The nonadherence and risk factors of eradication failure by sequential therapy as first-line anti-Helicobacter pylori treatment in real-world clinical practice.

BACKGROUND: The eradication rates of sequential therapy are high in clinical trials; however, the adherence for follow-up or the patient population in a real-world setting might be different from those in trails. This study investigates the effectiveness of sequential therapy in a real-world setting and the factors that lead to treatment failure. MATERIALS AND METHODS: In this retrospective study, patients receiving sequential therapy as a first-line anti-Helicobacter pylori (H. pylori) treatment in a real-world setting were reviewed. The age adjusted Charlson Comorbidity Index (age-CCI) and baseline variety of medications were reviewed to determine factors correlated with nonadherence for post-treatment testing and H. pylori eradication failure. RESULTS: A total of 1053 patients were reviewed. A total of 579 patients receiving sequential therapy were included in the analyses. Among them, 462 received post-treatment testing and were placed into the follow-up group. Thus, the post-treatment testing rate was 79.8%. Stroke was an independent factor of nonadherence for post-treatment testing. In the follow-up group, the eradication failure rate was 8.2%. Female sex (odds ratio [OR] 2.41 [95% CI 1.16-5.03], p = 0.02) and age-CCI ≥2 (OR 3.16 [1.05-9.48], p = 0.04) were independent factors of H. pylori eradication failure. The eradication failure rates were 14.4%, 7.8%, 7.1%, and 3.1% for the females with age-CCI ≥2, females with age-CCI <2, males with age-CCI ≥2, and males with age-CCI <2 subgroups, respectively (p = 0.027). CONCLUSIONS: In a real-world setting, the adherence rate of post-treatment testing for sequential therapy as a first-line anti-H. pylori treatment was found to be suboptimal. Female sex and age-CCI ≥2 were independent factors of eradication failure.

Identification of Endosonographic Features that Compromise EUS-FNB Diagnostic Accuracy in Pancreatic Masses.

BACKGROUND: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is highly accurate for diagnosing pancreatic mass. However, making diagnosis is challenging in 5-20% of patients. This study investigated the challenging features associated with reduced diagnostic performance in EUS-FNB and potential rescue methods that can improve the diagnostic rate. METHODS: This single-center retrospective study included patients with solid pancreatic tumors who underwent EUS-FNB between January 1, 2019, and December 12, 2021. Patients without a computed tomography (CT) scan or definite diagnosis were excluded. Challenging features were features that reduced diagnostic accuracy in EUS-FNB, as determined through multivariate analysis. Rescue methods were methods that assisted operators in assessing lesions in patients with challenging features. RESULTS: Of 332 enrolled patients, an accurate diagnosis obtained using EUS-FNB was achieved in 286 (86.1%). Univariable analysis revealed that the diagnostic accuracy was lower in cases of pancreatic tumors with isoattenuation in CT images (77.3% vs. 89.8%, odds ratio [OR]: 0.39, p = 0.003), an ill-defined margin on EUS (61.2% vs. 92.5%, OR: 0.13, p < 0.001), or tumor size < 20 mm (65.5% vs. 88.1%, OR: 0.26, p = 0.002). However, only ill-defined margins on EUS (OR: 0.14, p < 0.001) and tumor size < 20 mm (OR: 0.25, p = 0.005) were independent predictors of inconclusive EUS-FNB in the multivariate analysis. The use of contrast (OR: 4.46, p = 0.026) and a highly experienced endosonographer (> 5cases/month; OR: 3.25, p = 0.034) improved diagnostic performance in difficult cases. CONCLUSIONS: Pancreatic tumors with ill-defined tumor margins on EUS or size < 20 mm are challenging features in EUS-FNB. The use of contrast and a highly experienced endosonographer can improve diagnostic performance in difficult cases.

Endoscopic ultrasound avoids adverse events in high probability choledocholithiasis patients with a negative computed tomography.

