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The aim of this study was to identify dementia trajectories and their associated predictors among elderly Taiwanese people over a 14-year period using a nationwide representative longitudinal study. This retrospective cohort study was performed using the National Health Insurance Research Database. Group-based trajectory modeling (GBTM) was used to distinguish the specific trajectory groups of incident dementia during 2000–2013. All 42,407 patients were classified by GBTM to identify the trajectory of incident dementia, which included high- (n = 11,637, 29.0%), moderate- (n = 19,036, 44.9%), and low-incidence (n = 11,734, 26.1%) groups. Those diagnosed with hypertension (adjusted odds ratio [aOR] = 1.43; 95% confidence interval [CI] = 1.35–1.52), stroke (aOR = 1.45, 95% CI = 1.31–1.60), coronary heart disease (aOR = 1.29, 95% CI = 1.19–1.39), heart failure (aOR = 1.62, 95% CI = 1.36–1.93), and chronic obstructive pulmonary disease (aOR = 1.10, 95% CI = 1.02–1.18) at baseline revealed tendencies to be classified into high-incidence groups in dementia risk. The results from a 14-year longitudinal study identified three distinct trajectories of incident dementia among elderly Taiwanese people: patients with cardiovascular disease risk factors and cardiovascular disease events tended to be classified into high-incidence dementia groups. Early detection and management of these associated risk factors in the elderly may prevent or delay the deterioration of cognitive decline.

BackgroundPrevious studies have demonstrated that C-reactive protein (CRP) and glycated hemoglobin (HbA1c) levels are independently associated with neurodegenerative diseases, which can be improved by altering dietary patterns. This study investigates the combined effect of CRP and HbA1c, as well as the influence of dietary patterns, on the risk of dementia.MethodsA cross-sectional study was conducted with 536 participants aged ≥65 years who were recruited from the Nutrition and Health Survey in Taiwan between 2014 and 2016. The high levels of inflammation and glycation were defined as a CRP level of >0.21 mg/dl and a HbA1c level of ≥6.50%, respectively. Mild cognitive impairment (MCI) was evaluated using the Mini-Mental State Examination (MMSE) score. The dietary patterns associated with CRP and HbA1c levels were assessed using the reduced rank regression (RRR). Multivariate logistic regression analysis of both complete and imputed datasets was performed.ResultsParticipants with high levels of both CRP and HbA1c were associated with the highest odds ratio (OR) of MCI (adjusted OR [aOR] = 3.52; 95% CI = 3.48, 3.56; p < 0.001), followed by a high level of only HbA1c (aOR = 1.73; p < 0.001) and a high level of CRP (aOR = 1.49; p < 0.001). Using the reduced rank regression, an inverse relationship between higher consumption nuts and seeds and lower levels of CRP and HbA1c was found (both factors loading < −0.2). Concerning the combined effect of tertiles among the factor 1 and factor 2 analyzed by dietary patterns, group 1 with both T3 (high tertiles) was associated with the greatest OR of MCI (aOR = 4.38; 95% CI = 4.34, 4.42; p < 0.001) using multiple imputation.ConclusionsThe combined effect of high levels of inflammation and hyperglycemia was associated with an increased likelihood of MCI. Moreover, dietary patterns positively related to inflammation and hyperglycemia were associated with MCI, while eating nuts and seeds promoted better cognition.

Advanced glycation end products (AGE) and the receptor for AGE (RAGE) have been found to be pivotal biomarkers to predict the risk of inflammation and oxidative stress. Limited evidence focuses on the influence of occupational exposure to polycyclic aromatic hydrocarbon (PAH) and metal fumes on AGE and RAGE in shipyard welders. Our aim was to determine the relationships among PAH, metal exposure, and inflammatory biomarkers. From September 1 to December 31, 2017, 53 welding workers (exposed group) and 29 office workers (control group) were enrolled in the study. Comprehensive workups included demographic characteristics, laboratory data, AGE, RAGE, Interleukin-6 (IL-6), tumor necrosis factor-α, PAH, and urinary metal concentrations. RAGE levels were measured by flow cytometric analysis. Urinary 1-hydroxypyrene (1-OHP) was used as a biomarker of exposure to PAH. Several metals were elevated in the personal fine particulate matter (PM2.5) samples, including Mn, Fe, V, Co, Zn, and Cu. The exposed group had significantly higher exposure to PM2.5 (p = 0.015), RAGE (p = 0.020), IL-6 (p = 0.008) than the control group. After adjusting for pertinent variables, there was still a significant and positive association between Ni level and AGE (β = 0.101; 95% CI, 0.031–0.172). Significant relationship between Cr and Cd levels and RAGE was observed (β = 0.173; 95% CI, 0.017–0.329; β = 0.084; 95% CI, 0.011–0.157, respectively). Participants with elevated 1-OHP level had higher odds of high RAGE level in the model 1 (OR = 3.466, 95% CI, 1.053–11.412) and model 2 (OR = 3.454, 95% CI, 1.034–11.536). The RAGE expression of participants was significantly associated with IL-6 levels in the fully adjusted model (β = 0.294; 95% CI, 0.083–0.732). Our findings highlighted that urinary metal levels and PAH were associated with increased AGE and RAGE formation in shipyard workers. Elevated serum RAGE might induce the production of proinflammatory cytokines and trigger ensuing inflammatory cascades.

