Tissue inhibitor of metalloproteinase (TIMP)-1 predicts negative remodeling and recovery of ejection fraction in acute heart failure with reduced ejection fraction

Background

Heart failure with recovered ejection fraction (HFrecEF) is a recently identified phenotype of heart failure, which had lower rates of mortality, heart failure hospitalization, ventricular assist device placement, and heart transplantation compared to heart failure with reduced ejection fraction (HFrEF). Several predictors of HFrecEF had been proposed such as female gender, lower HF duration, nonischemic cause, no left bundle branch block (LBBB), lower EF, and lower N-terminal pro-brain natriuretic peptide (NT-proBNP) in the previous studies. Tissue inhibitors of metalloproteinase-1 (TIMP-1) was a biomarker that regulated the activity of metalloproteinases (MMPs). TIMP-1 was up-regulated during HF and was associated with ventricular remodeling and poor prognosis. However, the predictive value of TIMP-1 and MMP-9 in recovery of EF was yet to be investigated.

Purpose

The present study aimed at investigating the predictive value of TIMP-1 and MMP-9 of recovery of EF.

Methods

Subjects with acute decompensated heart failure and reduced left ventricular ejection fraction were eligible for this study. HFrEF was defined as EF <40% and HFrecEF was defined as follow-up EF ≥40% and ≥10% improvement from baseline EF. The biomarkers including NT-proBNP, plasma MMP-9 and serum TIMP-1 were measured in all enrolled subjects at admission. The receiver operating characteristic (ROC) curves and Youden index were used to select the model variables and cutoff values. Binary logistic regression analysis assessed the association between the biomarkers and recovery ejection fraction.

Results

Among a total of 91 AHF with reduced ejection fraction subjects (70.1±16.2 years, baseline EF 28.9±7.6%), 19 (20.8%) HFrecEF and 72 (79.2%) persistent HFrEF were found at 6 months. TIMP-1 and NT-proBNP were significantly higher in persistent HFrEF compared to HFrecEF. MMP-9 was similar between these two phenotypes of HF. The area under the ROC curve for recovery of ejection fraction of TIMP-1, MMP-9 and NT-proBNP were 0.69, 0.52, and 0.65, respectively. The optimal cutoff value of TIMP-1 according to Youden index was 200.68 ng/ml. In binary logistic regression analysis, TIMP-1 was negatively correlated with recovered ejection fraction as continuous variables [per 1-SD=8.96 ng/ml, odds ratio and 95% confidence interval: 0.99 (0.98–1.00)] and categorical variables [cutoff value 200.68 ng/ml, odds ratio and 95% confidence interval: 0.16 (0.05–0.54)] after adjusting age, gender, EF, acute myocardial infarction, LBBB and NT-proBNP.

Conclusions

In AHF subjects with HFrEF, TIMP-1 was negatively correlated to the recovery of EF and could be a potential biomarker for the prediction of the recovery of EF.

Funding Acknowledgement

Type of funding sources: None.

Age of First Oral Health Examination and Dental Treatment Needs of Medicaid-Enrolled Children

INTRODUCTION

Early childhood caries (ECC), despite being preventable, remains the most prevalent disease of childhood, particularly in children between the ages of 2 and 5 y. The association between the type of health care provider completing initial oral health examinations and subsequent dental caries in children under 6 y of age is unclear.

OBJECTIVE

The objective of the current study is to longitudinally assess the association between age at first oral health examination and provider type at first oral health examination on dental treatment for children under 6 y of age.

METHODS

Deidentified administrative claims data were used from the IBM Marketscan Multi-State Medicaid Database (n = 2.41 million Medicaid-enrolled children younger than 6 y in 13 states from 2012 to 2017). A Kaplan-Meier survival analysis was used to examine the association between age at first oral health examination and provider type with first treatment of dental caries at follow-up.

RESULTS

The adjusted hazard ratio (HR) of dental caries for children whose first oral health examination at 4 y of age is 5.425 times higher than for children whose first oral health examination was before 1 y of age (95% confidence interval [CI], 5.371-5.479). The adjusted HR of dental caries for children seen by pediatric dentists (HR = 1.215; 95% CI, 1.207-1.223) and physicians (HR = 2.618; 95% CI, 2.601-2.635) was higher than those seen by a general dentist.

CONCLUSIONS

Findings from this study highlight the importance of children having their first oral health examination no later than 12 mo of age in accordance with existing guidelines and referrals from physicians to prevent the need for invasive treatment.

KNOWLEDGE OF TRANSFER STATEMENT

Results of this study emphasize the need for a child's first oral health examination to be completed no later than 12 mo of age to prevent dental caries. Reinforcement and referrals by physicians based on this recommendation facilitate early establishment of a dental home in young children.

P5006Metformin reduces the risk of hospitalization for heart failure in type 2 diabetes patients: a retrospective cohort analysis

Background

A beneficial effect of metformin on heart failure requires confirmation.

Purpose

To investigate whether metformin might affect the risk of heart failure hospitalization in type 2 diabetes patients.

Methods

Patients with new-onset type 2 diabetes during 1999–2005 were enrolled from the reimbursement database of Taiwan's National Health Insurance and followed until December 31, 2011. Analyses were conducted in a propensity score (PS) matched-pair cohort (42,367 ever users and 42,367 never users) and hazard ratios were estimated by Cox's hazard regression analysis incorporated with the inverse probability of treatment weighting using the PS.

Results

A total of 1,592 never users and 987 ever users were hospitalized for heart failure for the first time during follow-up, with a respective incidence of 843.34 and 499.18 per 100,000 person-years. The overall hazard ratio was 0.588 (95% confidence interval: 0.543–0.637), and the hazard ratios for the first (<29.13 months), second (29.13–61.63 months), and third (>61.63 months) tertiles of cumulative duration were 1.018 (0.914–1.135), 0.575 (0.511–0.647), and 0.340 (0.297–0.390), respectively. Sensitivity analyses conducted in an unmatched cohort before and after excluding patients who received an irregular refill of metformin or who were treated with incretin-based therapies during follow-up consistently supported such a protective effect of metformin on heart failure.

Conclusion

Metformin use is associated with a lower risk of hospitalization for heart failure.

Acknowledgement/Funding

The study was partly supported by the Ministry of Science and Technology (MOST 107-2221-E-002-129-MY3) of Taiwan.

Metformin is associated with a lower risk of non-Hodgkin lymphoma in patients with type 2 diabetes

BACKGROUND

Whether metformin use might affect the risk of non-Hodgkin lymphoma (NHL) remained to be answered.

METHODS

A total of 610,089 newly diagnosed type 2 diabetes patients with 2 or more times of prescription of antidiabetic drugs during 1999-2009 were enrolled from Taiwan's National Health Insurance database. They were followed up for NHL incidence until December 31, 2011. Both intention-to-treat and per-protocol analyses were conducted. Cox regression incorporated with the inverse probability of treatment-weighting using propensity scores was used to estimate hazard ratios.

RESULTS

There were 414,783 metformin initiators and 195,306 non-metformin initiators within the initial 12-month of prescriptions of antidiabetic drugs. After a median follow-up of 5.07 years in metformin initiators and 6.78 years in non-metformin initiators, 1076 and 755 patients were diagnosed of new-onset NHL, respectively. The respective incidence was 47.74 and 57.68 per 100,000 person-years and the hazard ratio for metformin initiators versus non-metformin initiators was 0.849 (95% confidence interval 0.773-0.932) in the intention-to-treat analysis. In the per-protocol analysis, the hazard ratio was 0.706 (95% confidence interval 0.616-0.808). Sensitivity analyses after excluding patients with irregular follow-up, with an extension of minimal observation periods of 24 or 36 months, with incretin-based therapies, or in patients enrolled during 2 different periods (i.e., 1999-2003 and 2004-2009) consistently showed a lower risk among metformin initiators in both the intention-to-treat and the per-protocol analyses.