BACKGROUND: The current guideline recommends patients who meet high probability criteria for choledocholithiasis to receive endoscopic retrograde cholangiopancreatography (ERCP). However, adverse events can occur during ERCP. Our goal is to determine whether endoscopic ultrasound (EUS) before ERCP can avoid unnecessary ERCP complications, especially in patients with a negative CT scan. METHODS: A total of 604 patients with high probability of choledocholithiasis were screened and 104 patients were prospectively enrolled. Patients with malignant biliary obstruction, altered GI anatomy, and choledocholithiasis on CT scan were excluded. Among them, 44 patients received EUS first, and ERCP if choledocholithiasis present (EUS-first group). The other 60 patients received ERCP directly (ERCP-first group). The baseline characteristics, presence of choledocholithiasis, and complications were compared between groups. All patients were followed for 3 months to determine the difference in recurrent biliary event rate. Cost-effectiveness was compared between the two strategies. RESULTS: There was no marked difference in age, sex, laboratory data, presenting with pancreatitis, and risk factors for choledocholithiasis. Overall, 51 patients (49.0%) had choledocholithiasis, which did not justify the risk of direct ERCP. In the EUS-first group, 27 (61.4%) ERCP procedures were prevented. The overall complication rate was significantly lower in the EUS-first group compared to the ERCP-fist group (6.8% vs. 21.7%, P = 0.04). The number-needed-to-treat to avoid one unnecessary adverse event was 6.71. After a 3-month follow-up, the cumulative recurrence biliary event rates were similar (13.6% vs. 15.0%, P = 0.803). EUS-first strategy was more cost-effective than the ERCP-first strategy (mean cost 2322.89$ vs. 3175.63$, P = 0.002). CONCLUSIONS: In high-probability choledocholithiasis patients with a negative CT, the EUS-first strategy is cost-effective, which can prevent unnecessary ERCP procedures and their complications.

NKX6.1 Represses Tumorigenesis, Metastasis, and Chemoresistance in Colorectal Cancer.

Accumulating evidence suggests that NKX6.1 (NK homeobox 1) plays a role in various types of cancer. In our previous studies, we identified NKX6.1 hypermethylation as a promising marker and demonstrated that the NKX6.1 gene functions as a metastasis suppressor through the epigenetic regulation of the epithelial-to-mesenchymal transition (EMT) in cervical cancer. More recently, we have demonstrated that NKX6.1 methylation is related to the chemotherapy response in colorectal cancer (CRC). Nevertheless, the biological function of NKX6.1 in the tumorigenesis of CRC remains unclear. In this study, we showed that NKX6.1 suppresses tumorigenic and metastatic ability both in vitro and in vivo. NKX6.1 represses cell invasion partly through the modulation of EMT. The overexpression of NKX6.1 enhances chemosensitivity in CRC cells. To further explore how NKX6.1 exerts its tumor-suppressive function, we used RNA sequencing technology for comprehensive analysis. The results showed that differentially expressed genes (DEGs) were mainly related to cell migration, response to drug, transcription factor activity, and growth factor activity, suggesting that these DEGs are involved in the function of NKX6.1 suppressing cancer invasion and metastasis. Our results demonstrated that NKX6.1 functions as a tumor suppressor partly by repressing EMT and enhancing chemosensitivity in CRC, making it a potential therapeutic target.

Extrapyramidal symptoms after exposure to calcium channel blocker-flunarizine or cinnarizine.

PURPOSE: Flunarizine (fz) and cinnarizine (cz) have well-known extrapyramidal side effects (EPSEs). The aim of this study was to evaluate the incidence and occurrence time of cz- and fz-related EPSEs. METHOD: Patients who took fz or cz for more than 1 month were identified from the longitudinal health insurance database 2005 and 2010. Excluded were patients with any of the underlying diseases that may cause parkinsonism. Drug-induced EPSEs were defined as the new diagnosis of parkinsonism, dyskinesia, or secondary dystonia during drug use or within 3 months after discontinuing the medication. Age- and sex-matched controls were included in this study. RESULTS: Recruited for analysis were individuals who took fz (n = 26,133) and cz (n = 7186). The incidence rates of fz- and cz-induced EPSEs were 21.03 and 10.3 per 10,000 person-months, respectively. The hazard ratios (HRs) of EPSEs among fz and cz subjects were 8.03 (95% CI 6.55-9.84) and 3.41 (95% CI 2.50-4.63) when compared with the control individuals. Both fz and cz patients had a higher cumulative incidence of EPSEs than their control individuals (p < 0.001). Among subjects who took fz, the incidence of EPSEs was higher in the second than first year of drug exposure (45.59 vs 21.03 per 10,000 person-months). CONCLUSIONS: Fz and cz significantly increased the risk of parkinsonism, dyskinesia, and dystonia. Potential benefits and risks should be weighed when considering long-term use of these drugs especially fz.

