Symptom Checklist-32 (HCL-32) and Mood Disorder Questionnaire (MDQ) for detecting bipolar disorder in Taiwan were explored in this study. METHODS: In total, 59 participants who were initially diagnosed with unipolar depression were recruited from an outpatient clinic and were screened for bipolar disorder using the HCL-32 and MDQ; each participant also underwent a diagnostic interview based on the Structured Clinical Interview for DSM-IV Axis disorder patients (SCID). RESULTS: The results showed that the HCL-32 yielded the best combination of sensitivity (100%) and specificity (46.2%) at a cut-off point of 7/8, and the MDQ yielded the best combination of sensitivity (71.4%) and specificity (76.9%) at a cut-off point of 6/7. CONCLUSION: The results of our study demonstrate that the HCL-32 and MDQ are of reasonable validity to distinguish between bipolar disorder and major depressive disorder. However small sample size may limit generalization of the results.

Combined Effect of Inflammation and Hyperglycemia on Mild Cognitive Impairment and Associated Dietary Patterns in an Older Taiwanese Population.

BACKGROUND: Previous studies have demonstrated that C-reactive protein (CRP) and glycated hemoglobin (HbA1c) levels are independently associated with neurodegenerative diseases, which can be improved by altering dietary patterns. This study investigates the combined effect of CRP and HbA1c, as well as the influence of dietary patterns, on the risk of dementia. METHODS: A cross-sectional study was conducted with 536 participants aged ≥65 years who were recruited from the Nutrition and Health Survey in Taiwan between 2014 and 2016. The high levels of inflammation and glycation were defined as a CRP level of >0.21 mg/dl and a HbA1c level of ≥6.50%, respectively. Mild cognitive impairment (MCI) was evaluated using the Mini-Mental State Examination (MMSE) score. The dietary patterns associated with CRP and HbA1c levels were assessed using the reduced rank regression (RRR). Multivariate logistic regression analysis of both complete and imputed datasets was performed. RESULTS: Participants with high levels of both CRP and HbA1c were associated with the highest odds ratio (OR) of MCI (adjusted OR [aOR] = 3.52; 95% CI = 3.48, 3.56; p < 0.001), followed by a high level of only HbA1c (aOR = 1.73; p < 0.001) and a high level of CRP (aOR = 1.49; p < 0.001). Using the reduced rank regression, an inverse relationship between higher consumption nuts and seeds and lower levels of CRP and HbA1c was found (both factors loading < -0.2). Concerning the combined effect of tertiles among the factor 1 and factor 2 analyzed by dietary patterns, group 1 with both T3 (high tertiles) was associated with the greatest OR of MCI (aOR = 4.38; 95% CI = 4.34, 4.42; p < 0.001) using multiple imputation. CONCLUSIONS: The combined effect of high levels of inflammation and hyperglycemia was associated with an increased likelihood of MCI. Moreover, dietary patterns positively related to inflammation and hyperglycemia were associated with MCI, while eating nuts and seeds promoted better cognition.

Adults with late stage 3 chronic kidney disease are at high risk for prevalent silent brain infarction: a population-based study.

BACKGROUND AND PURPOSE: The close relationship between stroke and chronic kidney disease (CKD) has been well-documented. However, few studies have focused on silent brain infarction (SBI) in CKD. We investigated the prevalence of SBI in different stages of CKD. METHODS: We included 1312 participants aged 30 to 93 years who came from either a random sample of residents or from a group of physically examined subjects in the same community. Basic information, clinical evaluations, laboratory tests, and MRI images were assessed. Subjects were divided into groups 1, 2, 3a, and 3b, corresponding to the estimated glomerular filtration rate (eGFR) levels of ≥ 90.0, 60.0 to 89.9, 45.0 to 59.9, and 30.0 to 44.9 mL/min/1.73 m². RESULTS: The crude prevalence was 4.7%: 2.6% (20 of 759 subjects) in group 1; 6.3% (32 of 506) in group 2; 12.9% (4 of 31) in group 3a; and 37.5% (6 of 16) in group 3b (P<0.001). Additionally, SBI also correlated with age, male sex, hypertension, diabetes, moderate carotid plaque, higher blood pressures, obesity, and levels of triglyceride, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and uric acid (all P<0.05). The effects for SBI risk in each eGFR group versus group 1 did not increase except for group 3b (OR, 9.34; P<0.001). CONCLUSIONS: A close association exists between SBI and eGFR. We have found a significant increase in prevalence of SBI when eGFR is between 30.0 and 44.9 mL/min/1.73 m². Adults with late stage 3 CKD are at high risk for prevalent SBI.