BackgroundCentral obesity is known to be associated with diabetes. Increasing lower extremity circumference was hypothesized in association with lower risk of diabetes.ObjectiveThis study determined which anthropometric patterns correlates the best with pre-diabetic and diabetic status among healthy adults.DesignCross-sectional study with nationwide population sampling of participants was designed.ParticipantsIn total, 1,358 ethnic Chinese adult participants were recruited from the Nutrition and Health Survey in Taiwan 2013-2016; the whole-body composition was measured through dual-energy X-ray absorptiometry.Main outcome measuresFat and lean mass in whole and specific parts of body among heathy Asian adults with normal glycemic, pre-diabetic, and diabetic states were measured, separately.Statistical analyses performedThe generalized linear model was used to investigate the association between body composition (lean and fat mass) and hyperglycemic status. The reduced rank regression (RRR) was used to confirm the correlation between glycemic status and predicting factors (body composition parameters).ResultsTrunk fat positively correlated with the fasting glucose level (r = 0.327, P < 0.001) and HbA1c (r = 0.329, P < 0.001), whereas limb fat negatively correlated with the fasting glucose level (r = -0.325, P < 0.001) and HbA1c (ρ = -0.342, P < 0.001), respectively. In RRR analyses, fasting glucose and HbA1c exhibited a high positive association on fat amount per lean mass of the trunk (factor loading = 0.5319 and 0.5599, respectively) and of android area (0.6422 and 0.6104) and a high negative association fat amount per lean mass of the legs (-0.3863 and -0.3083) and gynoid area (-0.3414 and -0.3725).ConclusionsFor healthy community participants, increasing trunk fat had a greater risk of hyperglycemic status. Increasing lower extremity mass may confer lower risk of diabetes.

Background The relationship of alteration of metabolic syndrome (MetS) with dementia remains unclear. The purpose of study was to evaluate the association between dynamic change in MetS status around a 5‐year period and dementia. Methods and Results The cohort study was conducted from the Taiwanese Survey on Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia in 2002, with follow‐up in 2007. The sample was subsequently linked to the National Health Insurance Research Database. Participants were divided into 3 groups: persistent MetS (MetS both in 2002 and 2007); nonpersistent MetS (MetS either in 2002 or 2007); and non‐MetS (MetS neither in 2002 nor 2007). Furthermore, the individuals with nonpersistent MetS were categorized as improved MetS (MetS in 2002 but not in 2007) and worsened MetS (MetS not in 2002 but in 2007). Each participant was tracked until the end of 2011 to identify the development of dementia. In total, 3458 participants aged 40 to 80 years were included. Up to 10 years and 31 741 person‐years of follow‐up, 76 patients developed dementia. Only a relationship was found between the nonpersistent MetS and dementia (adjusted hazard ratio=1.93; 95% confidence interval =1.17–3.19; P =0.010). Moreover, a significantly higher dementia risk was observed in patients with worsened MetS (adjusted hazard ratio =2.22; 95% confidence interval =1.32–3.72; P =0.003), but not those with persistent ( P =0.752) or improved ( P =0.829) MetS. Similar results were detected in participants aged ≥65 years. Conclusions Patients with worsened MetS had an increased dementia risk during the 10‐year follow‐up period in a population‐based sample.

