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We aim to clarify the relationship between low skeletal muscle mass and varying levels of adiposity and to identify the types of physical function impairments associated with sarcopenic obesity (SO). This study examined cross-sectional data from the National Health and Nutrition Examination Survey with whole-body dual-energy X-ray absorptiometry (DXA) scans. The data included age, gender, DXA-assessed body composition, and physical functional activity with performing daily tasks by questionnaire. We subdivided the data by body composition into a non-SO group and a SO group (ASMI 0–49.99% and FMI of 50–100%), after which the SO data were subdivided into three classes. A higher class indicated higher adiposity and lower muscle mass. The physical function impairment of the two groups was compared. Our study examined 7161 individuals, of which 4907 did not have SO and 2254 had SO, and their data were further divided into three classes (i.e., class I, 826 individuals; class II, 1300 individuals; and class III, 128 individuals). Significant differences in demographics and DXA parameters were identified between the non-SO and SO groups (P < 0.001); the individuals with SO were older, included more women, and exhibited high adiposity and less lean muscle mass. The individuals with class III SO exhibited greater differences and reported more difficulty in performing daily activities. The individuals with class III SO exhibited the most severe physical function impairment. Our study highlights the considerable difficulties encountered by individuals with SO in performing daily activities. Given this finding, customized rehabilitation strategies should be implemented to improve the quality of life of individuals with SO. [ABSTRACT FROM AUTHOR]

Infection is a common cause of hospitalization in patients with heart failure (HF). The impact of infection on long term cardiovascular outcome in HF is not well studied. The aim of this study was to compare the long term risk of major adverse cardiovascular events (MACE) in HF patients with or without prior hospitalization for infection. From 2009 to 2015, 310,485 patients with their first HF admissions were enrolled from the Taiwan National Health Insurance Research Database. Among the patients, those with readmission due to infection within one year after HF discharge were defined as infection group and those without any infection admission were controls. The propensity score matching method was used to balance covariates between the two groups. Patients were followed until the occurrence of any component of the MACE or the end date of the study, December 31, 2019. In a mean follow-up time of 4.29 ± 2.92 years, 86.19% of patients in the infection group and 63.63% of patients in the control group had MACE. Multivariate Cox proportional hazards analysis showed the infection group had a higher risk of MACE (HR 1.760, 95% CI 1.714–1.807), including all-cause mortality (HR 1.587, 95% CI 1.540–1.636), myocardial infarction (HR 1.332, 95% CI 1.224–1.450), stroke (HR 1.769, 95% CI 1.664–1.882) and hospitalization for HF (HR 1.993, 95% CI 1.922–2.066). In conclusion, many HF patients discharged from the hospital experienced acute infection that required readmission. The patients had worse cardiovascular outcome after readmission for infectious disease compared to those without any infection. [ABSTRACT FROM AUTHOR]

Introduction: Osteoporosis has been demonstrated to be a risk factor for rotator cuff retears after surgery; however, no studies have directly investigated the association between osteoporosis and the development of rotator cuff tears. To investigate whether osteoporosis is associated with an increased risk of rotator cuff tears. Materials and methods: We conducted a population-based, matched-cohort study with a 7-year follow-uTwo matched cohorts (n = 3511 with osteoporosis and 17,555 without osteoporosis) were recruited from Taiwan's Longitudinal Health Insurance Dataset. Person-year data and incidence rates were evaluated. A multivariable Cox model was used to derive an adjusted hazard ratio (aHR) after controlling for age, sex, and various prespecified comorbidities. Age and sex were added in the model to test for interaction with osteoporosis. Results: Women constituted 88.5% of the cohorts. During follow-up of 17,067 and 100,501 person-years for the osteoporosis and nonosteoporosis cohorts, 166 and 89 rotator cuff tears occurred, respectively. The cumulative incidence of rotator cuff tears was significantly higher in the osteoporosis cohort than in the nonosteoporosis cohort (p < 0.001, log-rank). The Cox model revealed a 1.79-fold increase in rotator cuff tears in the osteoporosis cohort, with an aHR of 1.79 (95% confidence interval, 1.55–2.05). Effect modification of sex and age on rotator cuff tears was not found in patients with osteoporosis. Conclusion: This population-based study supports the hypothesis that compared with individuals without osteoporosis, those with osteoporosis have a higher risk of developing rotator cuff tears. [ABSTRACT FROM AUTHOR]

