The role of traditional Chinese medicine on fracture surgery, hospitalization, and total mortality risks in diabetic patients with osteoporosis.

BACKGROUND: Studies have confirmed that osteoporosis has been considered as one of the complications of diabetes, and the health hazards to patients are more obvious. This study is mainly based on the Taiwan National Health Insurance Database (TNHID). Through the analysis of TNHID, it is shown that the combined treatment of traditional Chinese medicine (TCM) medicine in patients of diabetes with osteoporosis (T2DOP) with lower related risks. METHODS: According to the study design, 3131 patients selected from TNHID who received TCM treatment were matched by 1-fold propensity score according to gender, age, and inclusion date as the control group. Cox proportional hazards analyzes were performed to compare fracture surgery, hospitalization, and all-cause mortality during a mean follow-up from 2000 to 2015. RESULTS: A total of 1055/1469/715 subjects (16.85%/23.46%/11.42%) had fracture surgery/inpatient/all-cause mortality of which 433/624/318 (13.83%/19.93%/10.16%) were in the TCM group) and 622/845/397 (19.87%/26.99%/12.68%) in the control group. Cox proportional hazards regression analysis showed that subjects in the TCM group had lower rates of fracture surgery, inpatient and all-cause mortality (adjusted HR = 0.467; 95% CI = 0.225-0.680, P<0.001; adjusted HR = 0.556; 95% CI = 0.330-0.751, P<0.001; adjusted HR = 0.704; 95% CI = 0.476-0.923, P = 0.012). Kaplan-Meier analysis showed that the cumulative risk of fracture surgery, inpatient and all-cause mortality was significantly different between the case and control groups (all log-rank p<0.001). CONCLUSION: This study provides longitudinal evidence through a cohort study of the value of integrated TCM for T2DOP. More research is needed to fully understand the clinical significance of these results.

Improving Respiratory Infection Diagnosis with Deep Learning and Combinatorial Fusion: A Two-Stage Approach Using Chest X-ray Imaging.

The challenges of respiratory infections persist as a global health crisis, placing substantial stress on healthcare infrastructures and necessitating ongoing investigation into efficacious treatment modalities. The persistent challenge of respiratory infections, including COVID-19, underscores the critical need for enhanced diagnostic methodologies to support early treatment interventions. This study introduces an innovative two-stage data analytics framework that leverages deep learning algorithms through a strategic combinatorial fusion technique, aimed at refining the accuracy of early-stage diagnosis of such infections. Utilizing a comprehensive dataset compiled from publicly available lung X-ray images, the research employs advanced pre-trained deep learning models to navigate the complexities of disease classification, addressing inherent data imbalances through methodical validation processes. The core contribution of this work lies in its novel application of combinatorial fusion, integrating select models to significantly elevate diagnostic precision. This approach not only showcases the adaptability and strength of deep learning in navigating the intricacies of medical imaging but also marks a significant step forward in the utilization of artificial intelligence to improve outcomes in healthcare diagnostics. The study's findings illuminate the path toward leveraging technological advancements in enhancing diagnostic accuracies, ultimately contributing to the timely and effective treatment of respiratory diseases.

Alternation of social behaviors for zebrafish (Danio rerio) in response to acute cold stress.

Low temperature is one of the most common abiotic stresses for aquatic ectotherms. Ambient low temperatures reduce the metabolic rate of teleosts, therefore, teleosts have developed strategies to modulate their physiological status for energy saving in response to cold stress, including behaviors, circulatory system, respiratory function, and metabolic adjustments. Many teleosts are social animals and they can live in large schools to serve a variety of functions, including predator avoidance, foraging efficiency, and reproduction. However, the impacts of acute cold stress on social behaviors of fish remain unclear. In the present study, we test the hypothesis that zebrafish alter their social behaviors for energy saving as a strategy in response to acute cold stress. We found that acute cold stress increased shoaling behavior that reflected a save-energy strategy for fish to forage and escape from the predators under cold stress. The aggressive levels measured by fighting behavior tests and mirror fighting tests were reduced by cold treatment. In addition, we also found that acute cold stress impaired the learning ability but did not affect memory. Our findings provided evidence that acute cold stress alters the social behaviors of aquatic ectotherms for energy saving; knowledge of their responses to cold is essential for their conservation and management.

Rapid insecticide resistance bioassays for three major urban insects in Taiwan.