The risk of venous thromboembolism (VTE) and the development of atherosclerosis are increased in patients with inflammatory bowel disease (IBD). Ulcerative colitis (UC) is one type of IBD; however, there is controversy in the literature regarding the association between UC and stroke. The present cohort study estimated the risk of subsequent stroke among UC patients compared with that among matched comparison subjects drawn from a population-based data set in Taiwan. This investigation analyzed administrative claims data sourced from the Taiwan National Health Insurance Database. Our study consisted of a study cohort comprising 516 UC patients and a comparison cohort of 2,579 subjects without IBD. Cox proportional hazards regressions were performed to estimate the risk of subsequent stroke during the follow-up period. We also conducted additional analyses investigating the risk of subsequent stroke by age group and gender. After adjusting for selected medical co-morbidities and recent prescriptions of selected pharmaceuticals, the hazard ratio (HR) for subsequent stroke among patients with UC was 2.045 (95 % confidence interval (CI) = 1.374–3.043) than that among comparison subjects. While we did not detect an association between stroke and UC among patients aged 30–40 or 40–50 years, we did detect increased risks for stroke among UC patients aged over 50 years (HR = 2.045). We also found the association to remain significant for both men (HR = 2.153) and women (HR = 2.750). This study detected an increased HR for subsequent stroke among Taiwanese UC patients when compared to that among matched comparison patients without IBD.

Findings on risk detection for having metabolic syndrome (MetS) components, each of which may individually increase the risk of disease and mortality, are limited in young adults. In this study, we aimed to calculate the likelihood of having &ge, 1 MetS component in normoweight young adults using two different metabolic health criteria. We recruited 1182 normoweight young adults from the Taiwan Survey on the Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia and the National Health Interview Survey (aged 16&ndash, 45 years, 39% male, body mass index = 18.5&ndash, 22.99, all without MetS) and followed them for 5 years. Metabolic health criteria were derived from the Harmonized criteria (unhealthy if showing abnormality in one or two MetS components) and the triglyceride-glucose index (TyG-i, unhealthy if TyG-i was in the &gt, 75th percentile). Odds ratio (OR) and 95% confidence interval (CI) estimations for having &ge, 1 MetS component and for having each MetS component in 5 years were assessed using multivariable-adjusted logistic regression. We observed a significantly increased likelihood of the presence of &ge, 1 MetS component in the unhealthy group by using the Harmonized criteria and TyG-i (adjusted OR (aOR), 95%CI: 2.67, 2.04&ndash, 3.49 and 2.1, 1.57&ndash, 2.82, respectively). The areas under the receiver-operating characteristics curves were 0.679 and 0.652 for the final models using Harmonized and TyG-i criteria, respectively. These findings support the recommendation of treating any metabolic component abnormality, even in young adults without a MetS diagnosis.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Although two prior studies detected increased prevalence ratios of cerebrovascular disease among AS patients, the results of the two studies investigating AS and stroke are in conflict. Therefore, the present cohort study set out to estimate the risk of subsequent stroke in AS patients compared with matched controls using a population-based dataset in Taiwan. This investigation analyzed administrative claims data sourced from the Taiwan National Health Insurance Database. Our study consisted of a study cohort comprising 1,479 AS patients and a comparison cohort of 5,916 subjects without AS. Cox proportional hazards regressions were performed to estimate the risk of subsequent stroke during the follow-up period. We also conducted additional analyses investigating the risk of subsequent stroke by gender and pharmaceutical prescription. After adjusting for chronic lower respiratory diseases, type 2 diabetes mellitus, hypertension, hyperlipidemia, renal disease, coronary heart disease, atrial fibrillation, income, and urbanization, compared with comparison patients, the hazard ratio for subsequent stroke among patients with AS was 2.3 (95 % CI 1.9-2.8). We also stratified our results by both gender and pharmaceutical prescription, but did not find a statistically significant difference for the risk of subsequent stroke either between men and women, or between AS patients taking various pharmaceutical regimens and the overall AS population. This is the first study to report an increased hazard ratio for subsequent stroke among AS patients when compared with matched comparison patients without AS.

