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Summary Background Data for the risk of any solid cancer in patients with polycystic kidney disease are scarce. Therefore, we did a nationwide cohort study in Taiwan to establish the risk of cancer in patients with polycystic kidney disease without either chronic kidney disease or end-stage renal disease. Methods From inpatient claims of the Taiwan National Health Insurance Research Database, we included patients aged 20 years and older and diagnosed with polycystic kidney disease between January, 1998 and December, 2010, in the polycystic kidney disease cohort. Patients with a history of cancer, a history of chronic kidney disease or of end-stage renal disease (recorded from the Registry of Catastrophic Illness Patient Database) were excluded. For each patient with polycystic kidney disease, one patient aged older than 20 years with no history of polycystic kidney disease or cancer was randomly selected from the National Health Insurance Research Database, matched 1:1 on the basis of the propensity score calculated by logistic regression, and was included in the control non-polycystic kidney disease cohort. The follow-up period for each patient was estimated from the index date to the date of diagnosis of cancer, or the patient was censored due to withdrawal from the insurance programme (eg, death, immigration, or imprisonment) or on Dec 31, 2011. The primary outcome of interest was a diagnosis of cancer during a 14-year follow-up period. The risk of cancer was represented as a hazard ratio (HR) calculated in Cox proportional hazard regression models. Findings 4346 patients with polycystic kidney disease and 4346 without were enrolled in the study. The median follow-up period in the polycystic kidney disease cohort was 3·72 years (IQR 1·25–7·31) and in the non-polycystic kidney disease cohort was 4·96 years (2·29–8·38). The overall incidence of cancer was higher in the polycystic kidney disease cohort than in the control cohort (20·1 [95% CI 18·3–21·9] per 1000 person-years vs 10·9 [10·1–11·8] per 1000 person-years; crude hazard ratio (HR) 1·77 [95% CI 1·52–2·07]; HR adjusted for age, sex, frequency of medical visits, and comorbidities was 1·83 [1·57–2·15]). The specific risks (adjusted subhazard ratios) were significantly higher in the polycystic kidney disease cohort than that in the non-polycystic kidney disease cohort for liver cancer (1·49 [95% CI 1·04–2·13]; p=0·030), colon cancer (1·63 [1·15–2·30]; p=0·006), and kidney cancer (2·45 [1·29–4·65]; p=0·006). Interpretation To our knowledge, this is the first report of the association of polycystic kidney disease without end-stage renal disease with the risk of liver, colon, and kidney cancer. Health-care professionals should be aware of this risk, when treating patients with polycystic kidney disease. Funding Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence, Academia Sinica Taiwan Biobank, Stroke Biosignature Project, NRPB Stroke Clinical Trial Consortium, Tseng-Lien Lin Foundation, Taiwan Brain Disease Foundation, Katsuzo and Kiyo Aoshima Memorial Funds, China Medical University Hospital, and Taiwan Ministry of Education.

Background Cytomegalovirus (CMV) remains the most critical viral pathogen after kidney transplantation (KTx). The universal prophylaxis, but not pre-emptive therapy, could avoid the wide range of indirect effects induced by CMV infection. This study aims to examine the effect of universal prophylaxis with oral valganciclovir for the first year of CMV disease after KTx. Methods The universal prophylaxis therapy was started in May 2008. Patients who received KTx between January 2006 and September 2010 were included in the study. Oral valganciclovir (Valcyte) was used for 3 months with dosage adjusted by eGFR. CMV disease was defined by typical CMV syndrome with positive viremia or tissue proven. The study end points are episode of CMV disease and first-year biopsy-proven acute rejection. Results In total, 68 KTx patients who received universal prophylaxis for 3 months (study group) and another 50 KTx recipients without universal prophylaxis (control group) were enrolled. The incidence of CMV disease was 8.0% (4 of 50) in the control group. The universal prophylaxis significantly reduced the first-year episodes of CMV disease to 0% (0 of 68). There were 8 episodes of biopsy-proven acute rejection (8 of 50, 16%) within 1 year after KTx in the control group, but only 2 episodes of biopsy-proven acute rejection (2 of 68, 2.9%) in the treatment group ( P Conclusions Universal prophylaxis with oral valganciclovir for 3 months significantly reduced episodes of first-year CMV disease and biopsy-proven acute rejection in kidney transplant recipients.

Summary The aim of this study was to detect brain functional deficits in patients with Behcet's disease (BD) and signs or symptoms of central nervous system (CNS) involvement at different times in their clinical history. A total of 24 patients aged 20 to 53 years (median age 39 years; 20 women, four men) with Behcet's syndrome fulfilling the diagnosis as defined by the syndrome classification were enrolled in this study. Single-photon emission computed tomography (SPECT) with 99mTechnetium (Tc)-hexamethylpropyleneamine oxime (HMPAO) as the perfusion tracer was performed to detect brain lesions. The results of 99mTc-HMPAO brain SPECT scans showed impaired perfusion in all cases with neurological complaints (24 out of 24, 100%). Temporal lobes and basal ganglia were the most common areas with such lesions. In contrast, brain MRI and CT images were normal or non-specific in all cases. In conclusion, 99mTc-HMPAO brain SPECT imaging is a powerful and sensitive tool for disclosing brain involvement in numerous clinical situations, even including patients with subtle neurological symptoms/signs such as headaches and dizziness. It is also a useful modality for evaluating the effects of treatment and disease monitoring to prevent CNS damage.