BACKGROUND: Taiwan's warm and humid climate and dense population provide a suitable environment for the breeding of pests. The three major urban insects in Taiwan are house flies, cockroaches, and mosquitoes. In cases where a disease outbreak or high pest density necessitates chemical control, selecting the most effective insecticide is crucial. The resistance of pests to the selected environmental insecticide must be rapidly assessed to achieve effective chemical control and reduce environmental pollution. METHODS: In this study, we evaluated the resistance of various pests, namely, house flies (Musca domestica L.), cockroaches (Blattella germanica L. and Periplaneta americana), and mosquitoes (Aedes aegypti and Ae. albopictus) against 10 commonly used insecticides. Rapid insecticide resistance bioassays were performed using discriminating doses or concentrations of the active ingredients of insecticides. RESULTS: Five field strains of M. domestica (L.) are resistant to all 10 commonly used insecticides and exhibit cross- and multiple resistance to four types of pyrethroids and three types of organophosphates, propoxur, fipronil, and imidacloprid. None of the five field strains of P. americana are resistant to any of the tested insecticides, and only one strain of B. germanica (L.) is resistant to permethrin. One strain of Ae. albopictus is resistant to pirimiphos-methyl, whereas five strains of Ae. aegypti exhibit multiple resistance to pyrethroids, organophosphates, and other insecticides. CONCLUSIONS: In the event of a disease outbreak or high pest density, rapid insecticide resistance bioassays may be performed using discriminating doses or concentrations to achieve precise and effective chemical control, reduce environmental pollution, and increase control efficacy.

Gender-specific impacts of thigh skinfold thickness and grip strength for predicting osteoporosis in type 2 diabetes.

BACKGROUND: Diabetes with co-existing bone fragility or osteoporosis is common in elderly patients, whereas is frequently underestimated. METHODS: We conducted dual-energy x-ray absorptiometry (DXA) with 7-site skinfold (SF) and dominant hand grip strength measurements among patients with type 2 diabetes (T2DM) to assess their gender-specific associations. A total of 103 patients with T2DM (60 females and 43 males), aged between 50 and 80 years (median 68.0 years) were enrolled and 45 non-DM females were also included to compare with T2DM females. RESULTS: Our results revealed osteoporosis was negatively correlated with grip strength in both genders, negatively correlated with lean mass solely in males and negatively correlated with fat mass (particular the gynoid fat mass and thigh SF thickness) in females. Via performing multivariable stepwise logistic regression, we identified grip strength in both genders and thigh SF thickness in females as predictors for osteoporosis. Receiver operating characteristic curve analysis further disclosed 20.5 mm female thigh skinfold thickness, 18.1 kg female grip strength and 29.0 kg male grip strength as reasonable cutoff levels for predicting osteoporosis in the Taiwanese patients with T2DM. CONCLUSIONS: Patients with T2DM presented gender-specific associations between osteoporosis, body composition and grip strength. Grip strength and thigh SF thickness might serve as predictors for detection of osteoporosis in patients with T2DM.

Responses of medaka (Oryzias latipes) ammonia production and excretion to overcome acidified environments.

Anthropogenic acidification of water is an on-going environmental disaster for freshwater fishes. Fishes rely on ammonia excretion to eliminate the excess acid and mitigate the harmful effects; however, it remains largely unknown how ammoniagenesis occurs and is coordinated with ammonia excretion upon acidic stress. Medaka (Oryzias latipes) was used to examine the effects of acidic stress on ammonia production and excretion. We reveal an undiscovered ammonia-producing cell type that is rich in glutaminase (GLS) and located adjacent to the ammonia-excreting ionocytes, Na+/H+ exchanger (NHE) cells, in the gills. The gills, comparing with other ammoniagenetic organs, is the quickest to respond to the acidic stress by triggering GLS-dependent ammonia production. The unique division of labor between GLS and NHE cells in the gills allows medaka to simultaneously upregulate GLS activity and ammonia excretion shortly after exposure to acidic environments. Pharmacological experiment with a GLS inhibitor abolished the activated ammonia excretion, further suggesting the essential role of the unique feature in the responses to acidic stress. Our study shades light on a novel physiological mechanism to timely and efficiently mitigate adverse effects of acidification, providing a new way to assess the impact of on-going environmental acidification on fish.

Sublethal ammonia induces alterations of emotions, cognition, and social behaviors in zebrafish (Danio rerio).