Background The pathophysiology of insulin resistance-induced hypertension and hyperlipidemia might entail differences in dementia risk in cases with hypertension and hyperlipidemia without prior diabetes mellitus (DM). This study investigated whether incident hypertension, incident hyperlipidemia, or both, increased the dementia risk in patients with and without DM. Methods A nationwide retrospective cohort study was conducted. The study sample was obtained from the National Health Insurance Research Database. We enrolled 10,316 patients with a new diagnosis of DM between 2000 and 2002 in the DM cohort. For the same period, we randomly selected 41,264 patients without DM in the non-DM cohort (matched by age and sex at a 1:4 ratio with the DM cohort). Both cohorts were then separately divided into four groups on the basis of incident hypertension or incident hyperlipidemia status. Results In total, 51,580 patients aged between 20 and 99 years were enrolled. The dementia risk was higher in the DM cohort than in the non-DM cohort (adjusted hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.30–1.67, p

Objective The incidence of chronic kidney disease (CKD) is on the rise. CKD patients are at high risk of cardiovascular (CVD) and all-cause mortality. CKD patients have several endocrine disorders, including low levels of dehydroepiandrosterone sulfate (DHEA-S). In the general population, low levels of DHEA-S are associated with high CVD and all-cause mortality. The aim of this study was to analyze the prognostic value of plasma DHEA-S on the survival of CKD patients on hemodialysis. Method This was a single-center prospective cohort study on two hundred CKD patients on hemodialysis, which assessed the prognostic value of plasma DHEA-S on their survival. Result We found that plasma DHEA-S levels were negatively associated with age, and positively associated with dialysis duration and plasma creatinine, albumin, and phosphate levels in hemodialysis men. Elderly patients with co-morbidities (i.e. diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease), poorer fluid control which was evaluated by higher cardiothoracic ratio, and low plasma creatinine and albumin levels seemed to have poor prognosis in hemodialysis men. Furthermore, low plasma DHEA-S levels were significantly associated with CVD-related [hazard ratio (HR) = 3.877; P = 0.021], non-CVD-related (HR = 3.522; P = 0.016), and all-cause mortality (HR = 3.667; P = 0.001) in hemodialysis men. But low plasma DHEA-S levels were not significantly associated with CVD-related, non-CVD-related, and all-cause mortality in hemodialysis women. Multivariate Cox regression analysis suggested that low plasma DHEA-S levels are significantly and independently associated with all-cause mortality in hemodialysis men (HR = 2.933; P = 0.033). Conclusion The study suggested that low plasma DHEA-S was independently and significantly associated with all-cause mortality in CKD hemodialysis men.

Objective: Hemodialysis has an adverse impact on the immunological, nutritional, and emotional status of patients. The biochemical markers of inflammation and nutrition were studied as well as the relationship of these factors to emotional symptoms. Method: One hundred and ninety-five patients undergoing hemodialysis were enrolled. The mean age was 58.5 years. Emotional symptoms were assessed using the Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale, Chalder Fatigue Scale, and Short-form Health-related Quality of Life. Venus blood was collected for laboratory assessment of serum hemoglobin, albumin, ferritin, C-reactive protein, interleukin (IL) 1β), IL-6, and tumor necrosis factor a. Results: Among the 195 subjects (92 men and 103 women), 47 (24.1%) fulfilled the criteria for a major depressive disorder (MDD). The IL-6 level in patients with a MDD was significantly higher than in the patients without a MDD. Significant correlation was observed among the following factors: IL-6, fatigue, and quality of life for both physical and mental components. The albumin levels showed a significant correlation with the IL-6 and depression scores. Conclusions: These results show that the serum levels of albumin and IL-6 might be laboratory markers associated with the expression of emotional symptoms in patients undergoing hemodialysis. Prospective studies are needed to determine the causal relationships among these variables.

Background. Higher cardiovascular mortality has been noted in patients with chronic kidney disease (CKD). CKD patients are also known to have impaired energy expenditure but the role of energy expenditure in cardiovascular disease is not yet known. Furthermore, the association between cold dialysis (CD) and clinical outcomes in hemodialysis patients is unclear. Methods. This was a single-center retrospective cohort study consisting of two groups: a CD group with dialyzate temperature

Background Ghrelin has a protective effect on endothelial cells. Endothelial cell dysfunction is associated with cardiovascular disease (CVD) and CVD remains the leading cause of morbidity in hemodialysis (HD) patients. Acylated ghrelin (A-Ghr) is the functional form of ghrelin, so we hypothesized that A-Ghr is associated with the occurrence of CVD in HD patients. Methods We conducted a prospective cohort study in 412 HD patients. The cohort was sub-grouped into low and high A-Ghr groups according to the median A-Ghr level of 4.88 pg/mL. The association between the low/high A-Ghr groups and the incidence of CVD were analyzed. Results The HD patients in a low A-Ghr group had a greater risk of incidental CVD than those in a high A-Ghr ghrelin. This association remained significant after the adjustment for possible confounding factors, including age, gender, HD duration, BMI, diabetes, albumin, nPCR and Charlson's comorbidity index score. Conclusion It appears that a low serum A-Ghr level is associated with the development of CVD in HD patients.

