Search

Purpose: The incidence of Tourette syndrome and chronic tic disorders has seldom been evaluated in Asia. Methods: Using the National Taiwan Insurance Research Database, the annual standardized incidence and prevalence of Tourette syndrome (TS) and chronic tic disorders were estimated from 2007 to 2015. The pre-existing comorbidity at disease diagnosis was also evaluated. Results: From 2007 to 2015, the age- and sex-standardized incidence increased from 5.34 (95% confidence interval [CI] 5.06–5.62) per 100,000 person-years to 6.87 (95% CI 6.53–7.21) per 100,000 person-years. In children and adolescents, the age- and sex-standardized incidence increased from 19.58 (95% CI 18.42–20.75) per 100,000 person-years to 31.79 (95% CI 30.09–33.49) per 100,000 person-years. In adults, the age- and sex-standardized incidence decreased from 2.01 (95% CI 1.79–2.23) per 100,000 person-years to 1.24 (95% CI 1.07–1.42) per 100,000 person-years. The incidence rate ratio (IRR) between males and females was 3.74 (95% CI 3.32–4.22). The age- and sex-standardized prevalence increased from 37.51 (95% CI 36.75–38.27) per 100,000 people in 2007 to 84.18 (95% CI 83.02–85.35) per 100,000 people in 2015. The rate risk (RR) between males and females was 3.65 (95% CI 3.53–3.78). Conclusion: The annual incidence rates of TS and chronic tic disorders increased in childhood and adolescence but decreased in adulthood from 2007 to 2015. The prevalence rates increased over the same period. [ABSTRACT FROM AUTHOR]

Background: Patients with cirrhosis and acute myocardial infarction (AMI) present dilemma whether dual antiplatelet therapy (DAPT) should be used. Methods: Electronic medical records between 2001–2013 were retrieved from Taiwan National Health Insurance Research Database. Patients were excluded for missing information, age <20 years old, history of AMI, liver transplant, autoimmune disease, coagulopathy, taking DAPT 3 months before index date, follow-up <3 months, anticoagulation user, without DAPT, and events of myocardial infarction (MI), ischemic stroke, major bleeding, and heart failure within 3-month of enrollment. Primary outcomes were 1-year all-cause mortality, recurrent MI, major bleeding, and gastrointestinal bleeding. Results: A total of 150,887 patients with AMI retrieved. After exclusion criteria and propensity score-matching, 914 cirrhotic and 3,656 non-cirrhotic patients with AMI on DAPT were studied. During 1-year follow-up, there was significantly increased mortality in cirrhotic patients compared to non-cirrhotic patients (HR = 1.49, 95% CI = 1.28–1.74). There was significantly decreased recurrent MI in cirrhotic patients compared to non-cirrhotic patients (subdistribution HR [SHR] = 0.71, 95% CI = 0.54–0.92). However, non-significantly increased major bleeding (SHR = 1.23, 95% CI = 0.87–1.73) and significantly increased gastrointestinal bleeding (SHR = 1.49, 95% CI = 1.31–1.70). Conclusions: In cirrhotic patients with AMI, DAPT offers benefit with decreased recurrent MI at the expense of increased gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Background Branched-chain amino acids (BCAAs) are elevated in the insulin-resistant (IR) state. The reasons for this increase remain unclear, but it may be related to abnormalities in BCAA metabolism and free fatty acid (FFA) metabolism. Objective In this study, we quantified BCAA and FFA kinetics of IR and insulin-sensitive (IS) nonobese Asian men with the use of stable-isotope tracers. We hypothesized that in addition to greater substrate flux, the BCAA oxidative pathway is also impaired to account for the higher plasma BCAA concentration in the IR state. Design We recruited 12 IR and 14 IS nonobese and healthy Asian men. Oral-glucose-tolerance tests (OGTTs) were performed to quantify insulin sensitivity, and subjects underwent 2 stable-isotope infusion studies. [U-13C6]Leucine was infused to measure leucine flux and oxidation as indexes of BCAA metabolism, whereas [U-13C16]palmitate was infused to measure palmitate flux and oxidation to represent FFA metabolism, The ²H2O dilution method was used to estimate body composition. Results IR subjects had greater adiposity and significantly higher fasting and post-OGTT glucose and insulin concentrations compared with the IS group. However, none of the subjects were diabetic. Despite similar dietary protein intake, IR subjects had a significantly higher plasma BCAA concentration and greater leucine flux. Leucine oxidation was also greater in the IR group, but the relation between leucine oxidation and flux was significantly weaker in the IR group than in the IS group (r = 0.530 compared with 0.695, P < 0.0388 for differences between slope). FFA oxidation was, however, unaffected despite higher FFA flux in the IR group. Conclusion The higher plasma BCAA concentration in healthy nonobese individuals with IR is associated with a weaker relation between BCAA oxidation and BCAA flux and this occurs in the presence of accelerated FFA flux and oxidation. [ABSTRACT FROM AUTHOR]