Ammonia pollutants were usually found in aquatic environments is due to urban sewage, industrial wastewater discharge, and agricultural runoff and concentrations as high as 180 mg/L (NH4+) have been reported in rivers. High ammonia levels are known to impair multiple tissue and cell functions and cause fish death. Although ammonia is a potent neurotoxin, how sublethal concentrations of ammonia influence the central nervous system (CNS) and the complex behaviors of fish is still unclear. In the present study, we demonstrated that acute sublethal ammonia exposure can change social behavior of adult zebrafish. The exposure to 90 mg /L of (NH4+) for 4 h induced a strong fear response and lower shoaling cohesion; exposure to 180 mg /L of (NH4+) for 4 h reduced the aggressiveness, and social recognition, while the anxiety, social preference, learning, and short-term memory were not affected. Messenger RNA expressions of glutaminase and glutamate dehydrogenase in the brain were induced, suggesting that ammonia exposure altered glutamate neurotransmitters in the CNS. Our findings in zebrafish provided delicate information of ammonia neurotoxicity in complex higher-order social behaviors, which has not been revealed previously. In conclusion, sublethal and acute ammonia exposure can change specific behaviors of fish, which might lead to reductions in individual and population fitness levels.

Association between Grip Strength, Obesity, and Cardiometabolic Risk Factors among the Community-Dwelling Elderly Population in Taiwan.

The aim of this study was to evaluate the association between grip strength, obesity, and cardiometabolic risk factors among elderly individuals with different grip strength statuses and weight statuses in Taiwan. We conducted a series of community-based health surveys among the elderly population in Chiayi County, Taiwan from 2017 to 2019. This is a cross-sectionally designed health check-up program that was conducted by the local public health bureau. Anthropometric characteristics, handgrip strength, diabetes, and cardiometabolic risk profiles were measured using standard methods. This study recruited 3739 subjects (1600 males and 2139 females). The non-obese subjects had lower blood glucose (BG) levels compared to the obese subjects. The BG levels of non-obese and obese subjects were 102.7 ± 25.6 mg/dL vs. 109.1 ± 34.3 mg/dL for males; and 102.8 ± 30.1 mg/dL vs. 112.5 ± 40.3 mg/dL for females (both p < 0.001). The grip strength was negatively associated with BG in both sexes (ß = -0.357, p < 0.001 for males and ß = -0.385, p < 0.05 for females). The relationship between the grip strength and the risk of diabetes showed that for every 1 kg increase in the grip strength, there was a 4.1% and 4.5% decrease in the risk for developing diabetes for males and females, respectively (OR = 0.959, 95% CI = 0.940-0.979 for males and OR = 0.955, 95% CI = 0.932-0.978 for females). A higher handgrip strength is associated with a lower BG level and a lower risk for diabetes mellitus in the elderly Taiwanese subjects. Additional health promotion should focus on the obese and sarcopenic population to prevent cardiometabolic comorbidities in later life.

Dipeptidyl peptidase-4 inhibitors attenuates osteoporosis in patients with diabetes: A nationwide, retrospective, matched-cohort study in Taiwan.

BACKGROUND: Patients with diabetes have a relatively high risk of fracture due to osteoporosis. However, the risk of osteoporosis associated with the use of oral hypoglycemic drugs and dipeptidyl peptidase-4 inhibitor (DPP-4i) by patients with diabetes is unclear. This study aimed to explore the effect of DPP-4i on the risk of osteoporosis in Taiwanese patients with type 2 diabetes mellitus (T2DM). METHODS: This study enrolled 6339 patients on DPP-4i (DPP-4i group) and 25 356 patients without DPP-4i (non-DPP-4i group). They were matched by 1:4 propensity score matching, using confounding variables including sex, age, comorbidities, medication, and index year. Cox proportional hazards analysis was used to compare hospitalization and mortality during an average follow-up period of 7 years. RESULTS: The mean age of patients in the two groups was 66 years. Men were slightly higher in number (51.79%) than women. At the end of the follow-up period, 113 (0.36%) patients had osteoporosis, of which 15 (0.24%) were in the case group and 98 (0.39%) in the control group. The risk of all-cause osteoporosis was significantly lower in the DPP-4i group than in the non-DPP-4i group (adjusted hazard ratio [HR] 0.616; 95% confidence interval [CI] 0.358-0.961; p = 0.011). Kaplan-Meier analysis showed that the preventive effect on osteoporosis was positively correlated with the cumulative dose of DPP-4i (log-rank, p = 0.039) with the class effect. CONCLUSION: Compared with not using DPP-4i, the use of DPP-4i in Taiwanese T2DM patients was associated with a lower risk of osteoporosis due to the class effect, and the preventive effect was dose-dependent. However, larger prospective studies are needed to validate this finding and to explore the possible mechanism of the preventive effect of DPP-4i.

