Examining the Relationship between Cardiorespiratory Fitness and Body Weight Status: Empirical Evidence from a Population-Based Survey of Adults in Taiwan

Background. Cardiovascular disease is the number one cause of death worldwide. Meanwhile, obesity has been recognized as a global epidemic. This study aims to examine the extent to which cardiorespiratory fitness is associated with body mass among adult males and females in Taiwan. Materials and Methods. A nationally representative dataset consisting of 68,175 adults aged 18–60, including 31,743 males and 36,432 females, was used. Several multivariate regression models were used to investigate the relationship between cardiorespiratory fitness and body weight status, after controlling for adults’ sociodemographic status. Results. A one-unit increase in the BMI lowered the cardiorespiratory fitness score by 0.316 and 0.368 points for adult males and females, respectively. Among adult males, compared to those of normal weight, adult males who were underweight, overweight, or obese had a lower cardiorespiratory fitness score by 1.287, 0.845, and 3.353 points, respectively. Similar results could be found in female samples. Conclusion. The overweight and obese adults had much lower levels of cardiorespiratory fitness as compared to their normal weight counterparts. Given the upward trend in the prevalence of overweight and obesity, it is important to help overweight and obese people to become more fit and reach their healthy weight

Association between use of non–vitamin k oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation

Importance:  Non–vitamin K oral anticoagulants (NOACs) are commonly prescribed with other medications that share metabolic pathways that may increase major bleeding risk. Objective:  To assess the association between use of NOACs with and without concurrent medications and risk of major bleeding in patients with nonvalvular atrial fibrillation. Design, Setting, and Participants:  Retrospective cohort study using data from the Taiwan National Health Insurance database and including 91 330 patients with nonvalvular atrial fibrillation who received at least 1 NOAC prescription of dabigatran, rivaroxaban, or apixaban from January 1, 2012, through December 31, 2016, with final follow-up on December 31, 2016. Exposures:  NOAC with or without concurrent use of atorvastatin; digoxin; verapamil; diltiazem; amiodarone; fluconazole; ketoconazole, itraconazole, voriconazole, or posaconazole; cyclosporine; erythromycin or clarithromycin; dronedarone; rifampin; or phenytoin. Main Outcomes and Measures:  Major bleeding, defined as hospitalization or emergency department visit with a primary diagnosis of intracranial hemorrhage or gastrointestinal, urogenital, or other bleeding. Adjusted incidence rate differences between person-quarters (exposure time for each person during each quarter of the calendar year) of NOAC with or without concurrent medications were estimated using Poisson regression and inverse probability of treatment weighting using the propensity score. Results:  Among 91 330 patients with nonvalvular atrial fibrillation (mean age, 74.7 years [SD, 10.8]; men, 55.8%; NOAC exposure: dabigatran, 45 347 patients; rivaroxaban, 54 006 patients; and apixaban, 12 886 patients), 4770 major bleeding events occurred during 447 037 person-quarters with NOAC prescriptions. The most common medications co-prescribed with NOACs over all person-quarters were atorvastatin (27.6%), diltiazem (22.7%), digoxin (22.5%), and amiodarone (21.1%). Concurrent use of amiodarone, fluconazole, rifampin, and phenytoin with NOACs had a significant increase in adjusted incidence rates per 1000 person-years of major bleeding than NOACs alone: 38.09 for NOAC use alone vs 52.04 for amiodarone (difference, 13.94 [99% CI, 9.76-18.13]); 102.77 for NOAC use alone vs 241.92 for fluconazole (difference, 138.46 [99% CI, 80.96-195.97]); 65.66 for NOAC use alone vs 103.14 for rifampin (difference, 36.90 [99% CI, 1.59-72.22); and 56.07 for NOAC use alone vs 108.52 for phenytoin (difference, 52.31 [99% CI, 32.18-72.44]; P < .01 for all comparisons). Compared with NOAC use alone, the adjusted incidence rate for major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin and was not significantly different for concurrent use of verapamil; diltiazem; cyclosporine; ketoconazole, itraconazole, voriconazole, or posaconazole; and dronedarone. Conclusions and Relevance:  Among patients taking NOACs for nonvalvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin compared with the use of NOACs alone, was associated with increased risk of major bleeding. Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs

Comparison between the use of percutaneous nephrostomy and internal ureteral stenting in the management of long-term ureteral obstructions

AbstractObjectivesIn this study, we compared between the efficacy and complications of percutaneous nephrostomy (PCN) tubes and those of internal ureteral stents (e.g., double-J stents) used for relieving ureteral obstructions.Materials and methodsA retrospective chart review was performed. Between 2003 and 2009, 110 patients (63 females and 47 males, with a mean age of 63.6 years, range 19–89 years) who had an extrinsic ureteral obstruction, and subsequently underwent either PCN tube placement (n = 44) or internal ureteral stent placement (n = 66), were enrolled. Clinical data on patients with duration of diversion/drainage for more than 6 months were collected. Statistical analyses were performed with respect to a patient's age, etiology of the obstruction, outcome of residual hydronephrosis, and renal function tests.ResultsPatient ages and procedure-related complications were comparable between these two groups. The mean duration of diversion was 16.8 ± 8.6 months in the stent group versus 14.1 ± 6.7 months in the PCN group (p = 0.067). A smaller elevation in serum creatinine was noted in the PCN group (0.21 vs. 0.78 mg/dL, p = 0.03). Nine of 86 (10.4%) double-J stents were converted to PCN tubes during the study period. Residual hydronephrosis after decompression was more common in the stent group than in the PCN group (65.2% vs. 27.2%, p = 0.01). These findings suggest better preservation of renal function by a PCN tube.ConclusionsResults of this study suggest that, to better preserve renal function, PCN is the choice of treatment, irrespective of the etiology. While patients who have a PCN tube may have to carry an additional external drainage device, the complications did not seem to differ significantly from those who used internal drainage with a ureteral stent. Because young cancer patients may especially need aggressive chemotherapy to prolong their survival, PCN urinary drainage may become a better choice from the standpoint of cancer control

