A Novel Computer-Vision Approach Assisted by 2D-Wavelet Transform and Locality Sensitive Discriminant Analysis for Concrete Crack Detection.

This study proposes FastCrackNet, a computationally efficient crack-detection approach. Instead of a computationally costly convolutional neural network (CNN), this technique uses an effective, fully connected network, which is coupled with a 2D-wavelet image transform for analyzing and a locality sensitive discriminant analysis (LSDA) for reducing the number of features. The algorithm described here is used to detect tiny concrete cracks in two noisy adverse conditions and image shadows. By combining wavelet-based feature extraction, feature reduction, and a rapid classifier based on deep learning, this technique surpasses other image classifiers in terms of speed, performance, and resilience. In order to evaluate the accuracy and speed of FastCrackNet, two prominent pre-trained CNN architectures, namely GoogleNet and Xception, are employed. Findings reveal that FastCrackNet has better speed and accuracy than the other models. This study establishes performance and computational thresholds for classifying photos in difficult conditions. In terms of classification efficiency, FastCrackNet outperformed GoogleNet and the Xception model by more than 60 and 80 times, respectively. Furthermore, FastCrackNet's dependability was proved by its robustness and stability in the presence of uncertainties produced by network characteristics and input images, such as input image size, batch size, and input image dimensions.

[Pediatric pancreatic lesions: a clinicopathological analysis of 42 cases].

Objective: To investigate the clinicopathological characteristics of pancreatic lesions in children. Methods: The clinicopathological data of pancreatic lesions in children were analyzed including 42 cases of pancreatic tumors diagnosed from January 2000 to May 2021 in Guangzhou Women's and Children's Medical Center, Guangzhou, China. Histological and immunohistochemical assessments were performed. Related literature was reviewed. Results: The 42 pediatric patients with pancreatic lesions aged 1 day to 12 years (mean, 4.25 years). There were 23 males and 19 females. Clinical presentations included abdominal masses, abdominal pain, vomiting and persistent hypoglycemia after birth. Ultrasound and computerized tomography examination showed space-occupying pancreatic lesions in 31 cases, but no detectable pancreatic lesions in 11 cases. Histologically, among the 42 cases, 22 cases (52.4%) were neoplastic, including 18 cases of epithelial origin. Nine cases of pancreatoblastoma showed that the epithelial tumor cells were arranged in a trabecular pattern, with squamous nests. Six cases of solid-pseudopapillary tumors revealed hemorrhagic and necrotic cysts and monomorphic epithelioid cells arranged in solid sheets, nests or pseudopapillae. Two cases of neuroendocrine tumors showed tumor cells arranged in cords or nests; one case had a mitotic count of about 3/10 high power field, and a Ki-67 index of about 5%, which was consistent with G2 neuroendocrine tumor; the other case showed tumor cells with cytological atypia, brisk mitoses, about 25/10 HPF and a Ki-67 index of about 80%, consistent with small-cell type neuroendocrine carcinoma. The case of acinar cell carcinoma showed high cellularity, tumor cells in solid, cord-like or acinar-like arrangement with little stroma, and monotonous tumor cells with single distinct nucleolus. There were 4 cases of mesenchymal tumors, including 3 cases of Kaposi's hemangioendothelioma and 1 case of inflammatory myofibroblastic tumor. Among the 20 cases (47.6%) of non-neoplastic lesions, there were 11 cases of hyperinsulinism with ATP-sensitive potassium channel abnormality (HAPCA). Severn cases of diffuse type HAPCA in which the islets scattered between the pancreatic acinar tissue, enlarged, and prominent nuclei. Three cases of focal type HAPCA showed pancreatic islet hyperplasia in the form of nested nodules (0.6-1.5 cm). One case of atypical type HAPCA had extensive islet hyperplasia in pancreatic tissue, and scattered proliferation of nest-like nodules was noted. There were also 7 cases of pseudocyst and 2 cases of congenital cyst. Immunohistochemically, pancreatoblastomas were diffusely positive for CKpan, CK8/18, and ß-catenin (nuclear staining of squamous nests only). Solid-pseudopapillary tumors expressed CD10, cyclin D1, CD99, vimentin, CD56, and ß-catenin (nuclear staining). Neuroendocrine tumors were positive for CK, Syn, NSE, CgA, CD56, and ß-catenin (membranous staining). The acinar cell carcinoma was positive for CK8/18, trypsin, and ß-catenin (membranous staining). Conclusions: Pancreatic lesions in children have a wide range of histopathological types. HAPCA is the most common lesion of newborns. Pediatric pancreatic tumors are rare and mostly malignant. It is important to recognize them and make correct pathological diagnoses.