Living with schizophrenia: Health-related quality of life among primary family caregivers.

AIMS AND OBJECTIVES: To examine influencing factors of health-related quality of life in primary family caregivers of people with schizophrenia receiving inpatient psychiatric rehabilitation services. BACKGROUND: Families, particularly primary family caregivers, have become more important than ever in mental health care. Yet, research on health-related quality of life among primarily family caregivers is limited. DESIGN: A correlational study design was used. METHODS: A convenience sample of 122 primary family caregivers participated in the study. Data were analysed with descriptive statistics, Pearson's product-moment correlation, t test, one-way analysis of variance and a hierarchical multiple regression analysis. RESULTS: Primary family caregivers who were parents, older, less educated, and had a lower monthly household income, increased affiliate stigma and decreased quality of family-centred care experienced poor health-related quality of life. Particularly, monthly household income, affiliate stigma and quality of family-centred care appeared to be the most critical determinants of health-related quality of life. CONCLUSIONS: Efforts to enhance satisfaction of life should focus on reducing affiliate stigma as well as increasing monthly household income and strengthening the quality of family-centred care. RELEVANCE TO CLINICAL PRACTICE: Findings may assist in the development of culturally integrated rehabilitation programmes to decrease affiliate stigma and increase family engagement as a means of promoting quality of life for primary family caregivers living with people who have schizophrenia.

Bladder pain syndrome/interstitial cystitis increase the risk of coronary heart disease.

AIM: Vascular factor was proposed as being involved in the etiology of bladder pain syndrome/interstitial cystitis (BPS/IC). However, few studies have attempted to investigate the relationship between BPS/IC and cardiovascular disease. This study aimed to investigate the risk of coronary heart disease (CHD) among BPS/IC subjects during a 3-year follow-up period. METHODS: Data for this retrospective matched-cohort study were retrieved from the Taiwan "Longitudinal Health Insurance Database 2000." There were 752 BPS/IC female subjects in the study cohort and 3,760 randomly selected female subjects in the comparison cohort. We individually tracked each subject for 3 years and identified each subject that received a subsequent diagnosis of CHD during that follow-up period. RESULTS: Results showed that incidence rates of CHD during the 3-year follow-up period were 19.50 (95% confidence interval (CI): 14.35-25.95) and 8.87 (95% CI: 7.25-10.74) per 1,000 person-years for the study and comparison cohorts, respectively. The Cox proportional hazards regression suggested that the hazard ratio for CHD in subjects with BPS/IC was 1.65 (95% CI: 1.09-2.48) within the 3-year follow-up period following the index date compared to the comparison subjects after adjusting for monthly income, geographic region, hypertension, diabetes, hyperlipidemia, chronic kidney disease, bladder outlet obstruction, urinary tract infection, chronic pelvic pain, overactive bladder, and number of physician visits during the 3-year follow up period. CONCLUSIONS: Our study demonstrated an association between BPS/IC and a subsequent CHD diagnosis. We advise clinicians to screen subjects with BPS/IC for modifiable risk factors for CHD.

Intragastric botulinum toxin injection directly regulates ghrelin expression via reactive oxygen species and NF-κB signaling.

AIMS: One effective clinical strategy to combat obesity is intragastric botulinum toxin (BTX) injection, which increases gastric emptying time and regulates appetite. However, it remains unknown if and how BTX affects ghrelin levels. MATERIALS AND METHODS: An obese animal model was established by feeding male mice with high-fat diet (HFD). BTX was administered by subserosal injection in the antrum via an upper midline laparotomy. The mice were monitored in terms of body weight and blood biochemical parameters. Glucose utility and insulin sensitivity were measured by intraperitoneal glucose and insulin tolerance tests. Additionally, stomach and liver were histologically examined after BTX treatment. AGS gastric adenocarcinoma cells were used to investigate the molecular mechanism by which BTX affects ghrelin expression. KEY FINDINGS: In HFD-fed mice, BTX injection significantly decreased both food intake and body weight over a 3-week monitoring period. Moreover, HFD-induced hyperglycemia, hyperinsulinemia, dyslipidemia and obesity readouts were improved after BTX injection. Importantly, mice also exhibited decreased plasma and gastric ghrelin levels after BTX injection. In cultured AGS cells, BTX significantly increased reactive oxygen species (ROS) levels and activated nuclear factor-κB (NF-κB), which led to decreased ghrelin expression. Pre-treatment with inhibitors of either ROS or NF-κB reversed the effects of BTX on ghrelin expression in the cultured cells. SIGNIFICANCE: BTX decreases ghrelin expression in HFD-fed animals and in AGS cells through an ROS/NF-κB-dependent pathway. This mechanism may contribute to decreased food intake in obese subjects receiving intragastric BTX injection for weight control.

