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Purpose: Laparoscopic radical nephroureterectomy (LNU) has gradually become the new standard treatment for localized upper tract urothelial cancer (UTUC). With more blunt dissection and tactile sensation, hand-assisted LNU might shorten the operative time compared with the pure laparoscopic approach. However, whether the use of the hand-assisted or the pure laparoscopic approach has an effect on oncological outcomes remains unclear. Methods: We retrospectively identified 629 patients with non-metastatic UTUC who underwent hand-assisted (n = 515) or pure LNU (n = 114) at 9 hospitals in Taiwan between 2004 and 2019. Overall survival, cancer-specific survival, recurrence-free survival, and bladder recurrence-free survival were compared between these two groups using inverse-probability of treatment weighting (IPTW) derived from the propensity scores for baseline covariate adjustment. Results: The median follow-up period was 32.9 and 28.7 months in the hand-assisted and the pure groups, respectively. IPTW-adjusted Cox proportional hazards models showed that the laparoscopic approach (pure vs. hand-assisted) was not significantly associated with all-cause mortality (HR 0.79, 95% CI 0.49–1.24, p = 0.304), cancer-specific mortality (HR 0.88, 95% CI 0.51–1.51, p = 0.634), or extra-vesical recurrence (HR 0.65, 95% CI 0.41–1.04, p = 0.071). However, the pure laparoscopic approach was significantly associated with lower intra-vescial recurrence (HR 0.64, 95% CI 0.43–0.96, p = 0.029) for patients who underwent LNU. Kaplan-Meier curves also revealed that the pure laparoscopic approach was associated with better bladder recurrence-free survival compared with the hand-assisted laparoscopic approach in both the original cohort and the IPTW-adjusted cohort (log-rank p = 0.042 and 0.027, respectively). Conclusions: The performance of hand-assisted or pure LNU does not significantly affect the all-cause mortality, cancer-specific mortality, or extra-vesical recurrence for patients with non-metastatic UTUC. However, the hand-assisted laparoscopic approach could increase the risk of intra-vesical recurrence for patients who undergo LNU. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Alterations in peripheral purinergic and muscarinic signaling of rat bladder after long‑term fructose‑induced metabolic syndrome" published in a previous issue of the periodical.

Tumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC). However, confounding effects can appear when these two factors are analyzed together. Therefore, we aimed to investigate the impact of tumor distribution on the outcomes of multifocal UTUC after radical nephroureterectomy. From the 2780 UTUC patients in the Taiwan UTUC Collaboration Group, 685 UTUC cases with multifocal tumors (defined as more than one tumor lesion in unilateral upper urinary tract) were retrospectively included and divided into three groups: multiple renal pelvic tumors, multiple ureteral tumors, and synchronous renal pelvic and ureteral tumors included 164, 152, and 369 patients, respectively. We found the prevalence of carcinoma in situ was the highest in the synchronous group. In multivariate survival analyses, tumor distribution showed no difference in cancer-specific and disease-free survival, but there was a significant difference in bladder recurrence-free survival. The synchronous group had the highest bladder recurrence rate. In summary, tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors. We believe that the distribution of tumors reflects the degree of malignant involvement within the urinary tract, but has little significance for survival or disease progression. [ABSTRACT FROM AUTHOR]

With many previous studies indicating a higher prevalence of sexual problems in patients with tinnitus, the association between tinnitus and erectile dysfunction (ED) has become an interesting topic that warrants further research. In our study, we hypothesized that tinnitus may be associated with ED and aimed to further explore the relationship between these two medical conditions using a nationwide population-based database. After retrieving data of 19,329 patients with ED and 19,329 propensity score-matched patients without ED (controls) from Taiwan's National Health Insurance Dataset, we defined the diagnosis date (the date of the first ED claim) for patients with ED as the index date for cases, and the date of the first utilization of ambulatory care by patients without ED during the index year of their matched case as the index date for controls. We found that 1247 out of 38,658 sampled patients (3.23%) had received a tinnitus diagnosis within the year before the index date, with 792 (4.10%) from cases and 455 (2.35%) from controls. We then utilized multiple logistic regression analysis and observed that cases were more likely to have had a prior tinnitus diagnosis compared to controls (OR 1.772; 95% CI 1.577–1.992; p < 0.001). Lastly, we adjusted the data for co-morbid medical disorders and social economic factors, with the end results showing that cases were more likely than controls to have a prior diagnosis of tinnitus (OR 1.779, 95% CI 1.582–2.001, p < 0.001). Through our investigation, we have ultimately detected a novel association between ED and tinnitus and urge physicians to be alert to the possibility of the development of ED in patients treated for tinnitus. [ABSTRACT FROM AUTHOR]