CONCLUSIONS

Metformin use is associated with a lower risk of NHL compared with non-metformin antidiabetics.

The association between septicemia and the risk of multiple sclerosis: a nationwide register-based retrospective cohort study in Taiwan

BACKGROUND

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system. Few studies focused on the relationship between septicemia and MS.

AIM

To evaluate the potential impact of septicemia on risk for MS.

DESIGN

Two cohorts of patients with septicemia and without septicemia were followed up for the occurrence of MS.

METHODS

Patients of 482 790 with septicemia was enrolled from the National Health Insurance Research Database between 2001 and 2011 as the study group to match the 1 892 820 individuals, as the control group, by age and gender. Incidence of MS in both groups was calculated. Cox proportional-hazards regressions were performed for investigating hazard ratios (HR) for MS between groups.

RESULTS

Septicemia patients had a 3.06-fold (95% CI: 2.16-4.32, P < 0.001) greater risk of developing MS than the matched group. In addition, higher severity of septicemia was associated with higher risk of developing MS (moderate: HR = 4.03, 95% CI: 2.53-6.45, P < 0.001; severe: HR = 11.1, 95% CI: 7.01-17.7, P < 0.001). Similar results also occurred in both male and female patients with septicemia (male: HR = 4.06, 95% CI: 2.17-7.58, P < 0.001; female: HR = 2.72, 95% CI: 1.79-4.11, P < 0.001). Patients without counterpart comorbidities had a significantly higher risk of MS than the controlled group (HR = 3.02, 95% CI: 2.10-4.35, P < 0.001).

CONCLUSION

The results indicated septicemia is linked to an increased risk for MS. Aggressively preventing and treating septicemia may be warranted for one of precautionary strategies of MS.

Metformin and risk of chronic obstructive pulmonary disease in diabetes patients

PURPOSE

This study aimed to investigate whether metformin can affect risk of chronic obstructive pulmonary disease (COPD) in type 2 diabetes (T2D) patients.

METHODS

T2D patients newly diagnosed during 1999-2005 were enrolled from the reimbursement database of Taiwan's National Health Insurance system and followed up to 31 December 2011. Analyses were conducted in an unmatched cohort (92,272 ever-users and 10,697 never-users of metformin) and a propensity score (PS) matched pair cohort (10,697 ever-users and 10,697 never-users). Cox regression incorporated into the inverse probability of treatment weighting using the PS was used to estimate hazard ratios (HRs).

RESULTS

In the unmatched cohort, 2573 never-users and 13,840 ever-users developed COPD with respective incidences of 5994.64 and 3393.19 per 100,000 person-years. The overall HR was 0.560 (95% confidence interval [CI]: 0.537-0.584). HRs for the first (<25.27months), second (25.27-55.97months) and third (>55.97months) tertiles of cumulative duration were 1.021 (0.975-1.070), 0.575 (0.548-0.603) and 0.265 (0.252-0.280), respectively. Analyses of the matched cohort showed an overall HR of 0.643 (0.605-0.682), with HRs of 1.212 (1.122-1.309), 0.631 (0.578-0.689) and 0.305 (0.273-0.340) for the respective tertiles.

CONCLUSION

A reduced risk of COPD is observed in metformin users with T2D.

Risk of developing pressure sore in amyotrophic lateral sclerosis patients - a nationwide cohort study

BACKGROUND

Prior investigations with few cases have disclosed lack of pressure sore (PrS) formation was characteristic in amyotrophic lateral sclerosis (ALS) patients. However, studies with larger samples are lacking to ascertain this concept.

OBJECTIVE

To investigate whether patients with ALS have higher risk of PrS.

METHODS

Utilizing a Taiwan National Insurance claims data set with 23 million participants, we extracted 514 patients with ALS and 2056 controls from 1 January 2000 to 31 December 2008. Both groups were followed up until PrS occurrence during study period (2000-2011). The PrS risk was calculated with Cox proportional regression model.

RESULTS

The patients with ALS had a greater PrS risk (adjusted hazard ratio [aHR] = 8.82, 95% confidence interval [CI] = 4.90-15.9, P < 0.001) than the controls did. PrS risk was much higher in ALS women (aHR = 26.6, 95% CI = 9.05-78.2, P < 0.001) than in ALS men (aHR = 4.38, 95% CI = 1.99-9.68, P < 0.001). Besides, in people aged 20-54, ALS was linked with a much greater PrS risk (aHR = 27.7, 95% CI = 5.79-132, P < 0.001) than in those aged ≥55 (aHR = 6.10, 95% CI = 3.10-12.0, P < 0.001).

CONCLUSIONS

Amyotrophic lateral sclerosis is discovered to be correlated with an enhanced PrS risk. For PrS prevention, it is needed to pay more attention to the management of the patients with ALS, particularly in women and those with relatively younger age. Further investigations are needed to confirm the findings in this study.

Novel mold-resistant building materials impregnated with thermally reduced nano-silver

In this study, we evaluated the long-term antifungal effectiveness of 3 types of interior building materials (gypsum board [GB], cement board [CB], and softwood plywood [S-PW]) impregnated with thermally reduced silver nanoparticles supported by titanium dioxide (AgNPs/TiO₂ ) under 95% relative humidity for 4 weeks. AgNPs/TiO₂ was synthesized at 2 thermal reduction temperatures (TRTs, 120 and 200°C) with 2 different AgNP weight percentages (2 and 5 wt%). Four different silver-loading levels (SLLs, 0.025, 0.05, and 0.5 μg/cm² and the critical concentration required to inhibit fungal growth on agar plates) and 3 fungal species (Aspergillus niger, Penicillium spinulosum, and Stachybotrys chartarum) were used in the experiments. Higher temperature reduced more ionic Ag⁺ to metallic Ag⁰ and increased the dispersion of Ag on TiO₂ surface. The 200°C thermally reduced AgNPs/TiO₂ demonstrated excellent antifungal efficiency: Mold growth was almost completely inhibited for 28 days at the low SLL of 0.5 μg/cm² . Additionally, AgNPs/TiO₂ exhibited higher antifungal activity on GB and CB than on S-PW. The stepwise regression results indicated that the TRT of AgNPs/TiO₂ (β = -0.739 to -0.51), the SLL (β = -0.477 to -0.269), and the Ag⁰ level in the AgNPs (β = -0.379 to -0.136) were the major factors influencing antifungal activity and TRT might be the most significant one.

Attitudes and potential barriers towards hepatitis C treatment in patients with and without HIV coinfection

This study aimed to assess attitudes and potential barriers towards treatment in patients with hepatitis C virus (HCV) infection, comparing those with and without HIV coinfection. A cross-sectional survey of 82 HCV-infected adults with and without HIV was conducted in greater Los Angeles between November 2013 and July 2015. Overall, there were 53 (64.6%) with HIV coinfection, 20 (25.0%) with self-reported cirrhosis, and 22 (26.8%) with a history of prior HCV treatment. Of all, 93.2% wanted HCV treatment, but 45.9% were unwilling/unable to spend anything out of pocket, 29.4% were waiting for new therapies, and 23.5% were recommended to defer HCV treatment. HIV/HCV-coinfected patients were more likely to want treatment within one year (90.2% versus 68.2%, p = 0.02), more willing to join a clinical trial (74.5% versus 8.0%, p < 0.01), more willing to take medications twice daily (86.3% versus 61.5%, p = 0.01), and more likely to prefer hepatitis C treatment by an infectious diseases/HIV physician (36.7% versus 4.0%, p < 0.01). Of all, 77.1% of coinfected patients were willing to change antiretroviral therapy if necessary to treat HCV, but only 48.0% of patients were willing to take a medication if it had not been studied in HIV-positive patients. Treatment preferences differ between HIV/HCV-coinfected and HCV-monoinfected patients. Despite a strong willingness among the study cohort to start HCV treatment, other factors such as cost, access to medications, and provider reluctance may be delaying treatment initiation.