Serum Cardiotrophin-1 Concentration Is Negatively Associated with Controlled Attenuation Parameters in Subjects with Non-Alcoholic Fatty Liver Disease.

BACKGROUND: Since non-alcoholic fatty liver disease (NAFLD) is highly associated with obesity, cardiovascular disease, and diabetes, biomarkers for the diagnosis of NAFLD have become an important issue. Although cardiotrophin-1 (CT-1) has a protective effect on the liver in NAFLD animal models, the serum levels of CT-1 in human subjects with NAFLD were still unknown. OBJECTIVE: The present study aimed to investigate the relationship between the circulating concentration of CT-1 and the severity of hepatic steatosis graded by the value of the controlled attenuation parameter (CAP) in humans. DESIGN AND METHODS: The study was designed as a cross-sectional study, and a total of 182 subjects were enrolled. Hepatic steatosis measurement was carried out with a Firoscan® device and recorded by CAP. The enrolled study subjects were categorized into CAP < 238 dB/m, 238 ≤ CAP ≤ 259 dB/m, 260 ≤ CAP ≤ 290 dB/m, and CAP > 290 dB/m. Serum CT-1 concentrations were determined by enzyme-linked immunosorbent assay. The association between the serum CT-1 concentration and NAFLD was examined by multivariate linear regression analysis. RESULTS: Body mass index, percentage of body fat, systolic and diastolic blood pressure, alanine aminotransferase (ALT), cholesterol, triglyceride, hemoglobin A1c and homeostatic model assessment for insulin resistance (HOMA-IR) were significantly increased in groups with higher CAP value, whereas high-density lipoprotein cholesterol was significantly decreased. In addition, serum CT-1 concentrations were significantly decreased in subjects with higher CAP values. In multivariate linear regression models, including age, sex, body fat percentage, CAP, high sensitivity- C reactive protein, uric acid, creatinine, ALT, total cholesterol, and HOMA-IR, only age, CAP and uric acid independently associated with CT-1 levels. Moreover, having NAFLD was independently associated with CT-1 after adjustment for sex, obesity and type 2 diabetes. CONCLUSIONS: Serum CT-1 concentrations are decreased in subjects with NAFLD and negatively associated with CAP.

Malignant mesothelioma of the tunica vaginalis testis: a malignancy associated with recurrent epididymitis?

A 53-year-old Taiwanese male had several episodes of left epididymitis with hydrocele refractory to antibiotic treatment. Partial epididymectomy plus preventive vasectomy were planned, and, incidentally, an ill-defined nodule was found lying on the tunica vaginalis near the epididymal head. The pathological diagnosis was malignant mesothelioma of the tunica vaginalis testis. Radical orchiectomy with wide excision of the hemi-scrotal wall was performed. So far, there is no evidence of recurrence after more than 3 years of follow-up. Malignant tumor should be considered in the case of recurrent epididymitis refractory to empirically effective antibiotic treatment. Although the nature of this tumor is highly fatal, the malignancy can possibly be cured by early and aggressive surgical treatment.

Association Between MTHFR rs17367504 Polymorphism and Major Depressive Disorder in Taiwan: Evidence for Effect Modification by Exercise Habits.