References 1 Tsai W-H, Wu C-H, Cheng C-H, Chien C-T. Ba-Wei-Di-Huang-Wan through its active ingredient loganin counteracts substance P-enhanced NF- B/ICAM-1 signaling in rats with bladder hyperactivity. 26287995 2 Tsai W-H, Wu C-H, Yu H-J, Chien C-T. l-Theanine inhibits proinflammatory PKC/ERK/ICAM-1/IL-33 signaling, apoptosis, and autophagy formation in substance P-induced hyperactive bladder in rats. [Extracted from the article]

Purpose: This study aimed to investigate associations between obstructive sleep apnea (OSA) and urological comorbidities using a large population-based dataset. Methods: This cross-sectional study used the Taiwan Longitudinal Health Insurance Database 2005. We included 1236 males with OSA in the study group and 4944 males without OSA in the comparison group. Conditional logistic regressions were performed to examine relationships between OSA and urological comorbidities. Results: We found that patients with OSA had significantly greater prevalences of hypertrophy of the prostate (15.13 vs. 7.28 %), chronic prostatitis (4.37 vs. 2.16 %,), urinary incontinence (3.32 vs. 0.87 %), nocturia (2.02 vs. 0.61 %), erectile dysfunction (2.91 vs. 0.97 %), urinary calculi (12.06 vs. 6.80 %), and prostate cancer (0.97 vs. 0.40 %) than the comparison group. Additionally, the adjusted odds ratios in males with OSA for hypertrophy of prostate, chronic prostatitis, urinary incontinence, nocturia, erectile dysfunction, urinary calculi, and prostate cancer were 2.54 (95 % confidence interval (CI) 2.05~3.15), 1.95 (95 % CI 1.38~2.74), 4.13 (95 % CI 2.63~6.50), 3.54 (95 % CI 2.03~6.18), 2.95 (95 % CI 1.89~4.61), 1.89 (95 % CI 1.53~2.33), and 2.14 (95 % CI 1.03~4.43) than those without OSA, respectively. Conclusions: This study concluded that males with OSA had higher odds ratios of hypertrophy of the prostate, chronic prostatitis, urinary incontinence, nocturia, erectile dysfunction, urinary calculi, and prostate cancer than comparison group. [ABSTRACT FROM AUTHOR]

Atherosclerosis-associated pelvic ischemia has been reported to be a risk factor for bladder dysfunction and subsequent lower urinary tract symptoms (LUTS) in the elderly population. However, the molecular mechanisms of this association remain unclear. We hypothesized that stress-induced cellular responses might play a role in the pathogenesis of ischemia-induced bladder dysfunction. In the present study, the animal model of bladder ischemia was induced by bilateral partial arterial occlusion (BPAO) in rats. We found that BPAO significantly induced the presence of detrusor overactivity (DO) and upregulated the expression of several molecular reactions, including biomarkers in endoplasmic reticulum stress (78 kDa glucose-regulated protein, GRP78 and C/EBP-homologous protein, CHOP), autophagy (Beclin-1, p62 and LC3 II) and apoptosis (caspase 3). BPAO also disturbed the Kelch-like ECH-associated protein 1–nuclear factor erythroid-2-related factor 2 (Keap1–Nrf2) pathways. These responses might collectively alter muscarinic and purinergic signaling and contribute to the presence of DO in the ischemic bladder. Therapeutically, treatment with neither a muscarinic nor purinergic receptor antagonist restored bladder function. Interestingly, sulforaphane effectively attenuated ischemia-enhanced endoplasmic reticulum stress, autophagy and apoptosis in the bladder, subsequently ameliorated ischemia-induced bladder dysfunction and might emerge as a novel strategy to protect the bladder against ischemia-induced oxidative damage. [ABSTRACT FROM AUTHOR]