Objective Depression is common in hemodialysis patients. Reduced DHEA-S levels have been shown to be associated with depression in general population. Abnormalities in hormone production and metabolism are found in hemodialysis patients. However, the association between DHEA-S levels and depression in hemodialysis patients has not been established. Method We conducted a cross-sectional study, in which 80 patients under regular hemodialysis were studied, and their serum DHEA-S levels were analyzed. Results The prevalence of depression in our studied hemodialysis population is 37.5% (30/80). The DHEA-S level was 1138.1 ± 1216.9 ng/mL in male patients and 502.1 ± 389.4 ng/mL in female patients. The levels were not significantly different between patients with or without depression (910.8 ± 1127.1 ng/mL vs. 769.3 ± 848.3 ng/mL, P = 0.533). As compared to the non-depressed patients, the depressed patients were more likely to be male, with lower body mass index, consuming more alcohol, and with more co-morbidity. The prevalence of depression was not associated with age, educational background, smoking, duration of dialysis, hemoglobin, albumin, CRP, ferritin, and urea clearance (Kt/V and URR). The serum DHEA-S levels exhibited significant and independent associations with age, gender, diabetes mellitus, and the levels of serum albumin. Conclusion The study suggested a lack of association between plasma DHEA-S levels and depression in hemodialysis patients.

Crohn’s disease (CD) is one type of inflammatory bowel disease (IBD) that has been speculated to share prognostic factors with the development of stroke. There is controversial information in the literature regarding the association between CD and stroke. The present cohort study estimated the risk of subsequent stroke among CD patients compared with matched comparison subjects drawn from a population-based dataset in Taiwan. This study drew data from the Taiwan National Health Insurance Database to conduct a historical cohort study. The study cohort comprised 3309 CD patients, and the comparison cohort comprised 13,236 subjects without an IBD. Cox proportional hazards regressions were performed to estimate the risk of subsequent stroke during the follow-up period. We also conducted additional analyses stratifying by age group and gender. After adjusting for selected medical co-morbidities and recent prescriptions of selected pharmaceuticals, the hazard ratio (HR) for subsequent stroke among patients with CD was found to be 1.911 (95 % confidence interval (CI) = 1.65–2.22) that of comparison subjects. While we did not detect an association between stroke and CD among patients aged 30–40 years, we did detect increased risks for stroke among CD patients aged 40–50 years (HR = 2.29) and those aged over 50 years (HR = 1.88). We also found women (HR = 2.39) to be at a greater risk than men (HR = 1.50). This study reports an increased HR for subsequent stroke among CD patients when compared to matched comparison patients without IBD in an Asian population.

Patients on hemodialysis commonly have comorbid depression and require treatment with psychotropic drugs. This study aimed to investigate the prevalence of the use of psychotropic drugs among patients on hemodialysis and to elucidate the factors associated with use of each class of psychotropic medication.This cross-sectional study enrolled 195 hemodialysis patients with a mean age of 58.5 years. Patients were assessed using the Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale, Chalder Fatigue Scale and Short-form Health-related Quality of Life. We analyzed the frequency of psychiatric outpatient department visits within six months prior to interview and psychotropic drugs use within one month prior to interview, including antidepressants, antipsychotics, mood stabilizers, benzodiazepines (BZDs) and hypnotics.Of the 195 patients, 47 (24.1%) fulfilled the DSM-IV criteria for major depressive disorder (MDD). Only 6.4% of patients diagnosed with MDD visited the psychiatry outpatient department within six months prior to interview. Of the total patients, the proportions with use of antidepressants, antipsychotics, mood stabilizers, BZDs and hypnotics were 5.6%, 1.0%, 3.1%, 42.6% and 20.0%, respectively. Having MDD was an independent factor associated with taking antidepressants (adjusted OR = 3.98, p = 0.036) and taking hypnotics (adjusted OR = 2.75, p = 0.011).Depression is generally undetected or not well-managed among hemodialysis patients in the clinical setting. Only a small proportion of depressed patients received antidepressant treatment. BZDs and/or hypnotics might be exorbitantly prescribed. Clinicians should pay more attention to patients' emotional distress and provide appropriate treatment.

