Increased Risk of Vascular Events in Emergency Room Patients Discharged Home with Diagnosis of Dizziness or Vertigo: A 3-Year Follow-Up Study

BACKGROUND: Dizziness and vertigo symptoms are commonly seen in emergency room (ER). However, these patients are often discharged without a definite diagnosis. Conflicting data regarding the vascular event risk among the dizziness or vertigo patients have been reported. This study aims to determine the risk of developing stroke or cardiovascular events in ER patients discharged home with a diagnosis of dizziness or vertigo. METHODOLOGY: A total of 25,757 subjects with at least one ER visit in 2004 were identified. Of those, 1,118 patients were discharged home with a diagnosis of vertigo or dizziness. A Cox proportional hazard model was performed to compare the three-year vascular event-free survival rates between the dizziness/vertigo patients and those without dizziness/vertigo after adjusting for confounding and risk factors. RESULTS: We identified 52 (4.7%) vascular events in patients with dizziness/vertigo and 454 (1.8%) vascular events in patients without dizziness/vertigo. ER patients discharged home with a diagnosis of vertigo or dizziness had 2-fold (95% confidence interval [CI], 1.35-2.96; p<0.001) higher risk of stroke or cardiovascular events after adjusting for patient characteristics, co-morbidities, urbanization level of residence, individual socio-economic status, and initially taking medications after the onset of dizziness or vertigo during the first year. CONCLUSIONS: ER patients discharged home with a diagnosis of dizziness or vertigo were at a increased risk of developing subsequent vascular events than those without dizziness/vertigo after the onset of dizziness or vertigo. Further studies are warranted for developing better diagnostic and follow-up strategies in increased risk patients

Twist Expression of Nasopharyngeal Carcinoma Predicts Pre-vertebral Space Invasion and Survival Outcome

Background: The purpose of this study was to explore Twist expression in nasopharyngeal carcinoma and to investigate the prognostic impact of Twist expression on survival rates in patients with nasopharyngeal carcinoma. Methods: We utilized Western blotting to investigate the expression of Twist, vimentin, and E-cadherin in NPC cell lines. Additionally, a retrospective review of case notes from the Dalin Tzu Chi General Hospital archives was performed. We analyzed the relationship between Twist expression of tissue specimen, TNM staging, and survival rates by using immunohistochemical staining. All nasopharyngeal carcinoma patients were included. We used Pearson's chi-square and Fisher's exact tests to analyze the correlation between Twist expression of tissue specimen and TNM staging and clinical features. Kaplan-Meier survival curves were constructed and survival analysis was completed using Cox proportional hazard models. Receiver operating characteristic (ROC) curve was also examined in order to validate the ability of Twist expression to predict outcomes. Results: A total of 48 patients with newly diagnosed NPC were enrolled in this study. Nineteen patients (40%) in this series were found to have Twist overexpression. Twist overexpression in NPC patients was associated with pre-vertebral space invasion (P = 0.032). Patients with Twist overexpression were found to have a poor overall survival rate compared with others (P = 0.01, respectively), but not metastasis free-survival rate (P = 0.126). There was a trend toward significance between Twist expression and advanced T classification (P = 0.094 respectively). Multivariate analysis showed that Twist overexpression was associated with poor survival rate (hazard ratio 5, 95% confidence interval 1.07-27; P = 0.041). The receiver operating characteristic (ROC) curves for predicting outcomes revealed that Twist expression (area under curve = 0.735) was superior to T classification (area under curve = 0.718) and clinical stage (area under curve = 0.598). Conclusions: Twist may be a useful molecular marker for nasopharyngeal carcinoma and indicator for overall survival. Patients with Twist expression should be treated more aggressively

Effects of Intradialytic Exercise on Dialytic Parameters, Health-Related Quality of Life, and Depression Status in Hemodialysis Patients: A Randomized Controlled Trial