[Application of multidisciplinary treatment comprehensive management model for early-stage lung cancer].

Objective: To explore the application of multidisciplinary treatment (MDT) and comprehensive management model in the diagnosis and treatment of early-stage lung cancer, and analyze its clinical value and the feasibility and significance of promotion. Methods: A retrospective study of 470 patients in Xijing Hospital who underwent surgery after MDT from January 8, 2018 to December 31, 2019. There were 172 males and 298 females, aged from 23 to 79 (54.46±11.08) years. Basic diagnosis and treatment information as well as postoperative pathology were analyzed, of which 441 cases were recommended for surgery by MDT and 29 cases were subjectively requested for surgery. The patients' general condition, preoperative diagnosis and pathological results were compared, and the specific content of the MDT and comprehensive management model were summarized. We also explored the value of MDT integrated management model in early stage lung cancer treatment in the context of the current lung cancer incidence in China. Results: Among 470 surgical patients, the majority of males had solid nodules (69/172,40.1%), and the majority of females had ground glass nodules (135/298,45.3%). The distribution of nodules showed a trend of more upper lobe(277/470)than lower lobe(161/470) and more right lung(276/470) than left lung(194/470). Among the 441 patients recommended for surgery, 98.11% of males (156/159) and 97.87% of females (276/282) showed malignant pathology after surgery. Adenocarcinoma was the main pathological type (93.59% of males, 146/156; 97.46% of females, 269/276). Among the malignant pathological results, carcinoma in situ (42.31% of males, 66/156; 47.10% of females, 130/276) and stage I lung cancer (50.64% of males, 79/156; 47.46% of females, 131/276) were the most common. In all patients, 1.89% of the males (3/159) and 2.13% of the females (6/282) recommended for surgery showed benign postoperative pathology, of which tuberculosis and fungal infection were the main pathological types (66.67% for each gender, males 2/3, females, 4/6). The postoperative pathology of 29 patients who subjectively requested surgery was also tuberculosis and fungal infection as the main pathological types (69.23% of males, 9/13; 68.75% of females, 11/16). The MDT comprehensive management model made full use of a variety of auxiliary diagnostic technologies and combined the experience advantages of multidisciplinary participation to make up for the limitations of single-diagnosis. The overall diagnosis coincidence rate reached 98.09%, with strong consistency (Kappa>0.81). The positive predictive value (PPV) was 97.96%, the negative predictive value (NPV) was 100%, and the average patient diagnosis and treatment cycle was 24.28-26.51 days. Conclusions: The MDT comprehensive management model meets the consensus requirements. It has great advantages in diagnostic efficiency and diagnosis and treatment cycle, and has a high promotion and application value for the diagnosis and treatment of early-stage lung cancer. At the same time, tuberculosis and fungal infection should be regarded as an important differential diagnosis item.

Directional massless Dirac fermions in a layered van der Waals material with one-dimensional long-range order.

One or a few layers of van der Waals (vdW) materials are promising for applications in nanoscale electronics. Established properties include high mobility in graphene, a large direct gap in monolayer MoS2, the quantum spin Hall effect in monolayer WTe2 and so on. These exciting properties arise from electron quantum confinement in the two-dimensional limit. Here, we use angle-resolved photoemission spectroscopy to reveal directional massless Dirac fermions due to one-dimensional confinement of carriers in the layered vdW material NbSi0.45Te2. The one-dimensional directional massless Dirac fermions are protected by non-symmorphic symmetry, and emerge from a stripe-like structural modulation with long-range translational symmetry only along the stripe direction as we show using scanning tunnelling microscopy. Our work not only provides a playground for investigating further the properties of directional massless Dirac fermions, but also introduces a unique component with one-dimensional long-range order for engineering nano-electronic devices based on heterostructures of vdW materials.

LncRNA SND1-IT1 accelerates the proliferation and migration of osteosarcoma via sponging miRNA-665 to upregulate POU2F1.