A Pitfall of Falsely Elevated ACTH: A Case Report and Literature Review.

A 35-year-old woman with unintentional weight gain, hyperpigmentation of bilateral palms, and general fatigue was initially suspected of Cushing's syndrome or adrenal insufficiency based on the isolated elevation of the plasma adrenocorticotropic hormone (ACTH) level (113.0 pg/mL) in the Siemens ACTH Immulite assay (ACTH [Immulite]). However, both of the diagnoses were excluded by screening tests including the overnight dexamethasone suppression test, the 24-hour urinary free cortisol excretion, and the ACTH stimulation test in spite of the consistent elevation of the plasma ACTH levels. We speculated that the existence of the immunoassay interference may be the underlying cause because the plasma ACTH level analyzed by the CIS Bio International ELSA-ACTH immunoassay (ELSA-ACTH) was within the normal range. After reviewing our case and several reported cases of falsely elevated plasma ACTH levels, we conclude that when discrepancy between clinical symptoms and laboratory measurements exists, medical practitioners ought to rely on formal diagnostic criteria rather than misleading laboratory results to avoid misdiagnosis or even unnecessary invasive testing and procedures. In addition, current methods for investigation and elimination of immunoassay interferences should be applied with caution due to variable efficacy and inevitable deviations.

Traditional Chinese medicine attenuates hospitalization and mortality risks in diabetic patients with carcinoma in situ in Taiwan.

BACKGROUND: Diabetic patients are at high risk of developing cancer. Traditional Chinese medicine (TCM) has become increasingly popular as an adjuvant treatment for patients with chronic diseases, and some studies have identified its beneficial effect in diabetic patients with cancer. The purpoes of this study was to outline the potential of TCM to attenuate hospitalization and mortality rates in diabetic patients with carcinoma in situ (CIS). METHODS: A total of 6,987 diabetic subjects with CIS under TCM therapy were selected from the National Health Insurance Research Database of Taiwan, along with 38,800 of 1:1 sex-, age-, and index year-matched controls without TCM therapy. Cox proportional hazard analysis was conducted to compare hospitalization and mortality rates during an average of 15 years of follow-up. RESULTS: A total of 3,999/1,393 enrolled-subjects (28.62%/9.97%) had hospitalization/mortality, including 1,777/661 in the TCM group (25.43%/9.46%) and 2,222/732 in the control group (31.80%/10.48%). Cox proportional hazard regression analysis showed a lower rate of hospitalization and mortality for subjects in the TCM group (adjusted HR=0.536; 95% CI=0.367-0.780, P<0.001; adjusted HR=0.783; 95% CI=0.574-0.974, P = 0.022). Kaplan-Meier analysis showed that the cumulative risk of hospitalization and mortality in the case and control groups was significantly different (log rank, P<0.001 and P = 0.011, respectively). CONCLUSIONS: Diabetic patients with CIS under TCM therapy were associated with lower hospitalization and mortality rates compared to those without TCM therapy. Thus, TCM application may reduce the burden of national medical resources.

Obesity, waist circumference, and appendicular muscle mass ratio in relation to blood pressure among the community-dwelling elderly population in Taiwan.

Hypertension is known to be related to obesity and both are the major factors for cardiovascular diseases. The relationship between body composition and blood pressure (BP) are discussed recently. Our study aims to evaluate the association between waist circumference (WC) and appendicular muscle mass (AMM) in relation to BP among the community-dwelling elderly population. Total 3739 patients (1600 males and 2139 females) were recruited in a series of community-based surveys that were conducted among the elderly population in Taiwan from 2017 to 2019. We collected data on anthropometric characteristics, handgrip strength, and BP using standard methods. AMM was calculated with an equation. History of chronic disease and lifestyle profiles were collected using questionnaires. The group with high AMM to body weight ratio (AMMW) showed lower systolic BP (SBP) (136.8 ± 19.1 to 140.6 ± 17.0 for males; 137.8 ± 18.3 to 142.7 ± 17.5 for females, both P < .001). Among central obese persons those with higher AMMW ratio had lower SBP. In the final model, AMMW in percentage is negatively associated to SBP (ß = -0.641 in male, -0.780 in female, both P < .01). In other words, every 10% increase in AMMW is associated with decrease of SBP 6.41 mmHg in male and 7.80 mmHg in female. Obesity and central obesity were positively associated with BP. The AMMW ratio was negatively associated with HTN and with a protective effect on BP even among the central obese. Health promotion programs to increase physical training may prevent hypertension among the elderly in Taiwan.