Background: Health of migrants is a major public health challenge faced by governments and policy makers. Asian Indians are among the fastest growing migration groups across Asia and the world, but the impact of migration and acculturation on diabetes and diabetes-related eye complications among Indians living in urban Asia remains unclear. Methodologies/Principal Findings:We evaluated the influence of migration and acculturation (i.e., migration status and length of residence) on the prevalence of type-2 diabetes mellitus (T2DM) and diabetes-related eye complications (diabetic retinopathy (DR) and cataract), among first-generation (defined as participant born in India with both parents born in India, n = 781) and second-generation (participants born in Singapore with both parents born in India, n = 1,112) Indian immigrants from a population-based study of Adult Indians in Singapore. Diabetes was defined as HbA1c$6.5%, use of diabetic medication or a physician diagnosis of diabetes. Retinal and lens photographs were graded for the presence of DR and cataract. Compared to first generation immigrants, second generation immigrants had a higher age- and genderstandardized prevalence of T2DM (34.4% versus 29.0%, p,0.001), and, in those with T2DM, higher age- and genderstandardized prevalence of DR (31.7% versus 24.8%, p<0.001), nuclear cataract (13.6% versus 11.6%, p<0.001), and posterior sub-capsular cataract (6.4% versus 4.6%, p<0.001). Among first generation migrants, longer length of residence was associated with significantly younger age of diagnosis of diabetes and greater likelihood of having T2DM and diabetes-related eye complications. Conclusion: Second generation immigrant Indians and longer length of residence are associated with higher prevalence of diabetes and diabetes-related complications (i.e., DR and cataract) among migrant Indians living in Singapore. These data highlight potential worldwide impacts of migration patterns on the risk and burden of diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been shown to improve both the health and the quality of life of morbidly obese patients. We compared the efficacy and safety of using a team approach to LRYGB versus an individual surgeon at a medical center. Methods: Data were collected from 200 consecutive patients undergoing LRYGB for morbid obesity from August 2005 to February 2008. Groups 1 and 2 included 50 patients each who underwent surgery and were cared for by the same surgeon. Group 3 included the next 100 consecutive patients, who underwent LRYGB by the same surgeon but who were cared for by a dedicated bariatric team. Results: For the 76 men (38%) and 124 women (62%) in the study, the excess weight loss at 1 and 3 months of follow-up did not differ; however, it was significantly different at 6 and 12 months. At the mean follow-up period, 30% of group 1, 6% of group 2, and 8% of group 3 had experienced complications. Most complications in group 1 occurred early and were related to the surgical technique; however, in groups 2 and 3, the complications related to the technique were markedly reduced. Men were 4.57 times as likely as women to experience complications related to bariatric surgery. Conclusion: A team-based approach is a better option for patients undergoing LRYGB than care by a single surgeon. With an experienced bariatric surgeon, the team approach resulted in shorter operative times and shorter hospital stays, with the same rate of complications. [Copyright &y& Elsevier]