OBJECTIVE: To clarify the role of long non-coding RNA (lncRNA) SND1-IT1 in accelerating the proliferative and migratory abilities of osteosarcoma (OS) via sponging miRNA-665 to upregulate POU2F1. PATIENTS AND METHODS: The relative level of SND1-IT1 in OS tissues was determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The target gene of SND1-IT1 was predicted by bioinformatics and verified by Dual-Luciferase reporter gene assay. Similarly, the target gene of miRNA-665 was identified. Correlation among SND1-IT1, miRNA-665 and POU2F1 was evaluated through linear regression test. Regulatory effects of SND1-IT1/miRNA-665/POU2F1 on cellular behaviors of MG63 and U2OS cells were evaluated. RESULTS: SND1-IT1 was upregulated in OS, knockdown of which attenuated proliferative and migratory abilities of OS cells. MiRNA-665 was the target gene of SND1-IT1, which was negatively correlated to SND1-IT1 in OS. POU2F1 was the target gene of miRNA-665. Its level was negatively regulated by miRNA-665 and positively regulated by SND1-IT1. Inhibited proliferative and migratory abilities of OS cells with SND1-IT1 knockdown were partially elevated by transfection of miRNA-665 inhibitor, and further downregulated by POU2F1 knockdown. CONCLUSIONS: LncRNA SND1-IT1 accelerates proliferative and migratory abilities of OS via sponging miRNA-665 to upregulate POU2F1, thus stimulating the progression of OS.

[Outcome of cochlear implantation in a patient with Chiari malformation type â who presented with hearing loss].

Summary Chiari malformation type Ⅰ（CMI） is a disorder characterized by tonsilla cerebelli herniating into an underdeveloped posterior cranial fossa, hearing loss is often covered by more striking neurological symptoms. Hearing loss in this syndrome is not specific in terms of gender side, degree, age of onset, and progression. The hearing improvement after posterior fossa decompression is controversial on the basis of literature, while satisfactory result was obtained after cochlear implantation in the patient reported here, who was diagnosed as CMI with hearing loss as the main symptom. Therefore, after ensuring the integrity of the auditory pathway, cochlear implantation may be considered in CMI patients with bilateral severe or profound without other severe neurological symptoms.

[Therapeutic effect of Jin Long capsule combined with neoadjuvant chemotherapy on invasive breast cancer and the expression change of multidrug resistance proteins].

Objective: To investigate the therapeutic effect of Jin Long Capsule (JLC) combined with neoadjuvant chemotherapy on the invasive breast cancer, and to explore the mechanism of JLC in inhibiting multidrug resistance of breast cancer. Methods: 200 patients were divided into experimental group and control group (100 cases per group). The control group used TEC regimen for neoadjuvant chemotherapy. And the experimental group was treated with TEC regimen combined with oral JLC. According to the Miller & Payne grading system (MP), the efficacy of neoadjuvant chemotherapy was evaluated based on histopathological changes of breast cancer after neoadjuvant chemotherapy. Adverse effect was evaluated according to the classification criteria of the National Cancer Institute of the United States-The Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. The expression of P-glycoprotein (P-gp), glutathione thiol transferase (GST)-π and topoisomerase Ⅱα (TopoⅡα) in breast cancer tissues before and after neoadjuvant chemotherapy were detected by immunohistochemical staining. Results: There were 83 effective cases (83%) in the experimental group, which was higher than that in the control group (65.0%, P<0.05). The incidence of leukopenia, gastrointestinal reactions and alopecia in grade 3 to 4 of the experimental group were lower than those of the control group (all P<0.05). The positive rates of P-gp, GST-π and TopoⅡα expression in the control group were 65.0% (65/100), 61.0% (61/100) and 69.0% (69/100), respectively, and they were 80.6% (75/93), 78.5% (73/93) and 37.6% (35/93) after chemotherapy. The positive rates of P-gp and GST-π expression were significantly higher than those before chemotherapy (both P<0.05), whereas the positive rate of TopoⅡα expression was significantly lower than that before chemotherapy (P<0.05). In the experimental group, the positive rates of P-gp, GST-π and TopoⅡα expression before chemotherapy were 62.0% (62/100), 63.0% (63/100) and 69.0% (69/100), respectively, while after chemotherapy, they were 68.2% (60/88), 67.0% (59/88) and 63.6% (56/88). There was no significant difference in the positive rates and expression intensity of P-gp, GST-π and TopoⅡα before and after the chemotherapy (P>0.05). Conclusion: Jin Long Capsule (JLC) can inhibit multidrug resistance, improve the efficacy of neoadjuvant chemotherapy, and reduce adverse reactions of breast cancer.

Helicobacter pylori infection increases the risk of adult-onset asthma: a nationwide cohort study.

