Ankylosing spondylitis and other inflammatory spondyloarthritis increase the risk of developing type 2 diabetes in an Asian population.

This study evaluated whether people with ankylosing spondylitis (AS) and spondyloarthritis are at higher risk of type 2 diabetes mellitus (T2DM). We used a sub-dataset of the National Health Insurance Research Database from 1996 to 2010 to established a AS cohort consisting new patients with AS or spondyloarthritis (N = 7,778) and a non-AS cohort without the diseases (N = 31,112). Incidences of T2DM in the two cohorts, hazard ratios (HRs) of risk of T2DM in association with AS, and cumulative probability of having T2DM were estimated by the end of 2010. The incidence of T2DM was 1.17-fold higher in the AS cohort than in the non-AS cohort (13.5 vs. 11.5, per 1,000 person-years), with an adjusted HR of 1.16 (95 % CI = 1.05-1.29). The T2DM incidence was higher for women than for men; while the Cox model measured sex-specific adjusted HR of T2DM was higher for men than for women. The incidence rate of T2DM increased with age in both cohorts, while the age-specific measures showed that the adjusted HR of T2DM was higher in young AS patients (≤50 years of age) than older ones, compared to their peers of non-AS group. The plot of Kaplan-Meier analysis showed that the overall probability of having T2DM was 2 % higher in the AS cohort than in the non-AS cohort (log-rank test: p < 0.0001). Patients with AS and spondyloarthritis have an increased risk of developing T2DM.

Motility differences in free colon and free jejunum flaps for reconstruction of the cervical esophagus.

BACKGROUND: Free colon and jejunal flaps have been described as reliable and safe conduits for pharyngoesophageal reconstruction. Compared with free colon flaps, free jejunum flaps have a smaller diameter and intrinsic peristaltic movement, both of which are considered possible causes of dysphagia. In this investigation, the authors evaluated motility differences in free jejunum and colon flaps using radionuclide esophageal scintigraphy. METHODS: Patients who received free jejunum flaps (n = 12) or free colon (n = 1) or ileocolon flaps (n = 13) for reconstruction after pharyngoesophagectomy for cancer were included. Radionuclide esophageal scintigraphy was performed using technetium-99m-labeled sulfur colloid. Transit rate was evaluated at 1 second (pharyngeal or initial clearance) and 10 seconds (esophageal or clearance throughout). Clinical progression of swallowing was recorded postoperatively. Statistical analysis was performed using the t test. RESULTS: Mean pharyngeal clearance was 61 +/- 20 percent for free colon and ileocolon flaps and 70 +/- 16 percent for free jejunum flaps. Mean esophageal clearance was 50 +/- 27 percent for free colon and ileocolon flaps and 69 +/- 17 percent for free jejunum flaps. Esophageal transit rate was significantly shorter in patients who underwent reconstruction with free jejunum flaps (p = 0.04). At 1 year, 10 of 12 free jejunum patients and eight of 14 patients were tolerating solid foods. CONCLUSIONS: Although neither flap showed normal swallowing characteristics, free jejunum flaps displayed greater esophageal clearance and should represent the first choice in hypopharyngeal reconstruction. Free colon and ileocolon flaps should be reserved for very proximal oropharyngeal defects and when simultaneous voice reconstruction is desired.

Serum adiponectin and leptin levels in Taiwanese breast cancer patients.

The role of two adipocytokines, adiponectin and leptin, in Taiwanese breast cancer patients remains to be determined. In this study, we analyzed the correlations between the serum levels of adiponectin and leptin and the various clinicopathological parameters in 100 newly diagnosed, histologically confirmed breast cancer patients and 100 controls. We found serum levels were decreased significantly for adiponectin in the breast cancer patients, in comparison to controls (Student t-test, P=0.003), while serum levels were increased significantly for leptin in the breast cancer patients in comparison to controls (Student t-test, P=0.025). Leptin/adiponectin (L/A ratio) were increased significantly in the breast cancer patients, in comparison to controls (Student t-test, P=0.009). Among the clinicopathological parameters, estrogen receptor, progesterone receptor, HER2/neu, lymph node metastasis, tumor stage, and tumor grade all showed no effect on the serum levels of adiponectin and leptin. BMI was negatively and positively correlated to serum adiponectin and leptin levels, respectively (Spearman's correlation, r=-0.333 and 0.323, respectively; P<0.001 for both). Intriguingly, serum L/A ratio disclosed a positive correlation to tumor size (r=0.21, P=0.036). In summary, our results suggest that low serum adiponectin levels and high serum leptin levels are associated with an increased risk for breast cancer. Also, independent of the effect of BMI, the increased serum ratio of L/A may indicate the presence of aggressive breast cancers.