Background/Aim: Recent studies reported that folate supplementation has beneficial effects on major depression. The Methylenetetrahydrofolate reductase (MTHFR) enzyme is crucial in folate metabolism. This population-based study examined the association between MTHFR rs17367504 polymorphism and major depressive disorder based on exercise habits. Methods: Taiwan Biobank (TWB) provided demographic and genotype data between 2008 and 2015. The biobank participants were Taiwanese aged 30 to 70. Data on major depressive disorder (MDD) were obtained from the National Health Insurance Research Database (NHIRD). Results: A total of 636 individuals were identified with MDD, whereas 17,298 individuals were considered controls. The associations of MTHFR rs17367504 and exercise with MDD risk were estimated using logistic regression models. The distribution of MTHFR rs17367504 genotype frequencies differed significantly between the MDD and control groups. We found that, compared with the AA genotype, the GG genotype was associated with a significantly increased risk of MDD [adjusted odds ratio (aOR), 1.76; 95% confidence interval (CI), 1.05-2.94; p = 0.033]. We found an interaction (p = 0.04) between rs17367504 and exercise, a well-known protective factor for MDD. A substantial increase in the risk of MDD was found among those with GG genotypes who did not exercise (aOR, 2.93; 95% CI, 1.66-5.17; p < 0.001). Conclusions: Our findings indicate that MDD is related to MTHFR rs17367504 and exercise, though the mechanisms remain to be determined.

Higher Risk of Tumor Recurrence in NASH-Related Hepatocellular Carcinoma Following Curative Resection.

The outcomes for patients with NASH-related HCC after curative resection have not been clarified. This study compared the overall survival (OS), time-to-tumor recurrence (TTR), and recurrence-free survival (RFS) associated with NASH-related HCC and virus-related HCC after resection. Methods: Patients with HCC who underwent curative resection were retrospectively enrolled. Baseline characteristics, including disease etiologies and clinical and tumor features, were reviewed. The primary outcomes were OS, TTR, and RFS. Results: Two hundred and six patients were enrolled (HBV: n = 121, HCV: n = 54, NASH: n = 31). Of those with virus-related HCC, 84.0% achieved viral suppression. In both the overall and propensity-score-matched cohorts, those with NASH-related HCC experienced recurrence significantly earlier than those with virus-related HCC (median TTR: 1108 days vs. non-reached; p = 0.03). Through multivariate analysis, NASH-related HCC (hazard ratio (HR), 2.27; 95% confidence interval (CI), 1.25-4.12) was independently associated with early recurrence. The unadjusted RFS rate of the NASH-related HCC group was lower than the virus-related HCC group. There was no difference in the OS between the two groups. Conclusions: NASH-related HCC was associated with earlier tumor recurrence following curative resection compared to virus-related HCC. Post-surgical surveillance is crucial for detecting early recurrence in patients with NASH-related HCC.

A Taiwanese study on real-world evidence with vortioxetine in patients with major depression in Asia (TREVIDA).

OBJECTIVE: The TREVIDA study aimed to evaluate vortioxetine for the treatment of major depressive disorder (MDD) in Taiwanese adults. METHODS: Patients with active depressive episode were recruited in this non-interventional, prospective, multi-site study conducted between June 2019 and August 2020 in Taiwan. Patient eligibility was independent of the physician's decision to prescribe vortioxetine for an MDD episode. Vortioxetine was initiated on the first visit. Depression severity, cognitive function, work productivity, functioning and safety were evaluated over 3 months. RESULTS: Overall, 242 patients were analyzed. At baseline, 70.7% and 90.4% of patients had moderately severe-to-severe depression based on PHQ-9 (Patient Health Questionnaire-9) and TDQ (Taiwanese Depression Questionnaire), respectively. By Month 3, significant improvements from baseline in depression severity (mean [SD] changes in PHQ-9, TDQ and CGI-S [Clinical Global Impression-Severity]: -6.3 [7.3]; -13.2 [14.0]; -1.5 [1.3], respectively), cognitive function (mean [SD] change in PDQ-D: -8.0 [17.5]), functioning (mean [SD] change in SDS: -5.4 [7.6]), and presenteeism (38.9% from 56.3%), work productivity loss (40.9% from 58.7%) and activity impairment (43.2% from 61.0%) were observed (p < .001 for all). By month 3, patient-reported (PHQ-9) response and remission rates were 43.4% and 52.9%, respectively; physician-reported (CGI-S) response and remission rates were 29.0% and 31.6%, respectively. Vortioxetine was well-tolerated and no unexpected side effects were reported. CONCLUSIONS: Vortioxetine reduced depression severity and improved cognitive function, work productivity, and functioning in Taiwanese patients with MDD in the real-world setting. Vortioxetine was well-tolerated in this Taiwanese population.

Physical activity is associated with lower health care costs among Taiwanese individuals with diabetes mellitus.