Background: Laboratory studies have demonstrated statin-induced apoptosis of cancer cells, including breast cancer cells, and evidence is accumulating on the mechanism of statin-induced apoptosis. However, despite numerous epidemiological studies, no consensus has been reached regarding the relationship between statin use and breast cancer risk. Methods: This retrospective case-control study enrolled 4332 breast cancer patients and 21,660 age-matched controls registered in the National Health Insurance program of Taiwan, which covers approximately 99% of the population. The study cases were women for whom a diagnosis of breast cancer (ICD-9-CM code 174.X) had been recorded in LHID2005 between January 1, 2004 and December 31, 2010. A logistic regression model was adjusted for potential confounding factors, including the level of urbanization, and the Charlson Comorbidity Index was applied to assess potential comorbidities. We also considered possible bias caused by random urbanization, because nutrition and lifestyle factors are related to breast cancer incidence. Results: Our results showed that lovastatin was associated with a lower risk of breast cancer (adjusted OR 0.596; 95% CI 0.497-0.714; p < 0.001), and atorvastatin exhibited a protective tendency against breast cancer (adjusted OR 0.887; 95% CI 0.776-1.013; p < 0.077). Conclusions: Although no consensus has been established regarding the relationship between statin use and breast cancer risk, our study indicated that lovastatin is a potential chemopreventive agent against breast cancer. Further detailed research is warranted. [ABSTRACT FROM AUTHOR]

Total knee replacement (TKR) is an effective and safe procedure. However, large-scale study to compare the incidence of coronary artery disease (CAD) after spinal or epidural anesthesia (SA-EA) or general anesthesia (GA) for TKR has not ever been conducted. To do so, we studied a population-based dataset from the Taiwan National Health Research Institute and hypothesized that the incidence of CAD might be different with regional than with general anesthesia. The risk of CAD-related events during a 90-day follow-up period among patients who received TKR under SA-EA or GA was evaluated in the present study. A total of 1500 patients from the Taiwan National Health Insurance claims database who underwent TKR from January 1, 2004, to December 31, 2006, were allocated into two groups. Group 1 included 1012 patients who received SA-EA during TKR procedure. Group 2 included 488 patients who received GA during this procedure. The number of patients who developed CAD during the 90-day follow-up period was 31 (3.1 %) in group 1 and 6 (1.2 %) in group 2. The Kaplan-Meier survival analysis of IHD-free cumulative survival rate during the 90-day follow-up period for patients who underwent TKR was significantly lower in group 1 than in group 2. The hazard ratio for the occurrence of CAD was 2.80 (95 % CI 1.16-6.78), and the hazard was higher for patients who received SA-EA than for patients who received GA after adjusted potential confounding factors. After the performance of TKR, patients had a potentially increased risk for CAD in SA-EA compared to GA during the 90-day follow-up period. [ABSTRACT FROM AUTHOR]

Background: The causative relationship between autoimmune thyroiditis and thyroid cancer remains a controversial issue. The aim of this population-based study was to investigate the risk of thyroid cancer in patients with thyroiditis. Methods: From the Longitudinal Health Insurance Database 2005 (LHID2005) of Taiwan, we identified adult patients newly diagnosed with thyroiditis between 2004 and 2009 ( n = 1,654). The comparison cohort ( n = 8,270) included five randomly selected age- and sex-matched controls for each patient in the study cohort. All patients were followed up from the date of cohort entry until they developed thyroid cancer or to the end of 2010. Multivariate Cox regression was used to assess the risk of developing thyroid cancer. A total of 1,000 bootstrap replicates were created for internal validation. Results: A total of 35 patients developed thyroid cancer during the study period, of whom 24 were from the thyroiditis cohort and 11 were from the comparison cohort (incidence 353 and 22 per 100,000 person-years, respectively). After adjusting for potential confounding factors, the hazard ratio (HR) for thyroid cancer in patients with thyroiditis was 13.24 (95 % CI 6.40-27.39). Excluding cancers occurring within 1 year of follow-up, the HR remained significantly increased (6.64; 95 % CI 2.35-18.75). Hypothyroidism was not an independent factor associated with the occurrence of thyroid cancer. Conclusions: We found an increased risk for the development of thyroid cancer after a diagnosis of thyroiditis, independent of comorbidities. [ABSTRACT FROM AUTHOR]

Background: The risk of colorectal cancer (CRC) in chronic kidney disease (CKD) patients relative to the general population is unknown. The aim of this population-based study was to investigate the risk of CRC in patients with CKD. Methods: The study cohort included patients aged ≥18 years diagnosed with CKD between 2004 and 2005 ( n = 15,975). The comparison cohort ( n = 79,875) included five randomly selected age- and gender-matched controls for each patient in the study cohort. All the subjects were followed up from the date of cohort entry until they developed CRC or until the end of 2006. Results: We identified 15,975 patients with a diagnosis of CKD who matched the inclusion criteria. A total of 460 patients developed CRC during the study period, of whom 116 were from the CKD cohort and 344 were from the comparison cohort. After adjusting for potential confounding factors, the CKD patients not undergoing dialysis were independently associated with a greater risk of CRC (hazard ratio, 1.79; 95 % confidence interval [CI] 1.41-2.27). The overall incidence rate of CRC was 341 per 100,000 person-years for CKD patients not undergoing dialysis, compared to 174 per 100,000 person-years. The age-matched hazard ratio of CRC after excluding dialysis patients was 1.64 (95 % CI 1.27-2.11) in patients 50 years and older, and 3.7 (95 % CI 1.83-7.49) in patients younger than 50 years. Conclusions: This population-based cohort study indicated that CKD patients not requiring dialysis have an increased risk of CRC compared to the general population, independent of comorbidities. [ABSTRACT FROM AUTHOR]