Influence of 131I diagnostic dose on subsequent ablation in patients with differentiated thyroid carcinoma: discrepancy between the presence of visually apparent stunning and the impairment of successful ablation.

BACKGROUND: In the management of patients with differentiated thyroid carcinoma, direct comparison of the presence of scintigraphic stunning after a diagnostic dose of 131I with subsequent successful ablation has not been evaluated. METHODS: This study included 245 patients who received a dose of 2775-3700 MBq of 131I for thyroid remnant ablation. In all patients, the thyroid-stimulating hormone (TSH) level before ablation was more than 30 microlU x ml. One hundred and twenty-six patients (Group A) were given a 185 MBq diagnostic scan (Dscan) 4-11 days before 131I ablation, and 119 patients (Group B) received 131I ablation directly after thyroidectomy. Scintigraphic stunning was considered to be present on any post-ablation scan that revealed either fewer foci or obviously less prominent uptake compared with the earlier corresponding Dscan. Successful ablation was defined as no visible uptake in the neck region or anywhere else on a follow-up Dscan 6-12 months later. RESULTS: Our results revealed that only 13 of the 126 patients (10.3%) in Group A had visually apparent thyroid stunning. Successful ablation was obtained in 56 of 126 cases (44.4%) in Group A, compared with 86 of 119 cases (72.2%) in Group B (P<0.001). In Group A, the success rate of ablation in patients with stunning (5/13) was not statistically different from that in those without (51/113) (odds ratio, 0.76; 95% CI, 0.23-2.47). Multiple logistic regression analysis revealed that the independent determinants of successful ablation were the use of Dscan before ablation (odds ratio, 0.23; 95% CI, 0.10-0.56) and the ablation dose of 131I (odds ratio, 1.05; 95% CI, 1.00-1.10). CONCLUSIONS: Visually apparent stunning is infrequent and may not be sufficiently sensitive to detect the influence of a 185 MBq Dscan on subsequent ablation outcome. For patients with differentiated thyroid carcinoma, we recommend that ablation should be performed directly after thyroidectomy.

Hyperhomocystinemia and the prevalence of symptomatic atherosclerotic vascular disease in Taiwanese chronic hemodialysis patients: a retrospective study.

AIM: Hyperhomocystinemia is now recognized as an independent risk factor for atherosclerotic cardiovascular disease in patients with normal renal function. Hyperhomocystinemia is common in patients with chronic renal failure. This aim of this study was designed to look for associations between hyperhomocystinemia and clinically symptomatic atherosclerotic vascular disease (ASVD) in Taiwanese chronic hemodialysis patients. METHODS: Two hundred patients undergoing hemodialysis were enrolled in the study. They had predialysis blood work performed for total homocysteine, serum folate, and vitamin B12 levels. A history of clinically significant ASVD was elicited using information from the patients' questionnaires and verified by careful inpatient and outpatient chart review. RESULTS: Mean homocysteine concentration was 29.0 micromol/L overall. A total of 196 patients had hyperhomocystinemia and were enrolled in this study. ASVD was present in 24.5% of patients. The mean homocysteine concentration was 31.9 micromol/L and 28.7 micromol/L in patients with (n = 48) and without (n = 148) ASVD, respectively (P = 0.04). There was association hyperhomocystinemia between chronic hemodialysis patients with ASVD and without ASVD. There were significant differences including age, homocysteine level, vitamin B12 level and glucose intolerance in the two groups (P < 0.05). Plasma homocysteine concentrations showed significant positive correlations with serum folate or vitamin B12 in majority patients. No patient had serum folate or vitamin B12 deficiency. The adjusted odds ratio for atherosclerotic disease was 2.8 (95% CI, 1.109-7.467) for those subjects with a homocysteine level in the highest quartile compared with the lowest 3 quartiles. CONCLUSIONS: The prevalence of hyperhomocystinemia is 98% among hemodialysis patients. There is a significant association between hyperhomocystinemia and ASVD in Taiwanese chronic hemodialysis patients. There are also associations between homocysteine levels and serum folate/vitamin B12 levels in the majority of the patients. Clinical trials are needed to determine the optimal therapy of folic acid dose for hyperhomocystinemia in Taiwanese chronic hemodialysis patients in the future.