Helicobacter pylori infection (HPI) appears to reduce risk of childhood-onset asthma, but the relationship between HPI and adult-onset asthma is inconclusive. This study explored the potential association between HPI and risk of adult-onset asthma. We conducted a national insurance retrospective cohort study using the longitudinal health insurance database (LHID 2000) in Taiwan. We enrolled the HPI group consisting of 1664 patients with HPI diagnosis between 2000 and 2007, and the non-HPI group consisting of 6,656 age- and sex-matched subjects without HPI. All study participants had been followed up from index date to the diagnostic date of asthma, withdrawal from the National Health Insurance program, or the end of 2011, which came first. We analyzed risk of adult-onset asthma with respect to sex, age, and comorbidities by using Cox models. Cigarette smoking status, which could not be obtained from the program, was adjusted indirectly by considering chronic obstructive pulmonary diseases in our statistical models because the disease is related to heavy smoking. After adjustment for sex, age, and comorbidities, HPI was significantly associated with an increased 1.38-fold risk of adult-onset asthma. Moreover, among people without comorbidities, the 1.85-fold risk of adult-onset asthma remained higher for the HPI population compared with the non-HPI population. In this study, patients with HPI exhibited a significantly higher risk of adult-onset asthma than did the subjects without HPI.

[Expression of hypoxia-inducible factor 1α, glucose transporter 1 and lactate dehydrogenase 5 in colorectal cancer and clinicopathologic significance].

Objective: To investigate the expression and clinicopathological significance of hypoxia-inducible factor 1 alpha (HIF-1α), glucose transporter 1(GLUT-1) and lactate dehydrogenase(LDH)-5 in colorectal cancer. Methods: The expression levels of HIF-1α, GLUT-1 and LDH-5 were detected by immunohistochemical staining in 142 specimens of human carcinoma in comparison with adjacent normal tissues. Results: The expression levels of HIF-1α(78.2%, 111/142), GLUT-1(75.4%, 107/142) and LDH-5(68.3%, 97/142) were higher in tumor tissues than in adjacent normal tissues(14.8%, 21/142; 11.3%, 16/142; 7.0%, 10/142; P<0.01 for all three proteins), and such over-expression was significantly associated with lymphovascular invasion, tumor grade and pathological stages(all P<0.01). Additional studies showed that HIF-1α, GLUT-1 and LDH-5 were positively associated with each other(r<0.3, P<0.05 for all three proteins). Conclusion: The data suggest that HIF-1α, GLUT-1 and LDH-5 expression may serve as prognostic indicators for colorectal cancer patients.

[Suture under tension across cartilage in the application of the crooked nose surgery].

Objective:Observing the effect of maintain tension across suture between cartilages to fix new nasal structure on balance the asymmetric strength of the two sides of the cartilage and the recurrence of the postoperative crooked nose.Method:A L-shaped struct made of the nasal septum cartilage were fixed to maintain tension across structure between cartilage during rhinoplasty in 39 patients with crooked nasal deformity. Of 21 cases were type I deviation, of 12 cases were C-shaped deviation,and of 6 cases were S-shaped deviation.Result:A 1-5 years follow-up were performed. The effects were divided into three degrees: 30 cases excellent (76.92%), 6 cases good (15.38%) and 3 cases acceptable (7.69%).The rate of excellent and good was 92.31%(36/39). The type I improvement rate was 80.3%,the rate of type C was 83.6% and the improvement rate of type S was 84.1%,the overall improvement rate was about 81.9%.Conclusion:Suture under tension across cartilage can fix reconstruction of nasal structure effectively,improve the postoperative effect, reduce recurrence of crooked nose. The operation is simple and is an essential part of the nasal deformity correction technique.

The ERK-ZEB1 pathway mediates epithelial-mesenchymal transition in pemetrexed resistant lung cancer cells with suppression by vinca alkaloids.

High thymidylate synthase (TS) level in cancer tissue is considered to result in resistance to pemetrexed therapy for advanced stages of nonsquamous non-small cell lung cancers. To further investigate the mechanism of pemetrexed resistance and potential prognostic outcomes in lung cancer, we established pemetrexed-resistant lung adenocarcinoma cell sublines from CL1 harboring a mutated TP53 gene (R248W) and A549 harboring wild-type TP53. We found the TS expression is upregulated in both pemetrexed-resistant sublines and the reduced TS level achieved through shRNA inhibition resulted in higher pemetrexed sensitivity. We also demonstrated that the acquisitions of pemetrexed resistance enhances epithelial-mesenchymal transition (EMT) in vivo with a mice animal model and in vitro with CL1 and A549 sublines, which was associated with upregulation of ZEB1 which, in turn, downregulates E-cadherin and upregulates fibronectin. When ERK1/2 phosphorylation was reduced by an inhibitor (U0126) or siRNA inhibition, both pemetrexed-resistant sublines reduced their migration and invasion abilities. Therefore, the ERK-mediated pathways induce apoptosis with pemetrexed treatment, and may in turn mediate EMT when cancer cells are resistant to pemetrexed. We further demonstrated that the growth of pemetrexed-resistant tumors could be inhibited by vinblastine in vivo and vincristine in vitro. Our data indicate that pemetrexed resistance could be relieved by non-cross-resistant chemotherapeutic drugs such as vinca alkaloids and might be independent to TP53 status. Furthermore, the phosphorylation of ERK was reduced by vincristine. This finding provides a new insight for overcoming pemetrexed resistance and metastasis by application of vinca alkaloids.

