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Dietary vitamin A status affects energy metabolism. The present study explored the effect of all‐trans retinoic acid (ATRA) on the expression levels of molecules and metabolites of brown adipocytes. Chronic ATRA treatment was initiated during the early stage (days 0‐8) or late stage (days 8‐12) of adipogenesis. Treatment with ATRA during the early and late stage of adipogenesis resulted in an increase in the expression level of Ucp1 and Cidea, genes highly expressed in brown adipocytes, on day 8 and day 12, respectively, whereas expression of Pgc‐1α, another gene expressed during brown adipogenesis, was unaffected by ATRA. Non‐targeted metabolomic analyses indicated that the pathways related to the glucose metabolism were affected by ATRA, irrespective of the differentiation stage. Cellular levels of glucose 6‐phosphate, fructose 6‐phosphate, citric acid, and succinic acid decreased after ATRA treatment on days 8 and 12. In contrast, glucose level was higher in ATRA‐treated cells on day 8, but it was lower on day 12. ATRA decreased the cellular level of aconitic acid, fumaric acid, and malic acid on day 12 but not on day 8. Furthermore, ATRA increased the expression level of Hxk2 and downregulated the expressions of G6pdh and Pfkl/Pfkp on day 8 but not on day 12. Together, the results indicate that the chronic treatment with ATRA stimulated the formation of activated brown adipocytes, eventually leading to alterations in the levels of cellular metabolites related to glucose metabolism. Significance of the study: Significance of the study treatment with all‐trans retinoic acid (ATRA) during the early and late stage of adipogenesis increased the expression of Ucp1 and Cidea, genes highly expressed in brown adipocytes, on day 8 and day 12. Cellular levels of glucose 6‐phosphate, fructose 6‐phosphate, citric acid, and succinic acid decreased after ATRA treatment on days 8 and 12. In contrast, glucose level was higher in ATRA‐treated cells on day 8, but it was lower on day 12. The present results indicate that ATRA stimulated the formation of activated brown adipocytes, eventually leading to alterations in the levels of cellular metabolites related to glucose metabolism. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the clinical effectiveness of influenza vaccination in patients with rheumatoid arthritis (RA). Methods: The present study was conducted by using the Taiwan National Health Insurance Research Database. In this retrospective nationwide study, we included 3748 RA patients who received influenza vaccinations in 2008, 2009 and 2010, and 3748 matched RA patients who did not receive influenza vaccinations. We followed the patients from 4 weeks after influenza vaccination to the end of the influenza season in each year. After adjustment for potential confounding factors, including disease‐modifying anti‐rheumatic drugs, we used the Cox proportional hazards regression model to analyze the clinical effectiveness of influenza vaccination. Results: The influenza vaccination rate in RA patients was 14.8% in 2008, 19.8% in 2009 and 9.50% in 2010. Receiving influenza vaccine was associated with reduced risk of hospitalization for septicemia, bacteremia or viremia (hazards ratio [HR] = 0.65, 95% CI = 0.45–0.94), and lower risk of mortality (HR = 0.62, 95% CI = 0.39–0.97). The effectiveness was particularly significant in elderly patients. Conclusions: RA patients receiving influenza vaccine have significantly lower morbidity and mortality, particularly in elderly patients. Further studies are needed to explore effective policies to increase the vaccination rate in elderly RA patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Both migraine and asthma are common health problems in the general population. However, the association between these two disorders is yet to be fully explored. Objective: We examined whether adult patients with migraine are at a higher risk of asthma development. Methods: We used data retrieved from the National Health Insurance Research Database in Taiwan to conduct this nationwide population‐based cohort study. We identified 6647 patients aged 20‐60 years who were newly diagnosed with migraine between 2000 and 2005 for the migraine group and identified 26 588 patients without migraine for the nonmigraine group. Both groups were followed up until the end of 2011 to examine the incidence of asthma. Cox proportional hazards regression analysis was used to measure the hazard ratio (HR) of asthma in the migraine group compared with the nonmigraine group. Results: The HR of asthma development was 1.37 (95% confidence interval = 1.21‐1.56) for the migraine group compared with the nonmigraine group after adjustment for age, sex, occupational status, insurance premium, urbanization, comorbidities, and annual outpatient department visits. Further stratified analysis revealed that this risk was also significantly higher for both sexes and in the 40‐ to 60‐year age group. The main limitation of this study was that some relevant data were unavailable, such as pain medication prescriptions and family history of migraine and asthma. Conclusion: Adult patients with migraine are at a higher future risk of asthma development. [ABSTRACT FROM AUTHOR]