Background: The benefits of regular physical activity for quality of life and disease prevention have been well documented. Identification of low activity groups would facilitate interventional programs. Many studies have focussed on leisure time activity, which may not capture the spectrum of physical activity relevant to disease prevention. Furthermore, few studies have been conducted in urban Asian settings. Methods: We evaluated physical activity in different domains (leisure time, occupational, household and transportation) and its sociodemographic determinants in 4750 adult Chinese, Malay, and Asian Indian Singaporeans. Physical activity was assessed using locally validated questionnaires. Results: Occupational and household activity contributed substantially more to total physical activity than leisure time or transportation activity. However, when only activity of at least moderate intensity was considered leisure time activity contributed most to total physical activity. Higher socio-economic status was associated with more leisure time activity, but less total physical activity due to reduced activity in the other domains. Chinese ethnicity was also associated with less total physical activity as a result of less activity in non-leisure time domains. Conclusions: In assessing levels of physical activity and recommending changes, it is important to consider physical activity in different domains. Focus on leisure-time physical activity alone could identify the wrong groups for intervention and miss opportunities for increasing physical activity in populations. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- The International Diabetes Federation (IDF) proposes that central obesity is an "essential" component of the metabolic syndrome, while the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) proposes that central obesity is an "optional" component. This study examines the effect of the metabolic syndrome with and without central obesity in an Asian population with ischemic heart disease (IHD). RESEARCH DESIGN AND METHODS -- From the population-based cohort study (baseline 1992-1995), 4,334 healthy individuals were grouped by the presence or absence of the metabolic syndrome and central obesity and followed up for an average of 9.6 years by linkage with three national registries. Cox's proportional hazards model was used to obtain adjusted hazard ratios (HRs) for risk of a first IHD event. RESULTS -- The prevalence of metabolic syndrome was 17.7% by IDF criteria and 26.2% by AHA/NHLBI criteria using Asian waist circumference cutoff points for central obesity. Asian Indians had higher rates than Chinese and Malays. There were 135 first IHD events. Compared with individuals without metabolic syndrome, those with central obesity/metabolic syndrome and no central obesity/metabolic syndrome were at significantly increased risk of IHD, with adjusted HRs of 2.8 (95% CI 1.8-4.2) and 2.5 (1.5-4.0), respectively. CONCLUSIONS -- Having metabolic syndrome either with or without central obesity confers IHD risk. However, having central obesity as an "optional" rather than "essential" criterion identifies more individuals at risk of IHD in this Asian cohort. [ABSTRACT FROM AUTHOR]

Perilipin is a lipid droplet surface protein present in adipocytes and steroidogenic cells. We examined five common single nucleotide polymorphisms (SNPs) at the perilipin ( PLIN) locus ( PLIN 6209C>T, 10171A>T, 11482G>A, 13041A>G, and 14995A>T) to investigate their association with obesity risk. The study population included 4,131 subjects of three ethnic groups (Chinese, Malay, and Indian) from Singapore. The prevalence of obesity in Malays and Indians was much higher than in Chinese. Moreover, in these groups the prevalence of obesity was three times higher in women than in men. Crude analysis indicated that haplotype 11212 (CAAAT) is shared by Malays and Indians and is significantly associated with increased obesity risk as compared to the most common haplotype 21111 (TAGAA): OR 1.65 (95% CI 1.11–2.46) in Malays and 1.94 (95% CI 1.06–3.53) in Indians. No associations between PLIN haplotypes and obesity risk were found in Chinese. To simplify the haplotype analyses we used a subgroup of three SNPs (11482G>A, 13041A>G, and 14995A>T) in positive linkage disequilibrium. These analyses revealed similar associations, showing that haplotypes XX212 (XXAAT) and XX222 (XXAGT) are associated with increased obesity risk in Malays OR 2.04 (95% CI 1.28–3.25) and 2.05 (95% CI 1.35–3.12) respectively, and that haplotype XXX212 (XXAAT) is significantly associated with increased obesity risk in Indians OR 2.16 (95% CI 1.10–4.26) after adjusting for covariates including age, sex, smoking, alcohol consumption, exercise, and diabetes status. Moreover, individual SNP analyses demonstrated that the PLIN 14995A>T SNP is the most informative single genetic marker for the observed haplotype association, being significantly associated with increased obesity risk in both Malays OR 2.28 (95% CI 1.45–3.57) and Indians OR 2.04 (95% CI 1.08–3.64). These results support the role of the PLIN locus as an ethnically dependent modulator of obesity risk in humans. [ABSTRACT FROM AUTHOR]