Decreased risk of intracerebral hemorrhage among patients with milder allergic rhinitis

BACKGROUND

This study investigated whether allergic rhinitis (AR) increases the risk of intracerebral hemorrhage (ICH).

METHODS

Using Taiwanese insurance outpatient claims data, 52,870 patients with new diagnoses of AR between 2000 and 2010 were identified, and 105,680 age- and sex-frequency matched people without AR were chosen randomly as controls. Risks of ICH were correlated with AR and comorbidities, such as diabetes, hypertension, coronary artery disease, hyperlipidemia, disease and chronic kidney disease, and were estimated by the end of 2011.

RESULTS

The risk of ICH was lower in the AR cohort than in the comparison cohort, with an adjusted hazard ratio (aHR) of 0.58 (95% confidence interval [CI] = 0.50-0.66), assessed using the multivariable Cox model. Age-specific analysis demonstrated that the aHR for ICH in the AR patients increased with age, with an aHR of 0.53 (95% CI = 0.39-0.71) in the ≤49-year age group, which increased to 0.72 (95% CI = 0.59-0.89) in the elderly age group. The risk of ICH increased with the severity of AR, from an aHR of 0.47 (95% CI = 0.40-0.56) in mild AR patients to 2.55 (95% CI = 1.88-3.47) in severe ones. For patients without comorbidities, the risk of ICH was 0.46 times (95% CI = 0.34-0.63) lower in the AR cohort than in the comparison cohort.

CONCLUSION

This study showed for the first time that milder AR is correlated with a reduction in the risk of ICH, particularly for elderly patients.

Electro-optically spectrum tailorable intracavity optical parametric oscillator

We report a unique, pulsed intracavity optical parametric oscillator (IOPO) whose output spectrum is electro-optically (EO) tailorable based on an aperiodically poled lithium niobate (APPLN) working simultaneously as an optical parametric gain medium and an active gain spectrum filter in the system. We have successfully obtained from the IOPO the emission of single to multiple narrow-line signal spectral peaks in a near-infrared (1531 nm) band simply by electro-optic control. The power spectral density of the EO tailored signal can be enhanced by up to 10 times over the original (nontailored) signal.

Helicobacter pylori infection increases subsequent ischemic stroke risk: a nationwide population-based retrospective cohort study

BACKGROUND AND PURPOSE

The association of Helicobacter pylori infection (HP-I) with ischemic stroke (IS) incidence has been studied, but conflicting results have been reported. The purpose of this study was to investigate the association between chronic HP-I and the risk of acute IS by using data from the Taiwan National Health Insurance Research Database.

METHODS

We identified17 332 patients with HP-I and 69 328 randomly selected age- and gender-matched controls from 1 January 2000 to 31 December 2010. Both cohorts were followed up until the occurrence of IS or until censored. The Cox proportional hazards model was used for assessing the association of HP-I with IS.

RESULTS

Compared with the control cohort, patients diagnosed with HP-I exhibited a higher incidence rate of IS (14.8 vs. 8.45 per 1000 person years) and a hazard ratio (HR) of 1.52 (95% confidence interval [CI] = 1.40-1.65). The HRs for IS were 1.49 (1.37-1.62) in patients diagnosed with HP-I who had one admission, increasing to 2.26 (1.71-1.98) for those who had two or more admissions when adjusted for age, sex and comorbidities (P for trend < 0.0001). In addition, we observed a significantly positive association between nonembolic IS and increased admissions (P for trend < 0.0001) but negative association with embolic IS.

CONCLUSION

Chronic HP-I is significantly associated with an increased risk of IS, particularly nonembolic IS. Anti-HP therapy may be beneficial to IS prevention.

Increased risk of ischaemic stroke among patients with multiple sclerosis

BACKGROUND AND PURPOSE

Inflammatory processes including autoimmune diseases which ignite endothelial dysfunction and atherosclerosis may promote development of cardiovascular diseases including ischaemic stroke. This study aimed to evaluate whether multiple sclerosis (MS) increases stroke risk.

METHODS

A national insurance claim data set of 22 million enrollees in Taiwan was used to identify 1174 patients with MS and 4696 randomly selected age- and gender-matched controls from 1 January 1997 to 31 December 2010. Both cohorts were followed up until the occurrence of stroke or censor. Relevant covariates, such as age, gender, hypertension, diabetes, hyperlipidaemia, coronary artery disease, congestive heart failure and pregnancy, were included for further survey. The hazard ratio (HR) of stroke was assessed using a Cox proportional hazards regression model.

RESULTS

After adjusting for the relevant covariates, the MS cohort had an increased risk of stroke (adjusted HR = 12.1 for 1 year; adjusted HR = 4.69 for 2-5 years) compared with the control cohort within 5 years of follow-up. Amongst participants without comorbidities, the MS cohort was still at a greater stroke risk than the control cohort [HR 4.93, 95% confidence interval (CI) 2.85-8.55]. Moreover, in the population aged ≤40, MS was associated with a significantly increased risk of stroke (HR 12.7, 95% CI 3.44-46.7).

CONCLUSIONS

Multiple sclerosis is declared to be associated with an increased risk in developing stroke, which requires closer attention to this group of patients for stroke prevention, especially in the younger population.

The association between chronic osteomyelitis and increased risk of diabetes mellitus: a population-based cohort study

Chronic inflammation is a well-known risk factor for type 2 diabetes mellitus (T2DM). The influence of chronic osteomyelitis (COM), an inflammatory disease, on the risk of developing T2DM remains unknown. This study investigated the risk of developing T2DM among COM patients. Using a retrospective cohort study, we identified 20,641 patients with COM and 82,564 age- and sex-matched controls for comparison from the Taiwan National Health Insurance Database (NHIRD) from 1997 to 2010. We followed up the COM cohort and the comparison cohort to compare the incidences of diabetes (ICD-9-CM code 250) until the end of 2010 or until the patients were censored because of death or withdrawal from the insurance program. The diabetes risk was analyzed using the Cox proportional hazards regression model. The incidence of T2DM was 1.6-fold higher in the group of COM patients than in the comparison group (29.1 vs. 18.2 per 10,000 person-years). The COM patients exhibited a higher diabetes risk [adjusted hazard ratio (aHR) = 1.64, 95 % confidence interval (CI) = 1.44-1.87] after controlling for the baseline and comorbidities. Younger and higher income patients exhibited a higher COM-to-reference incidence rate ratio (IRR) for T2DM compared with that of their counterparts. We also observed an increased risk of T2DM in COM patients with comorbidities (aHR = 1.70, 95 % CI = 1.47-1.96) compared with that of their non-COM counterparts. This is the first study to report the association between COM and an increased risk of developing T2DM, particularly among younger and higher income patients.

Tunable, pulsed multiline intracavity optical parametric oscillator using two-dimensional MgO: periodically poled lithium niobate-aperiodically poled lithium niobate

We report a tunable, pulsed multiline intracavity optical parametric oscillator (IOPO) realized in an Nd:YVO4 laser using a two-dimensionally domain engineered MgO:LiNbO3 as simultaneously an electro-optic Bragg Q switch and a multichannel optical parametric downconverter. The MgO:LiNbO3 was periodically and aperiodically poled along the crystallographic y and x axes, respectively, to simultaneously satisfy the phase-matching conditions required by the two quasi-phase-matching devices. When Q switched by 1 kHz, 300 V pulses, three signal lines at 1518, 1526, and 1534 nm were simultaneously generated, each with a peak power of ∼1  kW from the IOPO at 8.3 W diode power at 50°C. Spectral tuning of the three-line IOPO with temperature was demonstrated.