Preventing the arrival of invasive alien species ( IAS) is a major priority in managing biological invasions. However, information on introduction pathways is currently scattered across many data bases that often use different categorisations to describe similar pathways. This hampers the identification and prioritisation of pathways to meet the main targets of recent environmental policies., Therefore, we integrate pathway information from two major IAS data bases, IUCN's Global Invasive Species Database ( GISD) and the DAISIE European Invasive Alien Species Gateway, applying the new standard categorisation scheme recently adopted by the Convention on Biological Diversity ( CBD). We describe the process of mapping pathways from the individual data bases to the CBD scheme and provide, for the first time, detailed descriptions of the standard pathway categories. The combined data set includes pathway information for 8323 species across major taxonomic groups (plants, vertebrates, invertebrates, algae, fungi, other) and environments (terrestrial, freshwater, marine)., We analyse the data for major patterns in the introduction pathways, highlighting that the specific research question and context determines whether the combined or an individual data set is the better information source for such analyses. While the combined data set provides an improved basis for direction-setting in invasion management policies on the global level, individual data sets often better reflect regional idiosyncrasies. The combined data set should thus be considered in addition to, rather than replacing, existing individual data sets., Pathway patterns derived from the combined and individual data sets show that the intentional pathways 'Escape' and 'Release' are most important for plants and vertebrates, while for invertebrates, algae, fungi and micro-organisms unintentional transport pathways prevail. Differences in pathway proportions among marine, freshwater and terrestrial environments are much less pronounced. The results also show that IAS with highest impacts in Europe are on average associated with a greater number of pathways than other alien species and are more frequently introduced both intentionally and unintentionally., Synthesis and applications. Linking data bases on invasive alien species by harmonising and consolidating their pathway information is essential to turn dispersed data into useful knowledge. The standard pathway categorisation scheme recently adopted by the Convention on Biological Diversity may be crucial to facilitate this process. Our study demonstrates the value of integrating major invasion data bases to help managers and policymakers reach robust conclusions about patterns in introduction pathways and thus aid effective prevention and prioritisation in invasion management. [ABSTRACT FROM AUTHOR]

ABSTRACT Hip fracture, which is associated with substantial morbidity and long-term mortality, imposes a major burden on the healthcare system. Diabetes is a risk factor for osteoporosis, which is a crucial risk factor of hip fracture. However, epidemiological studies investigating the risk of hip fracture among patients with type 2 diabetes are limited. This study explored the association between hemoglobin A1c (HbA1c) and the risk of hip fracture in people with type 2 diabetes aged 65 years and older. We conducted a retrospective cohort study of 20 025 older patients with type 2 diabetes who participated in the National Diabetes Case Management Program in Taiwan. The HbA1c level at the baseline and hip fracture incidence over an average of 7.41 years of follow-up were analyzed (maximum and standard deviation were 10.9 and 2.42 years, respectively). A total of 1514 hip fracture cases were recorded. The incidence rates of hip fracture were 9.15, 8.02, 9.58, 10.61, 12.51, and 13.43 per 1000 person-years in patients with baseline HbA1c levels of < 6%, 6-7%, 7%-8%, 8%-9%, 9%-10%, and ≥ 10%, respectively. After multivariate adjustment, the risk of hip fracture increased among patients with HbA1c levels of 9%-10% and ≥ 10.0% compared with patients with HbA1c levels of 6-7% (hazard ratio, 1.24; 95% confidence interval, 1.02-1.49 and 1.32; 1.09-1.58, respectively). Significant linear trends among various HbA1c levels were observed (P < 0.05). Patients with type 2 diabetes whose HbA1c levels exceeded 9.0% exhibited an increased risk of hip fracture, confirming a linear relationship. Our study's findings demonstrated the importance of glycemic control for fracture prevention in older adults with type 2 diabetes. © 2015 American Society for Bone and Mineral Research [ABSTRACT FROM AUTHOR]