The more support elderly people have from their family, the less likely they are to suffer from chronic diseases. The objective of this study is to investigate how family support affects the PA middle-aged and elderly people engage in before and after they suffer from chronic diseases. We interviewed 428 middle-aged and elderly people using a structured questionnaire to measure their aerobic PA. Eighteen percent of middle-aged and elderly people did participate in PA after suffering from chronic diseases. Using multivariate logistic regression models, we found that middle-aged and elderly people who rely on family members when they are sick (OR = 1.87, 95%CI = 1.08–3.25) and who are accompanied by family members (OR = 2.09, 95%CI = 1.20–3.62) when they are healthy are more likely to exercise. The more middle-aged and elderly people are supported by their family, the more likely they are to exercise. Strengthening family relationships should help reduce the prevalence of chronic diseases among middle-aged and elderly people.

Circulating levels of inflammatory and prothrombotic factors are elevated in the metabolic syndrome (MS) and linked with the occurrence of cardiovascular events. The aim of our study was to investigate the relationship between inflammatory and prothrombotic markers and the MS in elderly institutionalized residents. A total of 326 non-diabetic residents of Chuang-Hua Veterans Care Home (age: 79.9+/-4.1 years; 100% males) were enrolled. MS was diagnosed according to the AHA/NHLBI Scientific Statement criteria. Body fat percentage was measured by bioelectrical impedance analysis. Insulin resistance was calculated by homeostasis model assessment for insulin resistance (HOMA-IR). Inflammatory markers, including tumor necrosis factor-a (TNF-alpha), high sensitivity C-reactive protein (hsCRP), and plasminogen activator inhibitor-1 (PAI-1), were determined using ELISA. Elderly residents with the MS had higher systolic and diastolic blood pressures (both p0.001) and higher HOMA-IR (p0.001), hsCRP (p = 0.008), and PAI-1 levels (p0.001) than those without the MS. On multivariate logistic regression analysis, PAI-1 was an independent risk factor for the MS. Of the MS components, elderly residents with higher waist circumferences and higher levels of plasma fasting glucose, and triglyceride (TG), and lower levels of high density lipoprotein (HDL) had higher PAI-1 levels than those without the above components.

This study investigated the relationship between hyperuricemia (HUC) and the components of the metabolic syndrome (MS) among elderly institutionalized men. In addition, this study explored the relationship between HUC and serum inflammatory markers. A total of 333 participants from Chang-Hua Veterans Care Home were enrolled. The MS was defined using a modified ATP III definition issued in 2004 by the Bureau of Health Promotion, Department of Health, ROC (Taiwan). The participants' mean age was 78.6+/-3.9 years, and their mean serum uric acid level was 6.9+/-1.7 mg/dl. The prevalence of HUC was 46.2% (n = 154). The prevalence of the MS was 38.4% (n = 128). HUC was correlated with components of the MS, including waist circumference (WC), triglyceride (TG), and high density lipoprotein cholesterol (HDL-C) but it was not related to blood pressure (BP) and fasting plasma glucose (FPG). Moreover, increased serum creatinine, albumin, prealbumin, and body fat were also associated with HUC. The plasma activator inhibitor-1 (PAI-1) levels were significantly elevated in the HUC group, but serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), serum intercellular cell adhesion molecule-1 (sICAM-1), serum levels of vascular cell adhesion molecule-1 (sVCAM-1), and P-selectin were not related to HUC. HUC in elderly men may represent poorer renal function, better nutritional status, and increased body fat.

The significance of very early experience in the maturation of whisker-to-barrel system comes primarily from neonatal whisker or infraorbital nerve lesion studies conducted prior to the formation of cortical barrels. However, the surgical procedures damage the sensory pathway; it is difficult to examine the consequence after the recovery of sensory deprivation. To address this issue, we performed a neonatal whisker-cut (WC) paradigm and examined their behavioral performance during P30 to P35. With fully regrown whiskers, the rats that had whisker cut from the date of birth (P0) to postnatal day (P) 3 (WC 0–3) exhibited shorter crossable distance in the gap-crossing test. However, the rats had whisker cut at P3 only (WC 3) behaved normally in this test, suggesting the critical period for the development of whisker-specific tactile function is P0–P3, agreed with previous findings demonstrated by lesion methods. In the WC 0–3 rats, the cortical areas in the layer IV somatosensory region in relation to the trimmed whiskers were enlarged and the spiny stellate neurons within had larger dendritic span and greater spine density. Furthermore, more long and multiple-head spines were found in these rats. With abnormal structure and function in the somatosensory system, the WC 0–3 rats showed higher explorative activity and more frequent social interactions. Our results have demonstrated that the early tactile deprivation, similar to early visual deprivation, perturbed the developmental program of the brain and affected later behaviors in various aspects.