Limits on spin-independent couplings of WIMP dark matter with a p-type point-contact germanium detector

We report new limits on a spin-independent weakly interacting massive particle (WIMP)-nucleon interaction cross section using 39.5 kg days of data taken with a p-type point-contact germanium detector of 840 g fiducial mass at the Kuo-Sheng Reactor Neutrino Laboratory. Crucial to this study is the understanding of the selection procedures and, in particular, the bulk-surface events differentiation at the sub-keV range. The signal-retaining and background-rejecting efficiencies were measured with calibration gamma sources and a novel n-type point-contact germanium detector. Part of the parameter space in the cross section versus WIMP-mass implied by various experiments is probed and excluded.

Decrease of postprandial endothelial dysfunction by spice mix added to high-fat hamburger meat in men with Type 2 diabetes mellitus

AIMS

Consumption of a high-fat diet has been demonstrated to promote endothelial dysfunction, possibly through an increase in lipid peroxidation and decrease in serum nitric oxide. The present study was designed to investigate whether consumption of a hamburger cooked with a polyphenol-rich spice mixture will reduce postprandial lipid oxidation and endothelial dysfunction in men with Type 2 diabetes.

METHODS

Twenty-two subjects consumed burgers cooked with salt only (control burger) or with salt and spice mix (spice burger) in randomized order. The postprandial concentration of urinary malondialdehyde and nitrate/nitrite as well as the peripheral arterial tonometry score were determined.

RESULTS

Eighteen subjects completed the study. Postprandial serum glucose, insulin and triglyceride concentrations were similar in all subjects after control burger or spice burger consumption. Urine malondialdehyde excretion in mmol/g creatinine was reduced by 31% (P < 0.001) after consuming the spice burger compared with the control burger. Two hours after consumption of the burgers, the peripheral arterial tonometry score was significantly different between control burger consumption (-9.7 ± 21.5%) and spice burger consumption (+18.0 ± 42.4%) (P = 0.025). Mean urinary nitrate/nitrite concentrations in urine collected during the 6 h after consumption of the control burger was 9.09 ± 5.7 mmol/g creatinine, but 12.37 ± 7.00 mmol/g creatinine after the spice burger (P = 0.053).

CONCLUSION

Adding a spice mix to hamburger meat prior to cooking resulted in a reduction in urinary malondialdehyde, an increase in urinary nitrate/nitrite and improvement of postprandial endothelial dysfunction in men with Type 2 diabetes. Therefore, cooking a hamburger with a polyphenol-rich spice mixture may lead to potential cardiovascular benefits in patients with Type 2 diabetes mellitus.

Electro-optically tunable, multi-wavelength optical parametric generators in aperiodically poled lithium niobates

We report on the design and demonstration of electro-optically tunable, multi-wavelength optical parametric generators (OPGs) based on aperiodically poled lithium niobate (APPLN) crystals. Two methods have been proposed to significantly enhance the electro-optic (EO) tunability of an APPLN OPG constructed by the aperiodic optical superlattice (AOS) technique. This is done by engineering the APPLN domain structure either in the crystal fabrication or in the crystal design process to increase the length or block-number difference of the two opposite-polarity domains used in the structure. Several orders of magnitude enhancement on the EO tuning rate of the APPLN OPGs constructed by the proposed techniques for simultaneous multiple signal wavelength generation over a conventional one has been demonstrated in a near infrared band (1500-1600 nm).

Diabetes and non-Hodgkin's lymphoma: analyses of prevalence and annual incidence in 2005 using the National Health Insurance database in Taiwan

BACKGROUND

The association between diabetes and non-Hodgkin's lymphoma (NHL) is rarely studied and the risk associated with insulin use is not known.

MATERIALS AND METHODS

The crude and age-standardized trends of NHL incidence in the general population from 1979 to 2007 were first calculated. NHL prevalence and annual incidence in 2005 were calculated in 329,198 insurants aged≥45 years from a random sample of 1,000,000 insurants of the National Health Insurance. The risk factors were evaluated using logistic regression.

RESULTS

NHL incidence trends increased significantly in either sex. A total of 1079 and 148 NHL cases were identified for prevalence and incidence analyses, respectively. The respective prevalence (per 100,000) for diabetic and nondiabetic subjects was 480.2 and 269.9 (P<0.01), and the respective incidence (per 100,000) was 70.9 and 35.3 (P<0.01). Odds ratio for diabetic versus nondiabetic subjects after adjustment for age, sex, occupation, and living region was 1.51 (95% confidence interval 1.33-1.71) for prevalence and 1.48 (1.06-2.06) for incidence. In diabetic patients, the adjusted odds ratio for insulin users versus nonusers was 1.63 (1.23-2.15) for prevalence and 2.52 (1.37-4.64) for incidence.

CONCLUSIONS

NHL incidence is increasing in Taiwan. Diabetes and insulin use are associated with a higher risk.

Diabetes and risk of bladder cancer: a study using the National Health Insurance database in Taiwan

AIMS/HYPOTHESIS

Studies on the link between diabetes and bladder cancer in Asians are rare. We investigated the association between diabetes and incidence of bladder cancer by using a large national insurance database.

METHODS

A random sample of 1,000,000 individuals covered by the National Health Insurance was recruited. A total of 495,199 men and 503,748 women for all ages and 187,609 men and 189,762 women ≥40 years old and without bladder cancer at recruitment were followed from 2003 to 2005. Cox regression evaluated the adjusted relative risk for all ages and for age ≥40 years old.

RESULTS

The results were similar for all ages and for age ≥40 years. In Cox models, patients with diabetes consistently showed a significantly higher relative risk ranging from 1.36 to 1.51 after adjustment for age, sex and other potential confounders. Age, male sex, nephropathy, urinary tract diseases (infection and stone) and statin use were associated with bladder cancer, but occupation, hypertension, stroke, ischaemic heart disease, peripheral arterial disease, eye disease, dyslipidaemia and medications (oral glucose-lowering agents including sulfonylurea, metformin, acarbose and thiazolidinediones, insulin, fibrates, ACE inhibitors/angiotensin receptor blockers and calcium channel blockers) were not. Chronic obstructive pulmonary disease and living in regions other than Metropolitan Taipei were associated with lower risk.

CONCLUSIONS

Patients with diabetes have a higher risk of bladder cancer. The association with urinary tract diseases suggests a complex scenario in the link between bladder cancer and diabetes at different disease stages.

Medical and non-medical correlates of carpal tunnel syndrome in a Taiwan cohort of one million

BACKGROUND

Carpal tunnel syndrome (CTS), with unclear etiology, is the most common entrapment neuropathy. Its occurrence is related to lots of medical and non-medical conditions with uncertain causality. With a large population, we characterized selected demographical and clinical factors to add more information on CTS-correlated factors and new insight into future CTS prevention.

METHODS

A national insurance claim dataset of one million enrollees in Taiwan was used to identify 15 802 patients with CTS and 31 604 randomly selected controls, during a period of 7 years starting 1 January 2000. Statistical association with CTS was determined for five sociodemographic and nine medical factors.

RESULTS

Patients were predominantly women (65.6% vs. 47.7% in the control group) and older (40 and above, 62.6% vs. 36.2%). Rheumatoid arthritis was found to be the most significant comorbidity associated with CTS, followed by gout, hypertension, diabetes, obesity, uremia, and acromegaly. For younger group age ≤39, the association of these comorbidities was stronger, and hypothyroidism and vitamin B(6) deficiency were additional comorbidities. Aging appears to reduce the relative impact of the diseases commonly associated with CTS as the possible risk factors.

CONCLUSIONS

Identification of the CTS correlates in younger group would be of greater value in timely detection and treatment for these diseases. Correcting these disorders may aid in removing possible causes of CTS. This is the first report on the effect of aging on probable CTS risk factors. How factors associated with aging contribute to the development of CTS remains to be determined.