This study examined whether glycated hemoglobin A1C (HbA1C) and chronic liver diseases are associated with hepatocellular carcinoma (HCC) risk in Type 2 diabetic patients. A retrospective cohort study consisting of 51,705 patients with Type 2 diabetes aged 30 and over enrolled in the National Diabetes Care Management Program before 2004 was used in Cox proportional hazards models. HbA1C was independently associated with HCC incidence, and multivariate-adjusted hazard ratio (HR) of HCC was 1.20 (95% confidence interval, CI: 1.02-1.41) for patients with a level of HbA1c ≥ 9% compared with patients with a level of HbA1c <7% after multivariate adjustment. We observed a significant linear trend in HCC incidence with increasing HbA1c ( p for trend = 0.02, HR = 1.07, 95% CI = 1.01-1.12 for every 1% increment in HbA1c). We observed significant HRs of HCC for patients with a level of HbA1c ≥ 9% with alcoholic liver damage, liver cirrhosis, HBV, HCV and any one of chronic liver diseases compared with patients with a level of HbA1c <9% and no counterpart comorbidity in the entire sample (HR = 8.63, 95% CI = 1.41-52.68; HR = 5.02, 95% CI = 3.10-8.12; HR = 2.53, 95% CI = 1.10-5.85; HR = 1.79, 95% CI = 1.01-3.17; and HR = 3.59, 95% CI = 2.56-5.02, respectively). Our results suggest significant joint associations of HbA1c ≥ 9% and chronic liver diseases. Lifestyle or treatment interventions such as maintaining a satisfactory glycemic control and chronic liver diseases may reduce the burden of HCC. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Tonsillectomy is related to increased risk of certain types of cancer. This study evaluates the possible association between tonsillectomy and cancer in Taiwan. Methods Data from the National Health Insurance system of Taiwan was used. A cohort study consisting of 997 patients with a new diagnosis of tonsillectomy from 2000 to 2005 and a comparison cohort of 3,988 subjects without tonsillectomy were used in the Poisson regression analysis to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of cancers. Results The incidence rate of all cancer types was higher in the tonsillectomy group than in the control group (4.28 vs. 2.97 per 1,000 person-years, respectively), with an IRR = 1.54 and 95% CI of 1.05 to 2.25, but the significant difference was limited to patients with more than 3 years follow-up. Site-specific analysis found no significant association between tonsillectomy and any individual cancer after adjusting for age, sex, hyperlipidemia, hypertension, and diabetes; however, tonsillectomy patients with more than 3 years follow-up had a marginally significantly higher risk for breast cancer development (adjusted IRR = 2.62; CI = 0.97-7.03). Conclusion Our study found that Taiwanese people with tonsillectomy have a significantly higher overall risk of developing cancer and a marginally higher risk of developing breast cancer when follow-up is longer than 3 years. Level of Evidence 2b. Laryngoscope, 125:134-139, 2015 [ABSTRACT FROM AUTHOR]

Abstract: Aim: The prevalence of hypothyroidism is high in haemodialysis (HD) patients and hypothyroidism increases all‐cause mortality in HD patients. Comorbidities are common in HD patients and are associated with both mortality and hypothyroidism. The aim of the study is to explore the effect of the interactions of comorbidities and hypothyroidism on all‐cause mortality in HD patients. Method: Patients with hypothyroidism (ICD‐9‐CM 244.0, 244.1, and 244.9) and matched patients without hypothyroidism in the Registry for Catastrophic Illness Patient Database of Taiwan Health Insurance from 2000 to 2010 were analyzed. The association of hypothyroidism and risk of all‐cause mortality was analyzed using Cox proportional hazard regression. Result: Nine hundred and eight HD patients with hypothyroidism and 3632 sex‐, age‐, gender‐ matched HD patients without hypothyroidism were analyzed. Hypothyroidism was associated with increased all‐cause mortality with an adjusted hazard ratio of 1.22 [95% confidence interval (CI): 1.10–1.36, P < 0.001]. TRT may decrease mortality associated with hypothyroidism (P < 0.001). There was a significant interaction (P = 0.04) between diabetes and hypothyroidism. There was no significant interaction found in hypothyroidism and the following comorbidities: hyperlipidaemia, hypertension, chronic obstructive pulmonary disease, coronary artery disease, stroke, peripheral arterial disease, asthma, congestive heart failure and cancer. Conclusion: Hypothyroidism is associated with increased all‐cause mortality in chronic HD patients. The interaction of hypothyroidism and diabetes, but not other common comorbidities in HD patients, has an effect on mortality risks. [ABSTRACT FROM AUTHOR]