Background and purpose
Migraine and irritable bowel syndrome (IBS) share many similarities characterized by their epidemiology, periodic pain, lack of definable organic causes, trigger factors, ...comorbidities and proposed pathophysiology. In this retrospective case–control study, the association between migraine and IBS was investigated using a nationwide population‐based database in Taiwan.
Methods
The data were retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan. In all, 14 117 newly diagnosed migraine cases were identified in a subset of the NHIRD and 56 468 migraine‐free individuals were randomly selected as the comparison cohort. The multivariate Cox proportional hazards regression model was used to explore the risk of IBS in migraine sufferers after adjusting for demographic characteristics and comorbidities.
Results
After adjusting for the covariates, the incidence of IBS was 1.95‐fold higher in the migraine cohort than in the comparison cohort (73.87 vs. 30.14 per 10 000 person‐years). The adjusted cumulative incidence of IBS was also higher in the migraine group than in the control group in the follow‐up years (log‐rank test, P < 0.0001). In addition, the risk was most prominent in the youngest group (<30 years old), exhibiting a 3.36‐fold increased risk (95% confidence interval 2.44–4.63) of IBS compared with the migraine‐free cohort. Moreover, the incidence of IBS in migraine sufferers tended to increase with the frequency of migraine diagnoses.
Conclusion
The current population‐based study demonstrated that migraine is associated with an increased risk of IBS after adjusting for comorbidities, particularly in the young population.
Summary
Background
Epidemiological investigations have examined the association between type 1 diabetes mellitus (T1DM) and atopic disease, but have obtained conflicting results.
Objectives
To ...analyse the association between T1DM and atopic dermatitis (AD) in a population‐based, retrospective cohort study that investigated the hypothesis that childhood T1DM is a risk factor for subsequent AD.
Methods
From claims data of the National Health Insurance programme of Taiwan, we identified 3386 patients with T1DM newly diagnosed from 1998 to 2011 and 12 725 randomly selected controls without T1DM. These were frequency matched by age, sex and year of diagnosis. Both cohorts were followed up until the end of 2011 to evaluate the AD risk. We used Cox proportional hazards regression models to analyse the risk of AD.
Results
The overall incidence rate of AD was 1·40‐fold (significantly) higher in the T1DM cohort than in the non‐T1DM cohort (3·31 vs. 2·35 per 1000 person years). After adjustment for potential risk factors, the overall risk of AD remained higher in the T1DM cohort adjusted hazard ratio (HR) 1·76, 95% confidence interval (CI) 1·29–2·39 than in those without T1DM. Compared with the non‐T1DM cohort, the patients with T1DM with more emergency room visits (adjusted HR 30·1, 95% CI 18·7–48·5) or hospitalizations (adjusted HR 70·3, 95% CI 45·6–114·5) had a higher risk of subsequent AD.
Conclusions
This nationwide, retrospective cohort study demonstrates that childhood T1DM may increase the risk of AD.
What's already known about this topic?
Some studies have reported that atopic dermatitis (AD) is associated with a lower risk of type 1 diabetes mellitus (T1DM).
An inverse association was theorized between T1DM and AD because the T‐helper 1/2 immune responses of these two diseases are mutually inhibitory.
What does this study add?
This nationwide, retrospective cohort study demonstrates that childhood T1DM may increase the risk of AD.
The overall AD incidence rate was 1·40‐fold (significantly) higher in the T1DM cohort than in the non‐T1DM cohort (3·31 vs. 2·35 per 1000 person years).
Linked Comment: Ezzedine and Barbarot, Br J Dermatol 2016; 174: 16.
Plain language summary available online
Objectives
Inflammatory processes (both infections and autoimmune diseases) may cause endothelial dysfunction and arterial atherosclerosis, subsequently increasing the risk of acute ischemic stroke ...(AIS). In this investigation, we analyzed the association between hepatitis B virus (HBV) infection and AIS risk.
Methods
A Taiwan national insurance claims data set of 1,000,000 patients was used to extract 22,303 patients with HBV and 89,212 randomly selected sex‐ and age‐matched controls from the beginning of 2000 to the end of 2006. Both groups were followed up until the appearance of AIS or the end of 2011. AIS risk was measured using the Cox proportional regression model.
Results
After adjusting for the relevant covariates, the HBV group exhibited a lower AIS risk (adjusted hazard ratio aHR = 0.77, 95% confidence interval CI: 0.66–0.89) compared with the controls at the end of follow‐up. Under the condition of no comorbidities, patients with HBV had a lower AIS risk compared with the controls (aHR = 0.65, 95% CI: 0.48–0.87). In 3 age‐stratified subgroups, HBV was correlated with a significantly diminished risk of AIS (age ≤ 49 years: aHR = 0.57, 95% CI: 0.39–0.82; age 50–64 years: aHR = 0.65, 95% CI: 0.53–0.80; age ≥ 65 years: aHR = 0.96, 95% CI: 0.76–1.23).