Furano-1,2-naphthoquinone inhibits EGFR signaling associated with G2/M cell cycle arrest and apoptosis in A549 cells

Furano-1,2-naphthoquinone (FNQ), prepared from 2-hydroxy-1,4-naphthoquinone and chloroacetaldehyde in an efficient one-pot reaction, exhibits an anti-carcinogenic effect. FNQ exerted anti-proliferative activity with the G(2)/M cell cycle arrest and apoptosis in A549 cells. FNQ-induced G(2)/M arrest was correlated with a marked decrease in the expression levels of cyclin A and cyclin B, and their activating partner cyclin-dependent kinases (Cdk) 1 and 2 with concomitant induction of p53, p21, and p27. FNQ-induced apoptosis was accompanied with Bax up-regulation and the down-regulation of Bcl-2, X-linked inhibitor of apoptosis (XIAP), and survivin, resulting in cytochrome c release and sequential activation of caspase-9 and caspase-3. Western blot analysis revealed that FNQ suppressed EGFR phosphorylation and JAK2, STAT3, and STAT5 activation, but increased in activation of p38 MAPK and c-Jun NH2-terminal kinase (JNK) stress signal. The combined treatment of FNQ with AG1478 (a specific EGFR inhibitor) significantly enhanced the G(2)/M arrest and apoptosis, and also led to up-regulation in Bax, p53, p21, p27, release of mitochondrial cytochrome c, and down-regulation of Bcl-2, XIAP, survivin, cyclin A, cyclin B, Cdk1, and Cdk2 in A549 cells. These findings suggest that FNQ-mediated cytotoxicity of A549 cell related with the G(2)/M cell cycle arrest and apoptosis via inactivation of EGFR-mediated signaling pathway.

Secular trend for mortality from breast cancer and the association between diabetes and breast cancer in Taiwan between 1995 and 2006

AIMS/HYPOTHESIS

Studies have identified an association between diabetes and breast cancer in postmenopausal women in Western countries. Such an association needs to be confirmed in an Asian population. The aim of this study was to evaluate the secular trend for breast cancer mortality in Taiwanese women in the general population and the mortality rate ratios between diabetic patients and the general population.

METHODS

Age-specific mortality rates for the general population, categorised into groups aged 25-54, 55-64, 65-74 and > or =75 years, were calculated for the years between 1995 and 2006 (inclusive) from vital statistics published by the Taiwanese government. Linear regression was used to test the trends. A total of 131,573 diabetic women aged > or =25 years from a national cohort recruited between 1995 and 1998 (inclusive) were followed prospectively for vital status, determined from the National Register of Deaths. Mortality rates and mortality rate ratios (mortality rate in diabetic women vs the average and highest mortality rates for the general population) were calculated.

RESULTS

A total of 14,230 women aged > or =25 years in the general population died of breast cancer between 1995 and 2006. A trend for an increase in the annual rate was observed for all age groups. A total of 482 diabetic women died of breast cancer, with a crude mortality rate of 45.7 per 100,000 person-years. Compared with the general population the relative risk of mortality for those with diabetes ranged from 1.37 (for the group aged 55-64 years) to 2.43 (for the group aged 25-54 years).

CONCLUSIONS/INTERPRETATION

We identified a secular trend of an increase in the rate of breast cancer mortality in the Taiwanese general population. Our data suggest a higher risk of breast cancer mortality in diabetic patients in all age groups.

Plasma-transforming growth factor-alpha expression in residents of an arseniasis area in Taiwan

Epidemiological studies have demonstrated an association between long-term exposure to inorganic arsenic and the related adverse effects such as cancers, skin lesions, and vascular diseases. Although several hypotheses have been proposed for the mechanism of arsenic-induced pathogenesis, it remains imperfectly understood. Recent studies have suggested that alterations in growth signal transduction pathways, particularly involving transforming growth factor-alpha (TGF-alpha), may be important. Immunoassays were used to determine the plasma levels of TGF-alpha and epidermal growth factor receptor (EGFR), which is the receptor for TGF-alpha, in residents of an arseniasis area of Taiwan in relation to their estimated cumulative arsenic exposure from drinking water. No relationship between arsenic exposure and EGFR was found. However, among the high cumulative exposure group (>6 ppm-years), levels of plasma TGF-alpha (25.5+/-38.2 pg ml-1) and the proportion of individuals with TGF-alpha over-expression (29.4%) were significantly higher (p<0.05) than normal, healthy unexposed controls (8.1+/-5.6 pg ml-1, 8.6%, respectively). There was a significant linear trend between cumulative arsenic exposure and the prevalence of plasma TGF-alpha over-expression after adjusting for age and sex (p=0.019). The results suggest that plasma TGF-alpha expression may be a useful biomarker when detecting adverse effects on arsenic exposed population.

Parental diabetes in Taiwanese diabetic women with and without previous gestational diabetes

Background Gestational diabetes mellitus (GDM) is reported to be associated with maternal but not paternal diabetes. This study examined the relative contribution of maternal and paternal diabetes among type 2 diabetic women with and without a GDM history. Materials and methods A total of 48 502 type 2 diabetic women from a national sample were interviewed by telephone. Among them, 510 reported a GDM history. Parental diabetes was compared between patients with and without a GDM history considering the confounding effects of age, body mass index, smoking, hypertension, duration of diabetes and insulin use. Results Patients with a GDM history were younger in age, had younger age of onset, longer duration of diabetes, slightly lower body mass index, higher prevalence of insulin use and lower prevalence of hypertension, but smoking rates were similar. The percentages of parental diabetes of nil, mother only, father only and both father and mother for those without a GDM history were 76.2, 15.2, 5.8 and 2.8%, respectively; and were 47.8, 26.8, 17.5 and 7.9%, respectively, for those with a GDM history (P < 0.001). The adjusted odds ratios for patients with versus without a GDM history for parental diabetes of nil, mother only, father only, and both father and mother were 1.000, 1.210 (0.948-1.544), 1.783 (1.341-2.371) and 2.094 (1.440-3.045), respectively. Conclusions Although maternal diabetes is more commonly seen, the disproportionately higher paternal diabetes in patients with a GDM history suggests an important role for paternal diabetes on the development of GDM into type 2 diabetes mellitus.

The association of gastric leptin with oesophageal inflammation and metaplasia

BACKGROUND

Gastro-oesophageal reflux disease complications may reflect imbalances between protective and injurious factors. Through its effects on cell growth, leptin may influence oesophageal mucosal homeostasis.

AIMS

To determine whether leptin receptors are present in the oesophagus, and whether serum or gastric leptin levels are associated with oesophageal inflammation and metaplasia.

METHODS

From patients referred for upper endoscopy, biopsies were obtained from the stomach and distal oesophagus, and serum samples were collected. Patients were classified as having normal, inflamed or Barrett's oesophagus. Quantitative immunohistochemistry was performed on representative sections, and leptin levels in plasma and gastric biopsy samples were determined by specific immunoassay.

RESULTS

Of 269 individuals enrolled, 105 were Helicobacter pylori-negative. Of the 88 patients with complete oesophageal biopsies, 44 were normal, 24 were inflamed and 20 were Barrett's oesophagus. Receptors for leptin were highly expressed on oesophageal epithelial cells, with similar density and staining pattern in all three conditions, and plasma and antral leptin levels did not differ significantly. Patients with Barrett's had significantly (p = 0.01) higher fundic leptin levels (median 202 (interquartile range 123-333) pg/mg) compared with normal (126 (78-221) pg/mg) or inflamed (114 (76-195) pg/mg) oesophagus. In multivariate analysis, for every twofold increase in fundic leptin, the odds of having Barrett's was 3.4 times (95% CI 1.5 to 7.6) higher compared with having a normal oesophagus.

CONCLUSIONS

Leptin receptor expression on oesophageal epithelial cells provides a pathway for leptin-mediated signal transduction. Variation in gastric leptin production could contribute to differential oesophageal healing and metaplasia progression.