Exercise is fundamentally important in managing chronic diseases and improving health-related quality of life (HRQL). However, whether intradialytic exercise is safe through assessment of changes in dialytic parameters and has a positive impact on HRQL and depression status of hemodialysis patients requires further research with diverse racial and cultural populations to identify. This study aimed to evaluate the effects of intradialytic exercise on dialytic parameters, HRQL, and depression status in hemodialysis patients. A randomized controlled trial was conducted at a medical center in Northern Taiwan. Sixty-four hemodialysis patients were recruited using stratified random sampling. Participants were randomized into an experimental group (EG, n = 32) or a control group (CG, n = 32). The EG received a 12-week intradialytic exercise program while the CG maintained their usual lifestyles. Dialytic parameters, HRQL, and depression status were collected at baseline and at 12 weeks. The results indicated no differences in the dialytic parameters from the baseline between both groups. However, the EG had increased HRQL (ß = 22.6, p &lt; 0.001) and reduced depression status (ß = −7.5, p = 0.02) at 12 weeks compared to the CG. Therefore, a 12-week intradialytic exercise regime is safe and effective in improving HRQL and reducing depression status for hemodialysis patients

Disease and economic burden for rare diseases in Taiwan: A longitudinal study using Taiwan's National Health Insurance Research Database.

BACKGROUND:High-cost orphan drugs are becoming increasingly available to treat rare diseases that affect a relatively small population. Little attention has been given to the prevalence of rare diseases and their health-related economic burden in Taiwan. OBJECTIVES:This study examined the national trends in the prevalence of rare diseases and their health-related economic burden (including medication costs) in Taiwan. METHODS:Rare disease-related claims data from 2003-2014 (12 years) from the National Health Insurance Research Database were used in this study. We used a time series analysis to assess trends in the yearly rates of treated patients with rare diseases, overall healthcare use, and expenditures, including drugs. RESULTS:During the 12-year study period, the estimated prevalence of rare diseases increased from 10.57 to 33.21 per 100,000 population, an average rate of a 19.46% increase per year. Total health expenditures for treatment of rare diseases increased from US$18.65 million to US$137.44 million between 2003 and 2014, accounting for 0.68% of the total national health expenditures in 2014. Drug expenditures for treatment of rare diseases increased from US$13.24 million to US$121.98 million between 2003 and 2014, which accounted for 71.00% and 88.75% of the health expenditures for patients with rare diseases in 2003 and 2014, respectively. In 2014, we found a 20.43-fold difference in average health expenditures and a 69.46-fold difference in average drug expenditures between patients with rare diseases and the overall population. CONCLUSIONS:The prevalence of rare diseases and the related economic burden have grown substantially in Taiwan over the past 12 years, and these trends are likely to continue. Drug expenditures accounted for almost 90% of health expenditures for rare diseases. Further analyses are underway to examine the economic burden of individual rare diseases

Adaptive Human <i>CDKAL1</i> Variants Underlie Hormonal Response Variations at the Enteroinsular Axis

<div><p>Recent analyses have identified positively selected loci that explain differences in immune responses, body forms, and adaptations to extreme climates, but variants that describe adaptations in energy-balance regulation remain underexplored. To identify variants that confer adaptations in energy-balance regulation, we explored the evolutionary history and functional associations of candidate variants in 207 genes. We screened single nucleotide polymorphisms in genes that had been associated with energy-balance regulation for unusual genetic patterns in human populations, followed by studying associations among selected variants and serum levels of GIP, insulin, and C-peptide in pregnant women after an oral glucose tolerance test. Our analysis indicated that 5′ variants in <i>CDKAL1, CYB5R4</i>, <i>GAD2</i>, and <i>PPARG</i> are marked with statistically significant signals of gene–environment interactions. Importantly, studies of serum hormone levels showed that variants in <i>CDKAL1</i> are associated with glucose-induced GIP and insulin responses (<i>p</i><0.05). On the other hand, a <i>GAD2</i> variant exhibited a significant association with glucose-induced C-peptide response. In addition, simulation analysis indicated that a type 2 diabetes risk variant in <i>CDKAL1</i> (rs7754840) was selected in East Asians ∼6,900 years ago. Taken together, these data indicated that variants in <i>CDKAL1</i> and <i>GAD2</i> were targets of prior environmental selection. Because the selection of the <i>CDKAL1</i> variant overlapped with the selection of a cluster of <i>GIP</i> variants in the same population ∼11,800 to 2,000 years ago, we speculate that these regulatory genes at the human enteroinsular axis could be highly responsive to environmental selection in recent human history.</p></div