The economic burden of diabetes has increased over time with disease severity. Previous publications investigating the effects of physical activity (PA) on medical costs have made use of small sample sizes. We assessed the relationship between PA and 1-year medical expenditure among Taiwanese patients with type-2 diabetes mellitus (T2DM).Data were recruited from three governmental databases, including the 2012 adult preventive health service database. Participants were grouped as inactive (no exercise), insufficiently active (exercise < 150 minutes/week), and sufficiently active (exercise >150 minutes/week) individuals. Patients were stratified according to age and Charlson score. Multivariate linear regression models were used to determine ß-coefficients and their P values.Overall, 218,960 individuals were identified with diabetes. The prevalence of the disease was 13.1% among sufficiently active, 35% among insufficiently active, and 51.9% among physically inactive adults. In general, patients who had exercise >150 minutes/week had lower health care spending (i.e., US$ 755.83) followed by those who had less than 150 minutes/week (US$ 880.08) when compared with inactive patients (P < .0001). Moreover, health care costs derived from outpatient or inpatient care were lower for sufficiently active than inactive participants (P < .0001).Compared with being sedentary, PA was associated with lower health care costs of Taiwanese adults with diabetes mellitus.

Connectome Analysis of Brain Functional Network Alterations in Depressive Patients with Suicidal Attempt.

Our study aimed to clarify the neuroimaging correlates of suicide attempt by comparing differences in functional magnetic resonance imaging (fMRI) among depressed suicide attempters, depressed patients without suicide attempt history, and healthy controls through comprehensive and novel fMRI analyses and methods in the same study population. The association between depression severity and aspects of the brain imaging was also discussed. Our study recruited 109 participants who were assigned to three groups: 33 depressed patients with suicide attempt (SA), 32 depressed patients without suicide attempt (NS), and 44 healthy controls (HC). All participants were scanned using a 3 T MRI imaging system to obtain resting-state functional images. In seed-based correlation analysis, we found altered functional connectivity in some brain regions of the SA compared with the NS or HC, especially in the hippocampus and thalamus. In the voxel-based analysis, our results showed differential activation and regional homogeneity of the temporal lobe and several brain regions in the SA compared with the NS and HC. We also found that some brain areas correlated with the Hamilton Depression Rating Scale (HAM-D), anxiety, and depression scores, especially in the frontal and temporal lobes. Graph theoretical analysis (GTA) and network-based statistical (NBS) analyses revealed different topological organization as well as slightly better global integration and worse local segregation of the brain network (i.e., more like a random network) in depressed participants compared with healthy participants. We concluded that the brain function of major depressive disorders with and without suicide attempts changed compared with healthy participants.

Body mass index modulates the association between CDKAL1 rs10946398 variant and type 2 diabetes among Taiwanese women.

CDKAL1 rs10946398 is a type 2 diabetes (T2D)-associated variant. It is a new body mass index (BMI)-associated variant in Asian populations. We investigated the association between rs10946398 and T2D among 9908 participants aged 30-70 years based on BMI: normal weight; 18.5 ≤ BMI < 24 kg/m2, overweight; 24 ≤ BMI < 27 kg/m2, and obesity; BMI ≥27 kg/m2. The CC genotype conferred a higher risk of T2D than the CA genotype. The odds ratios (ORs) were 1.83; 95% confidence interval (CI) 1.49-2.26 and 1.20; 95% CI 1.02-1.40, respectively. The C allele was the significant risk allele compared with A allele (OR = 1.32; 95% CI 1.19-1.47). For normal, overweight and obese participants with CC genotype, the ORs were respectively 1.69; 95% CI 1.02-2.81, 2.34; 95% CI 1.50-3.66, and 1.58; 95% CI 1.02-2.45 among men and 1.22; 95% CI 0.67-2.22, 2.42; 95% CI 1.30-4.52, and 2.3; 95% CI 1.19-4.50 among women. The C allele ORs were higher in obese and overweight women. In conclusion, the rs10946398 CC/CA genotypes, as well as the C allele increased the risk of T2D. The ORs were higher in women who were overweight and obese than in those with normal weight. Nonetheless, significant results were prominent only among those with CC genotype and C allele.

Different impact of aspirin on renal progression in patients with predialysis advanced chronic kidney disease with or without previous stroke.