Acute Paraparesis Caused by a Giant Cell Tumor of the Thoracic Spine

AbstractGiant cell tumor (GCT) is a benign but locally aggressive skeletal neoplasm of young adults. GCT located in the spine is relatively rare and may need a combination of surgical and adjunctive therapies. Here we present a patient who had intermittent thoracic back pain for two weeks and experienced an acute episode of decreased muscle power of both lower limbs. Magnetic resonance (MR) imaging examinations of the thoracic spine revealed that the patient had severe spinal canal compression caused by pathological fracture due to a tumor within the seventh thoracic vertebra. She underwent an emergent surgical intervention for total removal of the tumor and spinal reconstruction with autologous rib grafts and instruments. Postoperatively, the patient made an uneventful recovery of muscle power of bilateral lower limbs. She subsequently received adjuvant radiotherapy. In a follow-up period of 36 months, the patient had no clinical or radiological evidence of tumor recurrence. Even though spinal location for GCT is a rare event, it should be included in the differential diagnosis in patients with osteolytic lesions or pathological fractures of the vertebra, especially in young female patients sustaining no trauma who had a clinical history of persistent low back pain

Different Renal Function Equations and Dosing of Direct Oral Anticoagulants in Atrial Fibrillation

BACKGROUND: Randomized trials of direct oral anticoagulants (DOACs) adopted the Cockcroft-Gault (CG) formula to calculate estimated glomerular filtration rate (eGFR) to determine the dosages of DOACs. OBJECTIVES: The authors aimed to investigate the agreements/disagreements of eGFRs calculated using different equations (CG, Modified Diet in Renal Disease [MDRD], and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formulas), and their impacts on the dosages of DOACs and clinical outcomes. METHODS: Medical data from a multicenter health care provider in Taiwan including 39,239 patients with atrial fibrillation were used. Among these patients, there were 11,185 and 2,323 patients treated with DOACs and warfarin, respectively. RESULTS: At the cutoff values of eGFR of 50 mL/min, the agreements were 78% between MDRD and CG and 81% between CKD-EPI and CG. The disagreements among the different equations were largely due to overestimations, especially for patients aged >75 years and with a body weight of <50 kg (58.8% for MDRD and 50.9% for CKD-EPI). Among patients receiving DOACs whose dosages were defined as “on label” based on MDRD or CKD-EPI, only those whose dosages were “truly on label” based on CG were associated with a lower risk of major bleeding (adjusted HR: 0.34; 95% CI: 0.26-0.45) compared to warfarin. CONCLUSIONS: The adoptions of MDRD or CKD-EPI rather than CG would result in inappropriate dosing of DOACs (mainly overdosing), which would attenuate the advantages of DOACs compared to warfarin. The CG equation should be used as the gold standard to calculate eGFRs and guide the DOAC dosages

Reconsidering the Hierarchy and Translation of “Physical Education/Sports” Related Terms: Taiwan Perspective

OBJECTIVES In the past centuries, the concept of “physical education” has changed from a more general concepts including physical activities and sports, to specifically inferring “instruction of physical activity”. Instead, “sports” has become the comprehensive concept of sports, exercise, and physical education. Given to the inconsistent terminologies and English translations of “體育 (ti-yu)” (physical education) and “運 動 (yun-dong)” (sports or exercise) in Mandarin, the purpose of this study was to investigate in the current terminology usage, hierarchy, and the English translation of “體育 (ti-yu)” and “運動 (yun-dong)” in Taiwan. METHODS Three government authorities, two sport related universities, eight top sport and exercise journals, and nighty-six college departments in Taiwan were analyzed. RESULTS “運動 (yun-dong)” was the most widely used terminology as “體育 (ti-yu)” occupied the majority usage among government authorities, sport related universities, and title of top sport and exercise journals. Regarding English translation, despite of “department of physical education”, “sports” remained the most common terminology. Moreover, “體育 (ti-yu)” and “sports” are the highest hierarchy among government authorities, and sport related university; “體育 (ti-yu)” and “physical education” are the highest hierarchy among traditional sport and exercise journals; “運動 (yun-dong)” and “sports” are the highest hierarchy among college departments also the mainstream of current translation and hierarchy. CONCLUSIONS “體育 (ti-yu)” was the highest hierarchy in the past. However, “運動 (yun-dong)” has been the mainstream of the highest hierarchy in Mandarin according to college departments. In English, “sport(s)” is the main term in Taiwan when translating “體育 (ti-yu)” and 運動 (yun-dong)”, also being the highest hierarchy. On the other hand, “體育 (ti-yu)” and “physical education” are utilized regarding those departments focusing on educating PE teachers. This study expects the terminology, English translations, and hierarchy being align with the mainstream of current translation and hierarchy in the future