Acute bronchiolitis and asthma are respiratory tract diseases of childhood that are characterized by wheezing. However, the diagnosis of asthma is difficult in patients younger than 2 years. We evaluated the association between asthma or acute bronchiolitis and various risk factors in young children. This perspective cohort study included a study group of children younger than 2 years with a recorded diagnosis of acute bronchiolitis ( N = 4,586) as well as a control group ( N = 4,263). Children in both groups were registered between January 1, 2004 and December 31, 2004, on the Taiwan Longitudinal Health Insurance Database (2005), and each child was followed in our study until December 31, 2006, using data from the same source. Of the 8,849 children in our study, 355 experienced asthma during the 3-year follow-up period. Among these 355 asthma patients, 332 children (29.1 per 1,000 person-years, 95% CI 26.2-36.4) belonged to the acute bronchiolitis cohort and 23 children (2.0 per 1,000 person-years, 95% CI 13.3-29.9) belonged to the comparison cohort. Cox proportional hazard regression analysis showed that children with acute bronchiolitis were more likely to have asthma than the control population, after adjustment for potential confounders (adjusted hazard ratio [HR] 13.55, 95% CI 8.87-20.71). Boys with acute bronchiolitis had a higher HR for asthma than girls during the 3-year follow-up. Children with acute bronchiolitis who lived in rural areas had a 1.49 HR for asthma compared with their urban counterparts. Children living in the northern region of Taiwan had a higher HR ratio than those in other regions. Sex, urbanization, and geographic region all showed significant associations with acute bronchiolitis and asthma. Based on the asthma-free survival curves of Kaplan-Meier analysis in our study, young children with acute bronchiolitis should be monitored for 2 years to prevent them from developing asthma. This was the first study to evaluate the length of time for which acute bronchiolitis poses a risk for the development of asthma in young children. [ABSTRACT FROM AUTHOR]

The nucleotide sequence upstream to the glycoprotein E (gE) gene of pseudorabies virus (PrV, TNL strain) was cloned from the genomic virus DNA by polymerase chain reaction (PCR) and its DNA sequences were determined. The DNA segment, which was supposed to contain the gE promoter, was subcloned into a chloramphenicol acetyltransferase (CAT) reporter gene and the resulting plasmid was named pgEp-B-CAT. To examine the promoter function of this upstream sequence of gE gene, we transfected pgEp-B-CAT DNA into L–M cells and the promoter activity was analyzed by CAT assay. Results showed that our DNA fragment could exhibit promoter activity. Furthermore, we transfected L–M cells with pgEp-B-CAT for 48 h, then superinfected cells with pseudorabies virus, and performed CAT assay. It was found that PrV superinfection could slightly enhance the activity of gE promoter, suggesting that factors produced during viral infection could stimulate the promoter. To explore the possible mechanism of regulation at transcriptional level, the pgEp-B-CAT plasmid were cotransfected with eukaryotic vectors expressing viral regulatory proteins IE or EP0, and results indicated that the gE promoter was activated by IE protein whereas it was inhibited by EP0 protein. Moreover, the effect of exogenous IE or EP0 on the protein level of gE in PrV-infected cells was examined; conclusion similar to that of CAT assay were obtained. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) and dementia are prevalent causes of disability in geriatric patients. To date, information on the temporal correlation between these progressive diseases and the risk of dementia in patients with OA is limited. This retrospective population-based 4-year cohort study investigated the risk of dementia in patients with OA. We performed a case-control matched analysis by using the Taiwan Longitudinal Health Insurance Database 2005. Patients were selected on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification codes for OA between January 1, 2004 and December 31, 2007. The prevalence and the adjusted hazard ratio (HR) of dementia in patients with and without OA were estimated. The OA cohort comprised 35,149 patients and the non-OA cohort (comparison cohort) comprised 70,298 patients (1:2). The incidence of dementia was 21.7 per 10,000 person-years in the OA cohort and 14.7 per 10,000 person-years in the non-OA cohort. The HR for dementia during the follow-up period was 1.33 (95% confidence interval [CI], 1.17−1.50, P < 0.001) for patients with OA. The adjusted HR for dementia was 1.25 (95% CI, 1.10−1.43, P < 0.001) for patients with OA. The results of this study indicated that OA is an independent risk factor for dementia. [ABSTRACT FROM AUTHOR]