Japanese encephalitis is a mosquito-borne disease caused by the Japanese encephalitis virus (JEV) that is prevalent in Asia and the Western Pacific. Currently, there is no effective treatment for Japanese encephalitis. Curcumin (Cur) is a compound extracted from the roots of Curcuma longa, and many studies have reported its antiviral and anti-inflammatory activities. However, the high cytotoxicity and very low solubility of Cur limit its biomedical applications. In this study, Cur carbon quantum dots (Cur-CQDs) were synthesized by mild pyrolysisinduced polymerization and carbonization, leading to higher water solubility and lower cytotoxicity, as well as superior antiviral activity against JEV infection. We found that Cur- CQDs effectively bound to the E protein of JEV, preventing viral entry into the host cells. In addition, after continued treatment of JEV with Cur-CQDs, a mutant strain of JEV was evolved that did not support binding of Cur-CQDs to the JEV envelope. Using transmission electron microscopy, biolayer interferometry, and molecular docking analysis, we revealed that the S123R and K312R mutations in the E protein play a key role in binding Cur-CQDs. The S123 and K312 residues are located in structural domains II and III of the E protein, respectively, and are responsible for binding to receptors on and fusing with the cell membrane. Taken together, our results suggest that the E protein of flaviviruses represents a potential target for the development of CQD-based inhibitors to prevent or treat viral infections. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this article was to evaluate measurement equivalence of the English and Chinese versions of the Short Form 36 version 2 (SF-36v2) and Short Form 6D (SF-6D). Study Design and Setting: In this cross-sectional study, health-related quality of life (HRQoL) was measured from 4,973 ethnic Chinese subjects using the SF-36v2 questionnaire. Measurement equivalence of domain and utility scores for the English- and Chineselanguage SF-36v2 and SF-6D were assessed by examining the score differences between the two languages using linear regression models, with and without adjustment for known determinants of HRQoL. Equivalence was achieved if the 90% confidence interval (CI) of the differences in scores, due to language, fell within a predefined equivalence margin. Results: Compared with English-speaking Chinese, Chinese-speaking Chinese were significantly older (47.6 vs. 55.5 years). All SF- 36v2 domains were equivalent after adjusting for known HRQoL. SF-6D utility/items had the 90% CI either fully or partially overlap their predefined equivalence margin. Conclusion: The English- and Chinese-language versions of the SF-36v2 and SF-6D demonstrated equivalence. © 2013 Elsevier Inc. All rights reserved. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To evaluate family history (FH) of type 2 diabetes (T2DM) as a risk factor for impaired fasting glucose (IFG), impaired glucose tolerance (IGT), T2DM and related metabolic traits in South East Asia and to compare the effects of a paternal versus maternal history. Methods: We studied 4717 men and women (68% Chinese, 18% Malays and 14% Asian Indians) living in Singapore. FH was considered positive if at least one first degree relative had T2DM. Obesity, fasting lipids, glucose and insulin levels were measured for all subjects. Insulin resistance (IR) was estimated by homeostasis model assessment (HOMA). An oral glucose tolerance test was carried for all subjects except those on diabetes medication. Results: A positive FH was associated with increased risk of IFG/IGT (OR=1.67, 95% CI=1.42–1.97) and T2DM (OR=2.95, 95% CI=2.36–3.70) as well as higher levels of obesity, HOMA-IR, fasting triglyceride (TG), and lower levels of high density lipoprotein (HDL) cholesterol and HOMA-β. A maternal history of T2DM appeared to have a greater impact on obesity-related traits than a paternal history of T2DM. Compared to individuals with no FH of T2DM, a maternal history was associated with (i) greater body mass index (BMI) (24.15kg/m2 vs. 23.42kg/m2, p =0.016) and waist-to-hip ratio (WHR) (0.874 vs. 0.865, p =0.037) in men; and (ii) greater WHR (0.788 vs. 0.779, p =0.004), fasting triglyceride (1.23mmol/L vs. 1.09mmol/L, p <0.001), HOMA-IR (2.02 vs. 1.75, p <0.001), fasting plasma glucose (5.25mmol/L vs. 5.18mmol/L, p =0.005) and 2-h plasma glucose (6.01mmol/L vs. 5.78mmol/L, p =0.001) and lower HDL-C (1.41mmol/L vs. 1.47mmol/L, p =0.031) in women. Conclusion: T2DM appears to be heritable in South East Asians with excess maternal transmission of obesity, IR and dyslipidemia. [Copyright &y& Elsevier]