BACKGROUND: The benefit of reducing the risk of stroke against increasing the risk of renal progression associated with antiplatelet therapy in patients with advanced chronic kidney disease (CKD) is controversial. METHODS: We enrolled 1301 adult patients with advanced CKD treated with erythropoiesis stimulating agents from January 1, 2002 to June 30, 2009 from the 2005 Longitudinal Health Insurance Database in Taiwan. All of the patients were followed until the development of the primary or secondary endpoints, or the end of the study (December 31, 2011). The primary endpoint was the development of ischemic stroke, and the secondary endpoints included hospitalization for bleeding events, cardiovascular mortality, all-cause mortality, and renal failure. The adjusted cumulative probability of events was calculated using multivariate Cox proportional regression analysis. RESULTS: Adjusted survival curves showed that the usage of aspirin was not associated with ischemic stroke, hospitalization for bleeding events, cardiovascular mortality or all-cause mortality, however, it was significantly associated with renal failure. In subgroup analysis, aspirin use was associated with renal failure in the patients with no history of stroke (HR, 1.41; 95% CI, 1.14-1.73), and there was a borderline interaction between previous stroke and the use of aspirin on renal failure (interaction p=0.0565). CONCLUSIONS: There was no significant benefit in preventing ischemic stroke in the patients with advanced CKD who received aspirin therapy. Furthermore, the use of aspirin was associated with the risk of renal failure in the patients with advanced CKD without previous stroke.

Incidence of Major Depressive Disorder: Variation by Age and Sex in Low-Income Individuals: A Population-Based 10-Year Follow-Up Study.

Major depressive disorder (MDD), the most prevalent mental disorder is a global public health issue. The aim of this study was to assess the association between low income and major depressive disorder (MDD) by age and sex. The National Health Insurance Research Database (NHIRD) of Taiwan was used to retrieve data. A total of 1,743,948 participants were eligible for the study. Low-income individuals were identified from 2001 and 2003 (specifically, Group Insurance Applicants, ie, category"51" or "52") and followed from 2004 to 2010. MDD was identified using the ICD-9-CM 296.2 and 296.3 codes. Among non-low-income individuals, the MDD incidence rates increased with age in both males and females, that is, 0.35, 0.93, 0.97, 1.40 per 10,000 person-months for males and 0.41, 1.60, 1.89, 1.95 per 10,000 person-months for females aged 0 to 17, 18 to 44, 45 to 64, and ≥65 years, respectively. Low-income females (18-44 years) and males (45-64 years) had the highest incidence of MDD, which was 3.90 and 3.04, respectively, per 10,000 person-months. Among low and non-low-income individuals, the MDD incidence rates were higher in the females than males in all age groups. Males aged 45 to 64 and 0 to 17 years had highest hazard ratios (HR) of 2.789 (95% confidence interval [CI], 1.937-4.014) and 2.446 (95% CI, 1.603-3.732), respectively. The highest HRs for females were 2.663 (95% CI, 1.878-3.775) and 2.219 (CI, 1.821-2.705) in the 0 to 17 and 18- to 44-year age groups. Low income was not found to serve as a risk factor for the development of MDD in males and females aged ≥65 years. Among the non-low-income males and females, the incidence rates of MDD were found to increase with age. Low income was found to serve as a significant risk factor for MDD only in individuals under age 65.

The association between human papillomavirus infection and female lung cancer: A population-based cohort study.

Lung cancer is the leading cause of cancer deaths among Taiwanese women. Human papillomavirus (HPV) has been detected in lung cancer tissues. The aim of this study was to investigate the association between HPV infection and lung cancer among the Taiwanese women. The analytical data were collected from the longitudinal health insurance databases (LHID 2005 and 2010) of the National Health Insurance Research Database (NHIRD). The study participants were 30 years and older and included 24,162 individuals who were identified with HPV infection from 2001 to 2004 and 1,026,986 uninfected individuals. Lung cancer incidence among infected and uninfected individuals was compared using the univariate and multivariate regression models. Among the total participants, 24,162 individuals were diagnosed with HPV. After adjusting for age, gender, low income, residential area, and comorbidity, the risk of lung cancer was higher in women (hazard ratio [HR] 1.263, 95% CI 1.015-1.571), while all cancer risks were high in both men and women with corresponding hazard ratios (HR) of 1.161 (95% CI 1.083-1.245) and HR 1.240 (95% CI 1.154-1.331), respectively. This study showed a significant increase in lung cancer risk among Taiwanese women who were exposed to HPV infection.