Background: To date, the associations between chronic periodontitis (CP) and cancer lack large-scale population-based epidemiological evidence. This study aimed to investigate the subsequent risk for cancers among subjects with CP. Methods: This study cohort included 40,140 subjects with CP and 40,140 subjects who were matched for a comparison cohort. We individually tracked each patient for a 5-year period following their index date to identify those who had received a diagnosis of cancer. Results: The incidence rate of cancer during the 5-year follow-up period was 14.80 (95 % CI 14.28-15.34) per 1,000 person-years in subjects with CP. Cox proportional hazards regression revealed that the hazard ratio of cancer during the 5-year follow-up period for subjects with CP was 1.23 (95 % CI 1.20-1.27) compared to that of the comparison cohort. Conclusion: We observed an increased risk for the subsequent development of a number of cancers among subjects with CP. [ABSTRACT FROM AUTHOR]

Anxiety disorder (AD) is commonly associated with a number of physical illnesses. No previous study has investigated the association between AD and sudden sensorineural hearing loss (SSNHL). In this study, we investigated the association between prior AD and SSNHL using a population-based dataset in Taiwan. Sampled subjects of this case-control study were retrieved from the Taiwan 'Longitudinal Health Insurance Database'. We identified 3,522 patients who had a diagnosis of SSNHL as cases and 10,566 age- and gender-matched subjects without SSNHL as controls. A conditional logistic regression was used to calculate the odds ratio (OR) for having previously been diagnosed with AD between cases and controls. We found that of 14,088 patients, 13.4 % had a prior AD diagnosis, 17.8 and 11.9 % for the SSNHL group and controls, respectively. After adjusting for patient socioeconomic characteristics and comorbid medical disorders, SSNHL patients were more likely to have prior AD than the controls (OR 1.49, 95 % confidence interval (CI) 1.34-1.66, p < 0.001). Furthermore, we found that the significant relationship between SSNHL and prior AD decreased with age. The relationship was the most pronounced among those aged ≤44 years, with an adjusted OR of 1.86 (95 % CI 1.48-2.33, p < 0.001) for cases compared to controls. We concluded that patients with SSNHL had a higher proportion of prior AD than non-SSNHL-diagnosed controls. Further study is needed to confirm our findings and explore the underlying pathomechanisms. [ABSTRACT FROM AUTHOR]

Recent studies have shown that docetaxel-based chemotherapy confers a survival benefit in patients with castration-resistant prostate cancer (PC). Also epidermal growth factor receptor (EGFR) was found to have multiple roles in prostatic tumorigenesis. However, the EGFR-mediated chemoresistance mechanism in human PC was not well delineated. In this study, we explored the mechanism of EGFR-mediated docetaxel resistance in PC. A series of stable docetaxel-resistant PC/DX sublines were established at our laboratory. The docetaxel IC of PC3 and PC/DX25 cells were 0.01 and 1.33 μM, respectively. Cellular resistance to docetaxel was significantly associated with increased EGFR and EGFR activation in PC/DX25. There was a dose-dependent increase in EGFR expression associated with the magnitude of docetaxel resistance. Expression of EGFR in PC/DX25 was higher than that in PC3, RWPE-1 and LNCaP cells. Similar results were also found in human PC tissues by immunohistochemical staining. We showed that docetaxel sensitivity can be stored in PC/DX25 cells by knockdown and inactivation of EGFR expression through EGFR siRNA and specific inhibitors, respectively. Contrarily, overexpression of EGFR or recombinant EGF protein treatment could rescue PC3 cells from docetaxel-mediated cytotoxicity. Gefitninb (ZD1839) significantly inhibited the growth of PC/DX25 cells by MTT in vitro and on xenografted nude mice in vivo. Moreover, EGFR-mediated docetaxel resistance occurred through the Akt-dependent ABCB1 expression in PC cells. These findings demonstrated EGFR played an important role in docetaxel-resistant PC and EGFR inhibition may enhance the therapeutic efficacy of docetaxel-based treatment. [ABSTRACT FROM AUTHOR]