Background Chronic musculoskeletal (MS) pain is common in patients with chronic kidney disease (CKD) undergoing haemodialysis. However, epidemiological data for chronic MS pain and factors associated with chronic MS pain in patients with early- or late-stage CKD who are not undergoing dialysis are limited. Method A cross-sectional study to evaluate the prevalence of chronic MS pain and factors associated with chronic MS pain in patients with early- and late-stage CKD who were not undergoing dialysis, was conducted. In addition, the distribution of pain severity among patients with different stages of CKD was evaluated. Results Of the 456 CKD patients studied, 53.3% (n = 243/456) had chronic MS pain. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, as well as with the calcium × phosphate product levels. In CKD patients with hyperuricemia, chronic MS pain showed a negative, independent significant association with diabetes mellitus as a co-morbidity (odds ratio: 0.413, p = 0.020). However, in the CKD patients without hyperuricemia as a co-morbidity, chronic MS pain showed an independent significant association with the calcium × phosphate product levels (odds ratio: 1.093, p = 0.027). Furthermore, stage-5 CKD patients seemed to experience more severe chronic MS pain than patients with other stages of CKD. Conclusion Chronic MS pain is common in CKD patients. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, and with the calcium × phosphate product levels in early- and late-stage CKD patients who were not on dialysis.

Objective Patients with chronic kidney disease (CKD) who are undergoing maintenance hemodialysis have a higher prevalence of depression than the general population. The underlying cause of this association is unknown, but may be related to accumulation of uremic toxins. Little is known about the association of accumulation of uremic toxins and depression in hemodialysis patients. Method We conducted a cross-sectional study of 209 CKD patients from a single institution to evaluate the associations of a soluble small uremic toxin (urea), a soluble large uremic toxin (β2 microglobulin) and two protein-bound uremic toxins [total p-cresol sulfate (PCS) and indoxyl sulfate (IS)] with the presence of depression. Results A total of 47 patients (22.4%) had depression. Depressive patients had lower body mass index, lower serum creatinine, lower serum albumin and lower total IS. Univariate and multivariate logistic regression analyses that adjusted for age, gender and other statistically significant variables indicated that depression was significantly and independently associated with lower serum albumin and lower total IS. The levels of urea, β2 microglobulin and PCS were not significantly associated with depression. Conclusion Our results indicate that depression in patients with CKD was significantly and independently associated with lower serum albumin and lower total IS. However, the pathological mechanisms underlying these associations are unknown.

Objective. The sensitivity and specificity of the Chinese versions of the Hypomania Symptom Checklist-32 (HCL-32) and Mood Disorder Questionnaire (MDQ) for detecting bipolar disorder in Taiwan were explored in this study. Methods In total, 59 participants who were initially diagnosed with unipolar depression were recruited from an outpatient clinic and were screened for bipolar disorder using the HCL-32 and MDQ; each participant also underwent a diagnostic interview based on the Structured Clinical Interview for DSM-IV Axis disorder patients (SCID). Results. The results showed that the HCL-32 yielded the best combination of sensitivity (100%) and specificity (46.2%) at a cut-off point of 7/8, and the MDQ yielded the best combination of sensitivity (71.4%) and specificity (76.9%) at a cut-off point of 6/7. Conclusion. The results of our study demonstrate that the HCL-32 and MDQ are of reasonable validity to distinguish between bipolar disorder and major depressive disorder. However small sample siz...