Shorter GT repeat polymorphism in the heme oxygenase-1 gene promoter has protective effect on ischemic stroke in dyslipidemia patients.

BACKGROUND: The microsatellite polymorphism of heme oxygenase (HO)-1 gene promoter has been shown to be associated with the susceptibility to ischemic event, including coronary artery disease (CAD), myocardial infarction, and peripheral vascular disease. We aimed to examine whether the length of (GT)(n) repeats in HO-1 gene promoter is associated with ischemic stroke in people with CAD risk factors, especially low level of HDL. METHODS: A total of 183 consecutive firstever ischemic stroke inpatients and 164 non-stroke patients were screened for the length of (GT)(n) repeats in HO-1 promoter. The long (L) and short (S) genotype are defined as the averaged repeat number >26 and <==26, respectively. RESULTS: Stroke patients tended to have more proportions of hypertension, diabetics and genotype L, than those of genotype S. Patients with genotype L of HO-1 gene promoter have higher stroke risk in comparison with genotype S especially in dyslipidemia individuals. The significant differences on stroke risk in multivariate odds ratios were found especially in people with low HDL-C levels. CONCLUSIONS: Subjects carrying longer (GT)(n) repeats in HO-1 gene promoter may have greater susceptibility to develop cerebral ischemic only in the presence of low HDL-C, suggesting the protective effects in HO-1 genotype S in the process of ischemic stroke, particularly in subjects with poor HDL-C status.

Depression and suicide risk in hemodialysis patients with chronic renal failure.

BACKGROUND: Depression and suicide are well established as prevalent mental health problems for patients on hemodialysis. OBJECTIVE: The authors examined the demographic and psychological factors associated with depression among hemodialysis patients and elucidated the relationships between depression, anxiety, fatigue, poor health-related quality of life, and increased suicide risk. METHOD: This cross-sectional study enrolled 200 end-stage renal disease patients age ≥18 years on hemodialysis. Psychological characteristics were assessed with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, the short-form Health-Related Quality of Life Scale, and Chalder Fatigue Scale, and structural equation modeling was used to analyze the models and the strength of relationships between variables and suicidal ideation. RESULTS: Of the 200 patients, 70 (35.0%) had depression symptoms, and 43 (21.5%) had had suicidal ideation in the previous month. Depression was significantly correlated with a low body mass index (BMI) and the number of comorbid physical illnesses. Depressed patients had greater levels of fatigue and anxiety, more common suicidal ideation, and poorer quality of life than nondepressed patients. Results revealed a significant direct effect for depression and anxiety on suicidal ideation. CONCLUSION: Among hemodialysis patients, depression was associated with a low BMI and an increased number of comorbid physical illnesses. Depression and anxiety were robust indicators of suicidal ideation. A prospective study would prove helpful in determining whether early detection and early intervention of comorbid depression and anxiety among hemodialysis patients would reduce suicide risk.

Body composition patterns among normal glycemic, pre-diabetic, diabetic health Chinese adults in community: NAHSIT 2013-2016.