Effect of parental hypertension and/or parental diabetes on hypertension in Taiwanese diabetic patients

BACKGROUND

Both type 2 diabetes mellitus (T2DM) and hypertension aggregate in families. It is a common thought that diabetic patients with parental diabetes and/or parental hypertension are more likely to develop hypertension. This study evaluated the separate and joint effects of parental hypertension and parental diabetes on the prevalence of hypertension in patients with T2DM.

MATERIALS AND METHODS

A total of 89 956 patients from a national cohort were interviewed by telephone. Information about age, sex, onset age of diabetes, body height, body weight, systolic (SBP) and diastolic blood pressure (DBP), smoking, hypertension, and paternal and maternal history of diabetes and hypertension were obtained. Hypertension was defined in two ways: (1) a positive history; or (2) a positive history or a reported SBP > or = 140 mmHg and/or DBP > or = 90 mmHg in patients without a hypertension history.

RESULTS

While analysed separately in logistic models, both parental diabetes and parental hypertension were positively associated with hypertension. However, when both were analysed together, only parental hypertension was positively associated with hypertension, with paternal and maternal hypertension exerting a similar effect of an approximately 2.5-fold higher risk. While considering the effect of parental hypertension, both paternal and maternal diabetes was significantly associated with a lower risk of hypertension with odds ratios of approximately 0.8. Parental hypertension was also significantly associated with increased SBP and DBP; and parental diabetes with lower values in multiple linear regression.

CONCLUSIONS

Parental hypertension is strongly associated with hypertension. However, parental diabetes may be protective if the effect of parental hypertension is considered.

Angiotensin-converting enzyme gene polymorphism and stroke in type 2 diabetic patients in Taiwan

BACKGROUND

The effect of traditional risk factors on the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and stroke was rarely studied previously. We investigated such effect in Taiwanese type 2 diabetic patients.

MATERIALS AND METHODS

A total of 872 (422 men and 450 women) patients aged 63.5 (SD: 11.6) years were recruited. Among them, 92 cases (48 men and 44 women) had stroke. Polymerase chain reaction was used to classify the genotypes as II, ID and DD. Analyses were performed in separate sexes.

RESULTS

The adjusted odds ratios for stroke for ID vs. II and DD vs. II were 0.837 (0.413-1.697) and 1.778 (0.596-5.300), respectively, for men; but were 1.700 (0.824-3.505) and 3.706 (1.375-9.985), respectively, for women. In models assuming recessive (DD vs. II + ID), dominant (DD + ID vs. II) and additive (II = 0, ID = 1 and DD = 2) transmission, none of the odds ratios was significant for men; but were all significant for women: 2.784 (1.137-6.818), 1.996 (1.006-3.962) and 1.877 (1.155-3.050), respectively. In models using patients without risk factors (hypertension, obesity, smoking or dyslipidaemia ) as a referent group and comparing them to patients with the risk factor and with ID/II, and with DD genotypes, all models (except for smoking) favoured an increasing trend of risk with patients having the risk factor and DD genotype at the highest risk in women. Similar trends for hypertension and dyslipidaemia were also observed in men.

CONCLUSION

Traditional risk factors play an important role in the association between the ACE genotypes and stroke. Patients with DD genotype and having traditional risk factors are at the highest risk.

Body mass index and waist circumference as determinants of coronary artery disease in Taiwanese adults with type 2 diabetes mellitus

OBJECTIVE

This study examined the association between body mass index (BMI) and waist circumference (WC) and coronary artery disease (CAD) in Taiwanese type 2 diabetic patients.

METHODS

A total of 1183 (558 men and 625 women) patients aged 62.4+/-11.6 years were studied. CAD was diagnosed by history or an electrocardiogram by Minnesota codes.

RESULTS

The respective cutoffs of BMI and WC as determined by the receiver operating characteristic curves were 24.5 kg/m2 and 90 cm for men, and 25 kg/m2 and 80 cm for women. Distributions of CAD prevalence and multivariate-adjusted odds ratio (MAOR) for BMI cutoffs of 24.5 and 25 kg/m2 were quite similar in men. MAOR for WC above the respective cutoffs for men and women was 1.832 (1.267-2.648) and 1.450 (0.956-2.200, 0.05<P<0.1), and for BMI> or = 25 kg/m2 was 1.759 (1.213-2.551) and 1.471 (1.052-2.058) for men and women, respectively. Patients with BMI> or = 25 kg/m2 and WC > or = 90 cm for men or > or = 80 cm for women had the highest risk of CAD when compared to those without either risk factor, with respective MAOR of 2.053 (1.352-3.118) and 1.698 (1.071-2.691).

CONCLUSION

The recommended BMI and WC cutoffs for obesity for Asian adults are associated with CAD in Taiwanese T2DM.

Increasing incidence of diagnosed type 2 diabetes in Taiwan: analysis of data from a national cohort

AIMS/HYPOTHESIS

Epidemiological evidence shows an increasing prevalence of type 2 diabetes in Taiwan. The aim of this study was to assess the yearly incidence for this country during 1992-1996.

SUBJECTS AND METHODS

Data obtained by telephone interviews of 93,484 diagnosed diabetic patients enrolled in Taiwan's National Health Insurance programme formed the basis of this study. A total of 36,153 incident cases of type 2 diabetes (17,097 men and 19,056 women) were identified and incidence rates calculated. The trends of obesity and parental diabetes were also evaluated.

RESULTS

The overall 5-year incidences for men and women were 187.1 and 218.4 per 100,000 population, respectively. The trends from 1992-1996 were increased for all age groups in men and for most age groups in women. A 2.8-fold increase in incidence was observed for the youngest age group (<35 years), in which the increase in incidence was higher than in the older age groups. Men showed a higher fold increase in incidence than did women (3.5 vs 2.1). Obesity at interview increased from 39.2% in 1992 to 47.6% in 1996 (p<0.001) and was significant for all ages. Parental diabetes showed no yearly change when all patients were analysed together, but there was a trend towards a decrease in the youngest age group (<35 years) and a trend towards an increase in the oldest age groups (>/=55 years).

CONCLUSIONS/INTERPRETATION

An increasing incidence of diagnosed type 2 diabetes was observed for each sex in most age groups in Taiwan, but was most marked in the youngest age group. A parallel increase in obesity was observed with the increasing incidence of diabetes.

Idiopathic syringomyelia: case report and review of the literature

Syringomyelia is an uncommon disease that is caused most often by type I Chiari malformation, which develops in the hindbrain, and less frequently by other factors which are not limited to the hindbrain, including trauma, infection, or scoliosis. Idiopathic syringomyelia is rare. We present in this article a patient with idiopathic syringomyelia characterized by hypoesthesia and progressive weakness in the left lower limb. Decompression was attempted by means of laminectomy and a syringoarachnoid shunt. Motor, sensory, and bladder functions were monitored by the change in Japanese Orthopedic Association scores, which increased from 10 points preoperatively to 14 points 30 days postoperatively. This case demonstrates the effectiveness of surgical decompression in a patient with remarkable neurological deficit.

Prevalence and risk factors for stroke in Type 2 diabetic patients in Taiwan: a cross-sectional survey of a national sample by telephone interview

AIMS

To determine the prevalence and risk factors for stroke in patients with Type 2 diabetes mellitus (T2DM) and the age-specific prevalence odds ratios (POR) in comparison with the general population in Taiwan.

METHODS

A total of 16 994 T2DM patients were randomly selected for telephone interview from a group covered by the National Health Insurance programme. Lifetime prevalence of stroke was calculated and various risk factors were analysed. Age-specific POR was calculated using previously reported prevalence of stroke in the general population from a nationwide survey across Taiwan. Standardized prevalence and POR were also calculated using the 2000-2025 population of the World Health Organization.