Conclusion
HBV was correlated with a reduced risk of AIS development. Although a decrease in AIS risk was noted in the patients with HBV, preventing the development of AIS in this population warrants further attention.
Summary
Gastroesophageal reflux disease (GERD) with proton pump inhibitor (PPI) use is associated with an increased risk of osteoporosis. The risk of hip fracture is not increased in GERD patients ...with PPI use.
Introduction
The relationship between GERD with PPI treatment and the risk of osteoporosis is unclear. We aimed to determine the risk of developing osteoporosis in patients diagnosed with GERD.
Methods
Patients diagnosed with GERD and received PPI treatment between 2000 and 2010 were identified from the Longitudinal Health Insurance Database as the study cohort (
n
= 10,620), which was frequency matched with the comparison cohort (
n
= 20,738) sampled from the general population according to age, sex, index year, and comorbidities. Both cohorts were followed until the end of 2011. The risk of osteoporosis was evaluated in both groups by using Cox proportional hazards regression models.
Results
The GERD patients with PPI treatment had a greater incidence (31.4 vs 20.7 per 1000 person-year; crude hazard ratio cHR 1.51; 95 % confidence interval CI 1.40–1.63) and a higher risk (adjusted HR aHR 1.50; 95 % CI 1.39–1.62) of osteoporosis than that of the comparison cohort. However, the overall incidence of hip fracture was not different between the GERD with PPI use and the control cohorts (aHR 0.79; 95 % CI 0.53–1.18).
Conclusion
GERD with PPI use is associated with an increased risk of osteoporosis. The findings of our study do not support an increased risk of hip fracture in GERD patients treated with a PPI.
Abstract Superconductivity in the cuprates is found to be intertwined with charge and spin density waves. Determining the interactions between the different types of order is crucial for ...understanding these important materials. Here, we elucidate the role of the charge density wave (CDW) in the prototypical cuprate La 1.885 Sr 0.115 CuO 4 , by studying the effects of large magnetic fields ( H ) up to 24 Tesla. At low temperatures ( T ), the observed CDW peaks reveal two distinct regions in the material: a majority phase with short-range CDW coexisting with superconductivity, and a minority phase with longer-range CDW coexisting with static spin density wave (SDW). With increasing magnetic field, the CDW first grows smoothly in a manner similar to the SDW. However, at high fields we discover a sudden increase in the CDW amplitude upon entering the vortex-liquid state. Our results signify strong coupling of the CDW to mobile superconducting vortices and link enhanced CDW amplitude with local superconducting pairing across the H − T phase diagram.
The relationship between tuberculosis (TB) and subsequent chronic kidney disease (CKD) remains unclear. Therefore, we examined the risk of CKD among patients with TB in a nationwide study.
We ...conducted a retrospective cohort study using data from the National Health Insurance system of Taiwan. The cohort included 8735 patients who were newly diagnosed with TB. Patients were recruited between 1998 and 2002, and the date of diagnosis was defined as the index date. Each patient was randomly matched with four people from the general population without TB, according to age, gender and the index year. The occurrence of CKD was followed up until the end of 2011. The relative risks of CKD were estimated using the Cox proportional hazard model after adjusting for age, gender, index year and comorbidities.
The overall incidence of CKD was 1.27-fold greater in the TB cohort than in the non-TB cohort. The adjusted hazard ratio (HR) of CKD associated with TB was higher in women (1.72; 95% confidence interval CI: 1.33-2.22), those aged <50 years (1.67; 95% CI: 1.15-2.41) and those without comorbidities (1.39; 95% CI: 1.06-1.83). In addition, patients with more comorbidities among hypertension, diabetes and hyperlipidemia have a greater risk of developing CKD in both cohorts, and the adjusted HRs were higher in the TB cohort than in the non-TB cohort.
TB patients had a significantly higher risk of developing CKD than the general population. The detailed mechanisms need further investigation.
Periodontal disease encompasses gingivitis and periodontitis, which exerts systemic effects. We conducted a population-based study to evaluate the association between periodontal disease and the risk ...of cancer.
We used insurance claims data from 1997 to 2010, accessing a database of 1 million randomly selected insurants in Taiwan. All patients were older than 20 and newly diagnosed with periodontitis between 1 January 1997 and 31 December 2010. The comparison cohort comprised patients older than 20, who were newly diagnosed with gingivitis in the same period. Both cohorts were followed until a cancer diagnosis, lost to follow-up, death, termination of insurance, or the end of 2010.
The incidence rate of cancer was 1.14 times higher in the study cohort than in the comparison cohort confidence interval (CI) = 1.11-1.17. The adjusted hazard ratio (HR) was 1.05 (95% CI = 1.00-1.11). A multivariable analysis showed that the periodontitis patients exhibited an elevated risk of developing oral cancer (adjusted HR = 1.79, 95% CI = 1.42-2.25).