BACKGROUND: Central obesity is known to be associated with diabetes. Increasing lower extremity circumference was hypothesized in association with lower risk of diabetes. OBJECTIVE: This study determined which anthropometric patterns correlates the best with pre-diabetic and diabetic status among healthy adults. DESIGN: Cross-sectional study with nationwide population sampling of participants was designed. PARTICIPANTS: In total, 1,358 ethnic Chinese adult participants were recruited from the Nutrition and Health Survey in Taiwan 2013-2016; the whole-body composition was measured through dual-energy X-ray absorptiometry. MAIN OUTCOME MEASURES: Fat and lean mass in whole and specific parts of body among heathy Asian adults with normal glycemic, pre-diabetic, and diabetic states were measured, separately. STATISTICAL ANALYSES PERFORMED: The generalized linear model was used to investigate the association between body composition (lean and fat mass) and hyperglycemic status. The reduced rank regression (RRR) was used to confirm the correlation between glycemic status and predicting factors (body composition parameters). RESULTS: Trunk fat positively correlated with the fasting glucose level (r = 0.327, P < 0.001) and HbA1c (r = 0.329, P < 0.001), whereas limb fat negatively correlated with the fasting glucose level (r = -0.325, P < 0.001) and HbA1c (ρ = -0.342, P < 0.001), respectively. In RRR analyses, fasting glucose and HbA1c exhibited a high positive association on fat amount per lean mass of the trunk (factor loading = 0.5319 and 0.5599, respectively) and of android area (0.6422 and 0.6104) and a high negative association fat amount per lean mass of the legs (-0.3863 and -0.3083) and gynoid area (-0.3414 and -0.3725). CONCLUSIONS: For healthy community participants, increasing trunk fat had a greater risk of hyperglycemic status. Increasing lower extremity mass may confer lower risk of diabetes.

Factors associated with mortality from non-occlusive mesenteric ischemia in dialysis patients.

BACKGROUND: Among dialysis patients, acute mesenteric ischemia is mostly caused by non-occlusive mesenteric ischemia (NOMI). There is a very high mortality rate associated with this complication, but prognostic factors associated with NOMI are not well-known. METHOD: In this study, we retrospectively reviewed the records of dialysis patients to identify prognostic factors associated with mortality from NOMI. Overall, there were 541 patients on hemodialysis (HD) and 158 patients on peritoneal dialysis (PD) in our hospital from January 2007 to December 2008. Among these 699 patients, we diagnosed NOMI by surgical and/or radiological criteria. A total of 12 dialysis patients (9 on HD and 3 on PD) developed NOMI during the study period. RESULT: The incidence of NOMI was 1.04% per patient-year for all dialysis patients (0.95% for HD and 1.35% for PD patients). Most of the 12 patients had chronic hypotension (83.3%, 10/12). Four patients expired following development of NOMI. Our results showed that mortality was significantly higher in patients who were administered a cyclooxygenase (COX) inhibitor prior to ischemia. Hypobicarbonemia during NOMI, which might indicate the severity of hypoperfusion, is also associated with higher mortality. CONCLUSION: NOMI is rare in dialysis patients. COX inhibitor administration should be given with caution in long-term hypotensive dialysis patients.

Metabolic Unhealthiness Increases the Likelihood of Having Metabolic Syndrome Components in Normoweight Young Adults.

Findings on risk detection for having metabolic syndrome (MetS) components, each of which may individually increase the risk of disease and mortality, are limited in young adults. In this study, we aimed to calculate the likelihood of having ≥1 MetS component in normoweight young adults using two different metabolic health criteria. We recruited 1182 normoweight young adults from the Taiwan Survey on the Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia and the National Health Interview Survey (aged 16-45 years, 39% male, body mass index = 18.5-22.99, all without MetS) and followed them for 5 years. Metabolic health criteria were derived from the Harmonized criteria (unhealthy if showing abnormality in one or two MetS components) and the triglyceride-glucose index (TyG-i; unhealthy if TyG-i was in the >75th percentile). Odds ratio (OR) and 95% confidence interval (CI) estimations for having ≥1 MetS component and for having each MetS component in 5 years were assessed using multivariable-adjusted logistic regression. We observed a significantly increased likelihood of the presence of ≥1 MetS component in the unhealthy group by using the Harmonized criteria and TyG-i (adjusted OR (aOR); 95%CI: 2.67; 2.04-3.49 and 2.1; 1.57-2.82, respectively). The areas under the receiver-operating characteristics curves were 0.679 and 0.652 for the final models using Harmonized and TyG-i criteria, respectively. These findings support the recommendation of treating any metabolic component abnormality, even in young adults without a MetS diagnosis.