RESULTS

A total of 12 531 cases (73.7%) were successfully interviewed. Stroke prevalence was 7.5%. In multivariate logistic regression, independent predictors were: increasing age, male gender, lower body mass index, ex-smokers, hyperlipidaemia, systolic pressure (or diastolic pressure when systolic pressure was not adjusted), education level below high school, and living in eastern or southern Taiwan. When compared with the general population, POR for stroke in the age groups < 45, 45-54, 55-64 and > or = 65 years were 82.29 (9.60, 705.57), 5.43 (2.33, 12.68), 3.73 (2.20, 6.33) and 2.14 (1.59, 2.89), respectively. The age-standardized prevalence of stroke was 2.3% in the diabetic patients and 0.6% in the general population.

CONCLUSIONS

Stroke prevalence in Taiwanese T2DM is 7.5%. Diabetic patients have a higher risk of stroke than the general population, but the relative risk attenuates with age. Besides conventional atherosclerotic risk factors, stroke patients in Taiwan are characterized by lower body mass index, lower education level and residence in southern or eastern Taiwan. The negative association between body mass index and stroke in Taiwanese T2DM is in contrast to the generally accepted concept that obesity is a major risk factor as seen in most western countries.

Independent association of uric acid levels with peripheral arterial disease in Taiwanese patients with Type 2 diabetes

AIMS

Hyperuricaemia may be a risk factor for atherosclerotic disease. Its association with peripheral arterial disease (PAD) has not been studied in Taiwanese patients with Type 2 diabetes.

METHODS

Uric acid (UA) levels and PAD were evaluated in 508 Taiwanese outpatients with Type 2 diabetes (210 men, 298 women; mean age +/- sd, 63.8 +/- 10.6 years). PAD was diagnosed when the ankle-brachial index was < 0.9. Patients with an ankle-brachial index of > or = 1.3 were excluded because of possible medial arterial calcification. Potential confounding variables with P < 0.10 were adjusted for in multivariate analyses.

RESULTS

In univariate analyses, UA levels were higher in patients with PAD than in those without PAD (345.0 +/- 95.2 vs. 309.3 +/- 89.2 micromol/l; P < 0.0005). Prevalences of PAD for quintiles of UA levels were 6.8, 8.9, 10.2, 13.1 and 16.5%, respectively (P-trend < 0.05). With UA level as a continuous variable, the multivariate-adjusted odds ratio (95% confidence interval) for PAD was 1.005 (1.001-1.008) (P < 0.01). The optimal cut-off point for UA as determined by the receiver operating characteristic curve was 264.7 micromol/l. The sensitivity and specificity at this cut-off point was 82.6 and 33.3%, respectively. The area under curve was 0.60 (95% confidence interval: 0.53-0.68). The multivariate-adjusted odds ratio for PAD for UA above this level was 2.736 (1.239-6.043) (P < 0.05). The results after excluding 56 cases using diuretics were similar.

CONCLUSIONS

Elevated uric acid level is a significant and independent risk factor for PAD in Taiwanese patients with Type 2 diabetes.

The prevalence of TT virus and GB virus C/hepatitis G virus infection in individuals with raised liver enzymes but without HBV or HCV infection in Taiwan

The prevalence of TT virus (TTV) and GB virus-C/hepatitis G virus (GBV-C/HGV) infection and the association with raised liver function tests in 546 Taiwanese with negative HBsAg, anti-HCV and HCV RNA was elucidated. They were tested for serum alanine aminotransferase (ALT), GBV-C/HGV RNA, anti-envelope protein 2 antibody (anti-E2) and TTV DNA. Direct sequencing and phylogenetic analyses were performed on 58 isolates for TTV genotype determination. The prevalence of TTV DNA, GBV-C/HGV RNA, anti-E2 and over all GBV-C/HGV exposure was 24.9, 3.4, 8.2 and 11.1%, respectively. Using uni- and multi-variate analyses, male gender and TTV viremia were associated significantly with raised ALT values. Sixty-nine percent of TTV isolates were deduced to be TTV genotype 1 and they had significantly lower mean age than genotype non-1 isolates. In the population, raised ALT may be related to male gender and be attributable to TTV infection but not to GBV-C/HGV among individuals with no evidence of current HBV and HCV infection. TTV genotype 1 is the most prevalent genotype and associated with younger age.

Real-time PCR for rapid genotyping of angiotensin-converting enzyme insertion/deletion polymorphism

OBJECTIVE

To develop a real-time PCR technique for detection of the insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE) gene.

DESIGN AND METHODS

Three primers were designed for performing real-time PCR in the presence of SYBR Green I as flurochrome followed by melting curve analysis. Forty human genomic DNA that have been genotyped by two-rounds of conventional PCR were used for evaluation of this technique.

RESULTS

Melting curve analysis indicated the melting peak at 73.9 degrees C and 76.2 degrees C corresponding to the presence of I and D alleles, respectively. Comparable genotyping results were obtained by both conventional and real-time PCR. Besides, the mistyping of ID allele individuals by the first run of conventional PCR were accurately genotyped by single-tube real time PCR.

CONCLUSIONS

The real-time PCR method presented in this study provides a rapid and sensitive way for genotyping of ACE gene that may be suitable for large-scale clinical and epidemiologic study.

Enhanced effect of in-situ generated ammonium salts aerosols on the removal of NOx from simulated flue gas

The combined removal of sulfur dioxide (SO2, up to 3,000 ppm) and nitrogen oxides (NO and NO2, up to 1,200 ppm) has been investigated in a bench-scale pulsed-corona enhanced wet electrostatic precipitator (wESP) with the optional injection of ammonia and/or ozone. The reaction of ammonia with SO2 produces submicron aerosols under certain conditions. Experiments have shown the feasibility of combined SO2 and NOx removal from simulated flue gases by the action of these in-situ generated aerosols. The mechanisms for NOx removal include oxidation of NO to NO2 and subsequent absorption of NO2 into the water wall of the wESP. The results have shown that injecting NH3 (NH3/NOx molar ratio 1) resulted in NOx removal of approximately 13% in a simulated combustion flue gas. Injecting 200 ppm ozone (no ammonia) increased NO conversion to 35% by oxidation, but total NOx removal increased to only 17%. Without the formation of ammonium salts aerosols (e.g., without SO2 in the gas), co-injection of ammonia and ozone increased NO conversion to 60% and NOx removal to 40%. However, high NOx removals were measured in simulated flue gas that contained NH3, SO2, and ozone. The total NOx removal efficiency was 79% when the ammonium salts aerosols were formed in the presence of 2400 ppm SO2, 312 ppm O3, and 2,900 ppm NH3. The energy efficiency of collection improved by approximately 250% for SO2 removal and more than 4700% for NOx removal under these conditions. It was determined that the ammonium salts aerosols produced from the reaction of ammonia and sulfur dioxide substantially enhanced total NOx removal.

Induction of disabled-2 gene during megakaryocyte differentiation of k562 cells

Megakaryocyte differentiation is often accompanied by the changes of gene expression pattern. Here we reported that the expression of DAB2, a putative adaptor protein in cell signaling, was induced at the protein and mRNA levels upon 12-O-tetradecanoylphorbol-13-acetate-mediated megakaryocyte differentiation of human chronic myeloid leukemic K562 cells. On the other hand, the differentiation agents DMSO and retinoic acid had no effect on DAB2 expression. Analysis of promoter activity with the human DAB2 luciferase reporter constructs suggested that the regulation is partially at the transcriptional level. The responsive sequences located within an 80-bp DAB2 promoter region. To determine the involvement of MEK1-p42/p44 MAPK pathway in mediating DAB2 gene expression, we have performed the following experiments and found that (i) there was sustained activation of p42/p44 MAPK, but not p38 MAPK, upon K562 cells differentiation; (ii) application of MEK1 inhibitor U0126 reduced the expression of DAB2 protein, mRNA and promoter activity, as well as cell differentiation; (iii) constitutively active MEK1 increased DAB2 promoter activity; and (iv) dominant negative ERK2 abolished constitutively active MEK1-induced DAB2 promoter activity. Taken together, our results indicate that DAB2 gene is induced upon megakaryocyte differentiation by the MEK1-p42/p44 MAPK pathway and may define a new role of DAB2 in hematopoietic cell differentiation.