The findings indicated that patients in the periodontitis cohort exhibited a higher risk of developing oral cancer than those in the gingivitis cohort.
Summary
Background
Data are limited regarding the effectiveness and safety of generic velpatasvir plus sofosbuvir (VEL/SOF) for hepatitis C virus (HCV) in patients with or without human ...immunodeficiency virus (HIV) coinfection.
Aim
To evaluate the effectiveness and safety of generic VEL/SOF‐based therapy for HCV infection in patients with or without HIV coinfection in Taiwan.
Methods
Sixty‐nine HIV/HCV‐coinfected and 159 HCV‐monoinfected patients receiving 12 weeks of generic VEL/SOF with or without ribavirin (RBV) for HCV were prospectively enrolled. The anti‐viral responses and the adverse events (AEs) were compared between the two groups. The characteristics potentially related to sustained virological response 12 weeks off therapy (SVR12) were analysed.
Results
The SVR12 was achieved in 67 HIV/HCV‐coinfected patients (97.1%; 95% CI: 90.0%‐99.2%) and in 156 HCV‐monoinfected patients (98.1%; 95% CI: 94.6%‐99.4%) receiving VEL/SOF‐based therapy, respectively. The SVR12 rates were comparable between HIV/HCV‐coinfected and HCV‐monoinfected patients, regardless of pre‐specified baseline characteristics. One hundred twenty‐two (53.5%) and seven (3.1%) patients had baseline resistance‐associated substitutions (RASs) in HCV NS5A and NS5B regions, but the SVR12 rates were not affected by the presence or absence of RASs. One (1.4%) and five (3.1%) patients in the HIV/HCV‐coinfected and HCV‐monoinfected groups had serious AEs. No patient died or discontinued treatment due to AEs. The eGFR remained stable throughout the course of treatment in HIV/HCV‐coinfected patients receiving anti‐retroviral therapy containing tenofovir disoproxil fumarate (TDF).
Conclusions
Generic VEL/SOF‐based therapy is well‐tolerated and provides comparably high SVR12 rates for HCV infection in patients with and without HIV coinfection.
To evaluate the possible association between paediatric head computed tomography (CT) examination and increased subsequent risk of malignancy and benign brain tumour.
In the exposed cohort, 24 418 ...participants under 18 years of age, who underwent head CT examination between 1998 and 2006, were identified from the Taiwan National Health Insurance Research Database (NHIRD). Patients were followed up until a diagnosis of malignant disease or benign brain tumour, withdrawal from the National Health Insurance (NHI) system, or at the end of 2008.
The overall risk was not significantly different in the two cohorts (incidence rate=36.72 per 100 000 person-years in the exposed cohort, 28.48 per 100 000 person-years in the unexposed cohort, hazard ratio (HR)=1.29, 95% confidence interval (CI)=0.90-1.85). The risk of benign brain tumour was significantly higher in the exposed cohort than in the unexposed cohort (HR=2.97, 95% CI=1.49-5.93). The frequency of CT examination showed strong correlation with the subsequent overall risk of malignancy and benign brain tumour.
We found that paediatric head CT examination was associated with an increased incidence of benign brain tumour. A large-scale study with longer follow-up is necessary to confirm this result.
Asbestos-induced chronic inflammation is implicated in the pathogenesis of malignant mesothelioma (MM). We have investigated blood neutrophil-to-lymphocyte ratio (NLR), an index of systemic ...inflammation, as a prognostic factor in MM patients.
Patients with MM who had systemic therapy at participating institutes were studied. Potential prognostic factors such as age, gender, performance status, histologic subtype, and baseline laboratory parameters, including NLR, were analyzed. Overall survival from commencement of therapy was determined by the Kaplan-Meier method. Multivariate analyses using Cox Regression model were performed with significant factors (P ≤ 0.05) to determine their independent effect.
A total of 173 MM patients undergoing systemic therapy including 119 patients receiving first-line therapy and 54 patients receiving second- or third-line therapy were included in this retrospective evaluation. Forty-two percent of patients had an elevated NLR at baseline. The following variables were predictive of survival: female gender (P = 0.044), epithelioid histologic subtype (P < 0.001), baseline white blood cell count less than 8.3 × 10⁹/L (P = 0.008), baseline platelet count 400 × 10⁹/L or less (P = 0.05), and NLR of 5 or less (P < 0.001). After multivariate analysis, histologic epithelioid subtype hazard ratio (HR) = 2.0; 95% confidence interval (CI) = 1.3-2.9; P = 0.001, and NLR less than 5 (HR = 2.7; 95% CI = 1.8-3.9; P < 0.001) remained independent predictors. The 1-year survival rate was 60% versus 26%, whereas the 2-year survival rate was 34% versus 10% for NLR less than 5 and 5 or greater, respectively. In the separate analyses of chemotherapy-naive and previously treated patient groups, NLR was an independent predictor of survival in both groups.
Our results indicate that NLR is an independent predictor of survival for patients with MM undergoing systemic therapy.
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