Background and Purpose— The close relationship between stroke and chronic kidney disease (CKD) has been well-documented. However, few studies have focused on silent brain infarction (SBI) in CKD. We investigated the prevalence of SBI in different stages of CKD. Methods— We included 1312 participants aged 30 to 93 years who came from either a random sample of residents or from a group of physically examined subjects in the same community. Basic information, clinical evaluations, laboratory tests, and MRI images were assessed. Subjects were divided into groups 1, 2, 3a, and 3b, corresponding to the estimated glomerular filtration rate (eGFR) levels of ≥90.0, 60.0 to 89.9, 45.0 to 59.9, and 30.0 to 44.9 mL/min/1.73 m 2 . Results— The crude prevalence was 4.7%: 2.6% (20 of 759 subjects) in group 1; 6.3% (32 of 506) in group 2; 12.9% (4 of 31) in group 3a; and 37.5% (6 of 16) in group 3b ( P P P Conclusions— A close association exists between SBI and eGFR. We have found a significant increase in prevalence of SBI when eGFR is between 30.0 and 44.9 mL/min/1.73 m 2 . Adults with late stage 3 CKD are at high risk for prevalent SBI.

Among dialysis patients, acute mesenteric ischemia is mostly caused by non-occlusive mesenteric ischemia (NOMI). There is a very high mortality rate associated with this complication, but prognostic factors associated with NOMI are not well-known.In this study, we retrospectively reviewed the records of dialysis patients to identify prognostic factors associated with mortality from NOMI. Overall, there were 541 patients on hemodialysis (HD) and 158 patients on peritoneal dialysis (PD) in our hospital from January 2007 to December 2008. Among these 699 patients, we diagnosed NOMI by surgical and/or radiological criteria. A total of 12 dialysis patients (9 on HD and 3 on PD) developed NOMI during the study period.The incidence of NOMI was 1.04% per patient-year for all dialysis patients (0.95% for HD and 1.35% for PD patients). Most of the 12 patients had chronic hypotension (83.3%, 10/12). Four patients expired following development of NOMI. Our results showed that mortality was significantly higher in patients who were administered a cyclooxygenase (COX) inhibitor prior to ischemia. Hypobicarbonemia during NOMI, which might indicate the severity of hypoperfusion, is also associated with higher mortality.NOMI is rare in dialysis patients. COX inhibitor administration should be given with caution in long-term hypotensive dialysis patients.

Background. Human immunodeficiency virus (HIV) screening is a routine for long-term hemodialysis patients because of a high risk for infection. Enzyme-immunoassay (EIA) is a simple tool for screening HIV, but clinically false-positive EIA is a frequent result. Other tests such as Western blot analysis (WB) and HIV DNA and RNA by polymerase chain reaction have better specificity and sensitivity, but they cannot be accessible in many dialysis units. Methods. Four hundred and four patients with end stage renal disease on long-term hemodialysis were screened with EIA for HIV antibodies. Repeated EIA was performed if the first test was positive result. WB was used as the confirmatory test. Results. Two persons initially showed a positive EIA pattern among the 404 patients, but nobody had positive WB test result later. Conclusion. The ratio of false-positive EIA results for screening HIV is relatively high in long-term hemodialysis patients. Further tests should be employed to confirm the diagnosis.

Background/Aims: The prevalence ofcardiovascular disease and mortality rate is relatively low in Chinese dialysis patients. This study aimed to evaluate the predictive value of nutritional and inflammatory markers in Chinese hemodialysis patients. Methods: A total of 158 patients (70 men and 88 women, age 59.9 ± 13.2 years) were studied. Nutritional and inflammatory markers, including subjective global assessment (SGA), insulin-like growth factor-1, albumin, tumor necrosis factor-α, interleukin (IL)-1β, IL-6, serum amyloid A (SAA), and C-reactive protein (CRP), were measured. These patients were followed up until April 2004 (36 months) to determine the incidence and causes of death. Results: SGA (p = 0.001), IL-1β (p = 0.032), SAA (p = 0.031), IL-6 (p = 0.001) and CRP (p < 0.001) were found to be significant predictors of mortality. After adjusting with age, sex, diabetes, coronary artery disease, Kt/Vurea, and duration on dialysis, CRP (odds ratio = 4.58; p = 0.038) and SGA (odds ratio = 6.57; p = 0.004) remained the independent predictors of mortality. The adjusted mortality rate was highest for patients with a high CRP level and malnutrition (assessed by SGA). Conclusions: SGA and CRP levels are the most significant predictors of mortality in Chinese dialysis patients. Chinese dialysis patients with a high CRP level tend to be at higher risk of mortality only if they are malnourished.