Incidence of transitional cell carcinoma and arsenic in drinking water: a follow-up study of 8,102 residents in an arseniasis-endemic area in northeastern Taiwan

A significant association between ingested arsenic and bladder cancer has been reported in an arseniasis-endemic area in southwestern Taiwan, where many households share only a few wells in their villages. In another arseniasis-endemic area in northeastern Taiwan, each household has its own well for obtaining drinking water. In 1991-1994, the authors examined risk of transitional cell carcinoma (TCC) in relation to ingested arsenic in a cohort of 8,102 residents in northeastern Taiwan. Estimation of each study subject's individual exposure to inorganic arsenic was based on the arsenic concentration in his or her own well water, which was determined by hydride generation combined with atomic absorption spectrometry. Information on duration of consumption of the well water was obtained through standardized questionnaire interviews. The occurrence of urinary tract cancers was ascertained by follow-up interview and by data linkage with community hospital records, the national death certification profile, and the cancer registry profile. Cox proportional hazards regression analysis was used to estimate multivariate-adjusted relative risks and 95% confidence intervals. There was a significantly increased incidence of urinary cancers for the study cohort compared with the general population in Taiwan (standardized incidence ratio = 2.05; 95% confidence interval (CI): 1.22, 3.24). A significant dose-response relation between risk of cancers of the urinary organs, especially TCC, and indices of arsenic exposure was observed after adjustment for age, sex, and cigarette smoking. The multivariate-adjusted relative risks of developing TCC were 1.9, 8.2, and 15.3 for arsenic concentrations of 10.1-50.0, 50.1-100, and >100 microg/liter, respectively, compared with the referent level of < or =10.0 microg/liter.

Unexpected cytokines in serum of malignant melanoma patients during sequential biochemotherapy

Biochemotherapy, which combines traditional chemotherapy with immune modulating biologicals, produces an unexpectedly high response rate (>50%) in advanced melanoma patients. We hypothesize that immunological mechanism(s) are responsible for the increased response rate, and particularly that macrophage activation is involved in tumor reduction. Patients were randomized to receive chemotherapy, composed of cisplatin, vinblastine, and dacarbazine (CVD), or biochemotherapy, which is CVD followed by interleukin (IL)-2 and IFN-alpha2b (CVD-BIO). Laboratory analysis was performed on sera from 41 patients from each arm. Measurements of macrophage activation (neopterin), nitric oxide production (nitrite), and tumor necrosis factor-alpha (TNF-alpha), IL-1alpha, IL-1beta, IFN-gamma, IL-6, IL-10, and soluble IL-2 receptor (sIL-2R) were performed. Six of the nine biological responses (nitrite, neopterin, IFN-gamma, IL-6, soluble IL-2R, and IL-10) significantly (P < 0.0002) increased in the CVD-BIO patients but not in the CVD patients. The increased IL-6 (P = 0.04) and IL-10 (P = 0.05) correlated with patient response, but only when the minor responders were included in the analysis. Evidence of macrophage activation was found in CVD-BIO patients and not in those receiving CVD alone. In addition, an unusual cytokine elaboration composed of IL-6, IFN-gamma, IL-10, nitrite, neopterin, and sIL-2R, but not the expected TNF-alpha and IL-1, was detected. A trend of higher increase in IL-6 and IL-10 in patients having clinical response was found, suggesting an incomplete Th2 pattern of cytokine elaboration. These data show that macrophage activation does not appear to be critical in the response to CVD-BIO, but that IL-10 and IL-6 induced by the BIO component of the CVD-BIO were associated with tumor regression, and that their biology should be pursued further in the analysis of mechanism(s) of response.

The incidence of type 2 diabetes mellitus in Taiwan

Currently, diabetes mellitus is the fifth leading cause of death in Taiwan. The trends of diabetes mortality is increasing steadily. Epidemiologic studies also showed increasing prevalence of diabetes mellitus over the past few decades. The incidence of diabetes mellitus in Taiwan has only been studied in recent 10 years. The areas that have been included as study areas for diabetes incidence are Kin-Chen (Kinmen), Chu-Dung, Pu-Tzu, Pu-Li and Pu-Tai. The reported incidence rates ranged from 1.0 to 4.0% per year for people with varying degrees of baseline plasma glucose levels not reaching the diagnosis of diabetes mellitus according to the criteria of the World Health Organization. Age, baseline glucose level, and obesity are important predictors for the development of diabetes mellitus. In the Pu-Tai study, which was aimed at following a group of people who had been living in the hyperendemic villages of blackfoot disease and had been exposed to arsenic from drinking artesian well water, the incidence of diabetes mellitus was calculated to be 27.4 per 1000 person years. The incidence of diabetes mellitus in these arseniasis-hyperendemic villages correlated with age, body mass index and cumulative arsenic exposure.

Long-term arsenic exposure and incidence of non-insulin-dependent diabetes mellitus: a cohort study in arseniasis-hyperendemic villages in Taiwan

Diabetes prevalence in arseniasis-hyperendemic villages in Taiwan has been reported to be significantly higher than in the general population. The aim of this cohort study was to further evaluate the association between ingested inorganic arsenic and the incidence of non-insulin-dependent diabetes mellitus in these villages. A total of 446 nondiabetic residents in these villages were followed biannually by oral glucose tolerance test. Diabetes is defined as a fasting plasma glucose level > or = 7.8 mmol/L and/or a 2-hr post-load glucose level > or = 11.1 mmol/L. During the follow-up period of 1499.5 person-years, 41 cases developed diabetes, showing an overall incidence of 27.4/1,000 person-years. The incidence of diabetes correlated with age, body mass index, and cumulative arsenic exposure. The multivariate-adjusted relative risks were 1.6, 2.3, and 2.1 for age > or = 55 versus < 55 years, a body mass index ¿Greater/Equal to] 25 versus < 25 kg/m(2), and a cumulative arsenic exposure > or = 17 versus < 17 mg/L-years, respectively. The incidence density ratios (95% confidence intervals) between the hyperendemic villages and the two nonendemic control townships were 3.6 (3.5-3.6), 2.3 (1.1-4.9), 4.3 (2.4-7.7), and 5.5 (2.2-13.5), respectively, for the age groups of 35-44, 45-54, 55-64, and 65-74 years. The findings are consistent with our previous cross-sectional observation that ingested inorganic arsenic is diabetogenic in human beings.

Magnetic resonance imaging of convection in laser-polarized xenon

We demonstrate nuclear magnetic resonance (NMR) imaging of the flow and diffusion of laser-polarized xenon (129Xe) gas undergoing convection above evaporating laser-polarized liquid xenon. The large xenon NMR signal provided by the laser-polarization technique allows more rapid imaging than one can achieve with thermally polarized gas-liquid systems, permitting shorter time-scale events such as rapid gas flow and gas-liquid dynamics to be observed. Two-dimensional velocity-encoded imaging shows convective gas flow above the evaporating liquid xenon, and also permits the measurement of enhanced gas diffusion near regions of large velocity variation.

A system for low field imaging of laser-polarized noble gas

We describe a device for performing MRI with laser-polarized noble gas at low magnetic fields (<50 G). The system is robust, portable, inexpensive, and provides gas-phase imaging resolution comparable to that of high field clinical instruments. At 20.6 G, we have imaged laser-polarized (3)He (Larmor frequency of 67 kHz) in both sealed glass cells and excised rat lungs, using approximately 0.1 G/cm gradients to achieve approximately 1 mm(2) resolution. In addition, we measured (3)He T(2)(*) times greater than 100 ms in excised rat lungs, which is roughly 20 times longer than typical values observed at high ( approximately 2 T) fields. We include a discussion of the practical considerations for working at low magnetic fields and conclude with evidence of radiation damping in this system.