Background: Several reports mention that statin (HMG-CoA reductase inhibitor) use seems to be associated with several neurologic disorders and that the lipid-lowering effect of statins may contribute to some neural toxicity.Objective: This study aimed to evaluate the association between statin use and Bell's palsy using a population-based health insurance database.Methods: This case-control study identified 1,977 subjects with Bell's palsy as cases and 5,931 sex- and age-matched subjects without Bell's palsy as controls from the Taiwan Longitudinal Health Insurance Database 2000. Conditional logistic regressions was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for previous use of statins between the cases and controls. The associations of regular and irregular statin users with Bell's palsy were further analyzed.Results: By Chi-square test, there was a significant difference in the prevalence of statin use between cases and controls (23.2 vs. 16.4%, p < 0.001). Conditional logistic regression analysis revealed that after adjusting for diabetes mellitus, hypertension, and hyperlipidemia, the OR for prior statin use was 1.47 (95% CI 1.28-1.69) for cases compared with controls. Bell's palsy was significantly associated with previous regular statin use (≥60 days within 6 months) (adjusted OR: 1.46, 95% CI 1.28-1.67). However, there was no increased adjusted OR of irregular statin use (<60 days within 6 months) for cases compared with controls (OR: 1.09, 95% CI 0.82-1.46).Conclusions: Our present data suggest a potential association between regular statin use and Bell's palsy. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare laparoendoscopic single-site (LESS) total extraperitoneal (TEP) repair with conventional laparoscopic TEP repair for the treatment of inguinal hernias. To date, no other studies have compared the LESS and conventional laparoscopic TEP approaches for the treatment of inguinal hernia in a prospective randomized study setting. Methods: For this study, 100 patients undergoing inguinal hernia repair were prospectively randomized into either the LESS TEP group or the conventional laparoscopic TEP group. Pre-, intra-, and postoperative factors were recorded. The primary end point was postoperative pain. The patients were interviewed at outpatient clinics at 1 week, 3 months, and 6 months postoperatively. Results: The demographic data were comparable between the two groups. The median operative time was longer in the LESS TEP group (63.5 min) than in the conventional TEP group (50.5 min) ( p = 0.001). No conversion was performed in either group. The mean pain score 2 h postoperatively during rest was significantly higher in the conventional TEP group than in the LESS TEP group (3.9 vs. 2.6; p = 0.02). The postoperative results were comparable between the groups in terms of analgesic requirements, systemic stress responses, complications, and postoperative convalescence. Conclusions: The LESS TEP technique is associated with a longer operative time but offers the minor benefit of a reduction in immediate postoperative pain. [ABSTRACT FROM AUTHOR]

Purpose: We explored the pathophysiologic mechanisms of long-term fructose-induced lower urinary tract symptoms (LUTS) in rats. Methods: Male Wistar rats were fed with fructose for 3 or 6 months. Biochemical and transcystometric parameters were compared between fructose-fed and age-matched normal-diet rats. Pelvic nerve and external urethral sphincter-electromyogram activity recordings were performed to investigate fructose effects on neural control of bladders. Mitochondrial structure, ATP and acetylcholine content and purinergic and muscarinic cholinergic receptors were examined. Cytosolic cytochrome C staining by Western blot and immunocytochemistry for mitochondrial injury and PGP 9.5 stain for nerve density were also determined. Results: The fructose-fed rats with higher plasma triglyceride, LDL and fasting glucose levels displayed LUTS with increased frequency and suppressed voiding contractile amplitude in phase 1 and phase 2 duration versus normal-diet control. Fructose feeding altered the firing types in pelvic afferent and efferent nerves and external urethral sphincter-electromyogram activity. Increased mast cell number, disrupted and swollen mitochondria, increased cytosolic cytochrome C stain and expression and decreased nerve density in bladder smooth muscle layers appeared in the fructose-fed rats. Fructose feeding also significantly reduced ATP and acetylcholine content and enhanced protein expression of postsynaptic PX, PX and PX purinergic receptors and M and M muscarinic cholinergic receptors expression in the smooth muscles of urinary bladder. Conclusion: Long-term fructose feeding induced neuropathy and myopathy in the urinary bladders. Impaired mitochondrial integrity, reduced nerve density, ATP and acetylcholine content and upregulation of purinergic and muscarinic cholinergic receptors expression may contribute to the bladder dysfunction of fructose-fed animals. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to explore the feasibility and safety of performing laparoendoscopic single-site surgery (LESS) with conventional laparoscopic instruments. Methods: We retrospectively reviewed our data from 175 patients who underwent various urological LESS procedures via the same ergonomic and geometric principles between 2008 and 2011. LESS procedures performed included adrenalectomy ( N = 23), radical nephrectomy ( N = 5), radical nephroureterectomy with bladder cuff resection ( N = 5), varicocelectomy ( N = 12), nephropexy ( N = 4), lumbar sympathectomy ( N = 4), orchiectomy for intra-abdominal testis ( N = 1), pyeloureterostomy ( N = 1), dismembered pyeloplasty ( N = 1), and adult inguinal hernia mesh repair ( N = 119). Results: All procedures were completed successfully without the use of ancillary ports or articulating instruments except two cases that required laparoscopic conversion. The mean patient age was 48.9 years. Mean operative time was 99.7 min, mean estimated blood loss was 17.3 ml, and mean hospital stay was 2.1 days. There were no intraoperative complications. Conclusion: According to our ergonomic and geometric principles, use of conventional laparoscopic instruments is feasible and safe in LESS procedures. [ABSTRACT FROM AUTHOR]