Association between grip strength and anthropometric characteristics in the community-dwelling elderly population in Taiwan.

BACKGROUND: Sarcopenia and muscle weakness in elderly are contributed burden of public health and impact on quality of life. Weak grip strength was key role in diagnosis of sarcopenia and reported increased mortality, function declined in elderly. This study evaluated the association between GS and each common anthropometric characteristic in community-dwelling elderly. DESIGN AND METHOD: From 2017 to 2019, we conducted a community-based health survey among the elderly in Chiayi county, Taiwan. Participants were 65 years old or older, and total of 3,739 elderly subjects (1,600 males and 2,139 females) with a mean age of 76 years (range 65-85 years old) were recruited. General demographic data and lifestyle patterns were measured using a standard questionnaire. Anthropometric characteristics such as body height, body weight, body mass index (BMI), body waist and hip circumference, and body fat were measured by standard methods. GS was measured using a digital dynamometers (TKK5101) method. RESULTS: The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females (p < 0.001). For both sexes, elderly subjects with the same body weight but smaller body waist circumference had greater GS. The subjects with the same body waist size but heavier weight had greater GS. Furthermore, after adjusting for age, lifestyles, disease status, and potential anthropometric variable, multivariate regression analyses indicated that BMI was positively associated with GS (for males, beta = 0.310 and for females beta = 0.143, both p < 0.001) and body waist was negatively associated with GS (for males, beta = -0.108, p < 0.001; for females, beta = -0.030, p = 0.061). CONCLUSIONS: This study suggested that old adults with higher waist circumstance had weaker GS. Waist circumstance was negatively associated with GS, body weight was positively associated with GS in contrast. It may implies that central obesity was more important than overweight for GS in elderly.

Relationship of Multimorbidity, Obesity Status, and Grip Strength among Older Adults in Taiwan.

Background: The combination of multiple disease statuses, muscle weakness, and sarcopenia among older adults is an important public health concern, and a health burden worldwide. This study evaluates the association between chronic disease statuses, obesity, and grip strength (GS) among older adults in Taiwan. Methods: A community-based survey was conducted every 3 years among older adults over age 65, living in Chiayi County, Taiwan. Demographic data and several diseases statuses, such as diabetes mellitus, hypertension, cerebrovascular disease, cardiovascular disease, and certain cancers, were collected using a questionnaire. Anthropometric characteristics were measured using standard methods. Grip strength was measured using a digital dynamometer (TKK5101) method. Results: A total of 3739 older individuals were recruited (1600 males and 2139 females) with the mean age of 72.9 years. The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females. GS significantly decreased most in males with cerebrovascular disease (from 33.0-29.5 kg, p < 0.001) and in females with diabetes mellitus (from 21.8-21.0 kg, p < 0.01). GS was highest in older adults with obesity (body mass index ≥ 27 kg/m2); however, there was no significant change of GS as the disease number increased. Conclusion: Older adults who have two, rather than one or greater than three chronic diseases, have significantly lower GSs than those who are healthy. Stroke and CKD for males, and hypertension and diabetes for females, are important chronic diseases that are significantly associated with GS. Furthermore, being overweight may be a protective factor for GS in older adults of both sexes.

Oxytocin Signaling Acts as a Marker for Environmental Stressors in Zebrafish.

The oxytocin system plays a role in stress responses and behavior modulation. However, the effects of oxytocin signaling on stress adaptation remain unclear. Here, we demonstrated the roles of oxytocin signaling as a biomarker under stress conditions in the peripheral tissues (the gills) and central nervous system (the brain). All the environmental stressors downregulated the expression of oxytocin receptors in the gills, and the alteration of the expression of oxytocin receptors was also found in the brain after the acidic (AC) and high-ammonia (HA) treatments. The number of oxytocin neurons was increased after double-deionized (DI) treatment. By transgenic line, Tg(oxtl:EGFP), we also investigated the projections of oxytocin neurons and found oxytocin axon innervations in various nuclei that might regulate the anxiety levels and aggressiveness of adult zebrafish under different environmental stresses. The oxytocin system integrates physiological responses and behavioral outcomes to ensure environmental adaptation in adult zebrafish. Our study provides insight into oxytocin signaling as a stress indicator upon environmental stressors.