Many preventative strategies have been proposed to control hepatitis C virus (HCV) infection in the hemodialysis unit. The effectiveness of isolation as a preventive policy remains unclear. The aim of this study was to evaluate the effect of an isolation policy on the incidence of hepatitis C in our hemodialysis unit.A total of 325 hemodialysis patients with a mean age of 62 +/- 14 years and a mean duration of dialysis of 4.8 +/- 4.4 years, who were treated from January 1993 to December 2000 were included in this retrospective study. Data were collected from medical records. HCV antibody was monitored at 6-month intervals. During the period before September 1997 all patients were dialyzed in a single room. Isolation started after September 1997, when an additional room became available. Patients positive for either hepatitis B or C were clustered in 1 area (Area 1). Anti-HCV-negative and hepatitis B surface antigen (HBsAg)-negative patients were assigned either to a segregated zone (Area 2) adjacent to Area 1 in the same room or to a separate independent room (Area 3). Dialyzers were not reused and hygienic precautions remained the same throughout the study period.Forty months after the implementation of the isolation policy, there was significant reduction in the total prevalence (49.7 vs 31.7%, p0.01) and incidence (9.1 vs 2.9 % patient-years, p0.01) of HCV infection. Seroconversion of anti-HCV was detected in 9 patients, 7 in Area 1, 2 in Area 2, with no new cases in Area 3. The incidence of seroconversion of anti-HCV was significantly different in the 3 areas. Regression analysis indicated that isolation was the most prominent independent factor in reducing seroconversion of anti-HCV.These results support the use of an isolation policy to combat HCV infection among hemodialysis patients, particularly in high prevalence units.

a Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan b Graduate Institute of Clinical Medical Sciences, Chang Gung University Medical College, Taoyuan School of Medicine, Taiwan c Chang Gung University, Taipei, Taiwan d Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan e Division of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan f Laboratory of Epidemiology, Department of Health Care Management, Chang Gung University, Taipei, Taiwan g Division of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan h Department of Internal Medicine, Taipei Medical University, Taipei, Taiwan

Background Depression and suicide are well established as prevalent mental health problems for patients on hemodialysis. Objective The authors examined the demographic and psychological factors associated with depression among hemodialysis patients and elucidated the relationships between depression, anxiety, fatigue, poor health-related quality of life, and increased suicide risk. Method This cross-sectional study enrolled 200 end-stage renal disease patients age ≥18 years on hemodialysis. Psychological characteristics were assessed with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, the short-form Health-Related Quality of Life Scale, and Chalder Fatigue Scale, and structural equation modeling was used to analyze the models and the strength of relationships between variables and suicidal ideation. Results Of the 200 patients, 70 (35.0%) had depression symptoms, and 43 (21.5%) had had suicidal ideation in the previous month. Depression was significantly correlated with a low body mass index (BMI) and the number of comorbid physical illnesses. Depressed patients had greater levels of fatigue and anxiety, more common suicidal ideation, and poorer quality of life than nondepressed patients. Results revealed a significant direct effect for depression and anxiety on suicidal ideation. Conclusion Among hemodialysis patients, depression was associated with a low BMI and an increased number of comorbid physical illnesses. Depression and anxiety were robust indicators of suicidal ideation. A prospective study would prove helpful in determining whether early detection and early intervention of comorbid depression and anxiety among hemodialysis patients would reduce suicide risk.

Background The microsatellite polymorphism of heme oxygenase (HO)-1 gene promoter has been shown to be associated with the susceptibility to ischemic event, including coronary artery disease (CAD), myocardial infarction, and peripheral vascular disease. We aimed to examine whether the length of (GT)n repeats in HO-1 gene promoter is associated with ischemic stroke in people with CAD risk factors, especially low level of HDL. Methods A total of 183 consecutive firstever ischemic stroke inpatients and 164 non-stroke patients were screened for the length of (GT)n repeats in HO-1 promoter. The long (L) and short (S) genotype are defined as the averaged repeat number >26 and ≦26, respectively. Results Stroke patients tended to have more proportions of hypertension, diabetics and genotype L, than those of genotype S. Patients with genotype L of HO-1 gene promoter have higher stroke risk in comparison with genotype S especially in dyslipidemia individuals. The significant differences on stroke risk in multivariate odds ratios were found especially in people with low HDL-C levels. Conclusions Subjects carrying longer (GT)n repeats in HO-1 gene promoter may have greater susceptibility to develop cerebral ischemic only in the presence of low HDL-C, suggesting the protective effects in HO-1 genotype S in the process of ischemic stroke, particularly in subjects with poor HDL-C status.