Background: The safety and feasibility of laparoendoscopic single-site (LESS) adrenalectomy for benign adrenal lesions was proved in early clinical series. However, the advantages of LESS over multiport laparoscopic adrenalectomy still are under investigation. Methods: Since October 2009, the authors have prospectively performed LESS retroperitoneal adrenalectomy for 21 consecutive patients with benign adrenal tumors (LESS group). Another 28 patients with benign adrenal tumors were prospectively collected between June 2006 and October 2009 and served as a multiport laparoscopic adrenalectomy group. The patients' demographic data, operating time, estimated blood loss, peri- and postoperative complications, and short-term outcome were collected for further analysis. Results: The demographic data were comparable between the two groups in terms of the patient age, gender, body mass index (BMI), laterality, diagnosis, and resected specimen weight. No major complication or mortality occurred in either group. Neither group had any conversions. No differences were observed between the two groups in terms of intraoperative hemodynamic status or peri- or postoperative complications. The LESS patients had quicker resumption of oral intake (0.18 vs 1 day; p < 0.001), a shorter hospital stay (2 vs 4 days; p < 0.001), and a reduced analgesic requirement postoperatively (0 vs 0.84 mg/kg; p = 0.023) than the multiport laparoscopic patients. Conclusions: The results demonstrate that LESS adrenalectomy is as safe and effective as conventional multiport laparoscopic adrenalectomy for benign adrenal tumors. In addition, LESS adrenalectomy provides short-term convalescence advantages over multiport laparoscopic adrenalectomy. [ABSTRACT FROM AUTHOR]

Background: This report aims to describe the authors' initial experience with laparoendoscopic single-site (LESS) totally extraperitoneal (TEP) inguinal hernia repair in 100 patients. Methods: Patients who underwent an elective LESS TEP inguinal hernia repair between December 2008 and September 2010 in a single center were enrolled prospectively in this study. Patient demographic data, hernia characteristics, and operative and postoperative outcomes were analyzed. An Alexis wound retractor was placed through the 2-cm subumbilical incision as a homemade transumbilical access platform after the preperitoneal space was created by a balloon dissector. Standard procedures of TEP all were finished using conventional straight laparoscopic instruments. Results: Of the 100 patients in this study, 2 underwent conversion to LESS transabdominal preperitoneal (TAPP) repair. The remaining 98 patients received successful LESS TEP inguinal hernia repair by a single surgeon. No patient required open or conventional laparoscopic conversion. However, one patient did experience recurrence. The mean operative time was 64.2 min, and the hospital stay was 1.54 days. One patient with a history of bladder surgery had a minor intraoperative bladder injury. No major postoperative complication occurred, but 11 patients had seroma or hematoma, 2 had epididymitis, 2 had urinary tract infection, 1 had wound dehiscence, 1 had wound infection, and 1 had urinary retention. This single-arm observational study was limited by the absence of a control cohort. Conclusions: Based on our experience, in the hands of experienced laparoscopic surgeons, LESS TEP repair for adult inguinal hernia using the homemade port as an access platform is feasible and safe and provides acceptable operative outcomes. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the feasibility and safety of totally extraperitoneal (TEP) endoscopic hernia surgery after previous lower abdominal surgery, which may preclude preperitoneal dissection. Methods: All 331 consecutive patients undergoing TEP surgery between January 2008 and December 2010 were included in a prospective cohort study. This case-control study included a study group and a comparison group. The study group consisted of 23 patients with a history of previous lower abdominal surgery before undergoing TEP endoscopic hernia repair. For the comparison group, 46 patients were randomly selected (two for every patient in the study group) and matched with the study cohort in terms of age, gender, and laterality of inguinal hernia. Perioperative data were obtained for all the patients including demographic data, operation time, length of hospital stay, narcotic dose, conversions, and complications. Results: A total of 69 patients with inguinal hernias underwent TEP surgery: 23 patients with previous abdominal surgery (study group) and 46 patients without such surgery (control group). No conversions were necessary in the control group, but one case (4.4%) in the study group was converted to transabdominal preperitoneal hernia repair (TAPP) ( P = 0.33). Peritoneal injury requiring intracorporeal repair was encountered in six study group patients and eight control group patients ( P = 0.53). No differences were observed between the two groups in terms of operative times, analgesic use, hospital stay, return to daily activities, or postoperative complications. Conclusions: In experienced hands, TEP hernia repair for patients with previous lower abdominal surgery can be performed safely. In this study, the operative outcomes were comparable with those for patients who had no history of lower abdominal surgery. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the risks of thromboembolic vascular disease following androgen deprivation therapy (ADT) administered to prostate cancer (PCa) patients. A total of 24,464 men with newly diagnosed PCa during 2000–2008 were recruited through a longitudinal health insurance database in Taiwan. All PCa patients were stratified into two: ADT and non-ADT groups. Patients with ADT treatment were grouped into three: surgical castration, chemical castration, and anti-androgen alone. The risks of pulmonary embolism (PE), peripheral arterial occlusion disease (PAOD), and deep vein thrombosis (DVT) were assessed in multiple Cox proportional-hazards regression with time-dependent covariates. During the 12-year follow-up period, incidence rates per 1000 person-years in ADT and non-ADT groups were 2.87 and 1.62 for DVT, 1.00 and 0.52 for PE, and 1.03 and 0.70 for PAOD, respectively. The DVT and PE risks were significantly increased in patients receiving combined androgen blockade (CAB) compared with the counterpart ADT non-recipients. After adjusting for potential risk factors, PCa patients receiving CAB had the highest PE risk (HR = 3.11), followed by DVT risk (HR = 2.53). The DVT risk remained elevated throughout the entire duration of chemical castration. However, high PE risk was observed in patients with ≤720-day treatment duration. No association was found between ADT and PAOD risks. Overall, the risks of PE and DVT were considerably heightened in Asian men subjected to CAB for PCa, whereas PAOD risk was unrelated to such treatments. [ABSTRACT FROM AUTHOR]

A correction to the article "Association Between Statin Use and Bell's Palsy: A Population-Based Study: is presented.

The risk for stroke in alopecia areata (AA) patients is still unknown. This study aimed to investigate the risk for subsequent risk of a stroke in AA patients in a large-scale retrospective cohort study. We identified 3231 patients with AA included in the study group from 2004 to 2011 in the 'Longitudinal Health Insurance Database 2000' in Taiwan. We randomly selected 16,155 matched patients as the comparison group. We individually tracked each patient for a 3-year period to identify patients who had received a diagnosis of stroke during the follow-up period. We found that incidence rates of stroke during the 3-year follow-up periods were 5.44 (95% confidence interval (CI) = 4.03 ~ 7.20) and 2.75 (95% CI = 2.30 ~ 3.27) per 1000 person-years for patients with and those without AA, respectively. Cox proportional hazard regressions showed that the adjusted hazard ratio for stroke for those patients with AA was 1.61 (95% CI = 1.13 ~ 2.30) within the follow-up period compared to the controls. We concluded that patients with AA were associated with a higher risk of stroke in the 3-year follow-up period. [ABSTRACT FROM AUTHOR]