Mn vacancy defects, grain boundaries, and A-phase stability of helimagnet MnSi.

Mn vacancy defect and grain size are shown to modify the magnetic phase diagram of MnSi significantly, especially near the critical regime of A-phase (skyrmion lattice) formation and the helimagnetic phase transition. Crystals grown using controlled nonstoichiometric initial precursors creates both grain boundaries and intrinsic Mn vacancy defect of various levels in MnSi. The results of combined transport, specific heat, and AC spin susceptibility measurements are compared for MnSi single crystal samples of various manganese deficiency levels and grain sizes. The finite-size effect and Mn vacancy level dependent helical phase transition temperature T(c) have been identified and verified. The stability of A-phase in H-T phase space has been examined through AC spin susceptibility data analysis.

Association between lumbar discectomy and subsequent cervical discectomy.

BACKGROUND: Lumbar discectomy (LD) is one of the most common spinal surgical procedures. However, the remote effect of the cervical spine has seldom been discussed. The comparative incidence of cervical discectomy with or without a previous LD is an essential feature in predicting this effect. METHODS: A cohort comparative study was conducted from the National Health Research Institute, Taiwan, over the period from 1996 to 2010. Patients who received LDs and patients who did not receive LDs in the same period were randomly selected to serve as samples for comparison. A total of 14 480 patients who did not undergo LD surgery and 3620 patients who received LDs were enrolled in this study. The incidence rates of discectomy-cervical in both groups were calculated from the follow-up period until the end of 2010. The baseline comorbidity history was determined for each patient. Comorbidities included facture and osteoporosis. RESULTS: During the follow-up period, the overall incidence rate of CD was significantly higher in patients who were treated with LD than in those who were not (24.7 vs. 2.73 per 10 000 person years). The risk of CD in the LD-treated cohort was ∼9-fold greater than that of the non-LD-treated cohort (HRs = 8.58, 95% CI = 5.38-13.7). CONCLUSION: Patients who have undergone LDs are at A greater risk of subsequent CDs, an increased risk that is evident in all patients regardless of demographics or the presence of fracture or osteoporosis.

Distyly and floral morphology of Psychotria cephalophora (Rubiaceae) on the oceanic Lanyu (Orchid) Island, Taiwan.

BACKGROUND: Psychotria cephalophora Merr. (Rubiaceae), a shrub in oceanic islands of Taiwan and the Philippines, appears to be distylous, but distyly is usually rare on oceanic islands. To elucidate the functional breeding system of P. cephalophora can improve our understanding of plant reproductive ecology on oceanic islands. RESULTS: Field investigations on Lanyu (Orchid Island) off the coast of southeastern Taiwan revealed the flowers to be distylous with short (S)- and long (L)-styled morphs, with only one morph per individual. Laboratory observations revealed that both morphs had stainable pollen grains and indicated dimorphism in stigmatic papillae and pollen size. In hand pollination experiments, the pollen tubes reached the base of the style in intermorph crossing, whereas they rarely penetrated stylar tissue in intramorph crossing and selfing. Open pollinated S- and L-styled flowers produced fruit. CONCLUSIONS: The results indicate that the breeding system of P. cephalophora is morphologically and functionally distylous.

Helicobacter pylori infection and the risk of acute coronary syndrome: a nationwide retrospective cohort study.

Helicobacter pylori infection (HPI) imposes substantial social costs and is of major etiological importance in peptic ulcer disease, gastric cancer, and accelerated cardiovascular diseases. This study determined the risk of acute coronary syndrome (ACS) associated with HPI in a nationwide retrospective cohort study. By using the Taiwan National Health Insurance Research Database (NHIRD), we identified patients diagnosed with HPI from 1998 to 2010. In addition, we randomly selected non-HPI controls frequency-matched by age, sex, and index year from the general population free of HPI. The risk of ACS was analyzed using Cox proportional hazards regression models in which sex, age, and comorbidities were included as variables. We identified 17,075 participants for the HPI group and selected 68,300 participants for the comparison group. The incidence rates were increased in the patients in the HPI group compared with those in the comparison group. Overall, the HPI patients exhibited a 1.93-fold high crude hazard ratio for ACS, and a 1.48-fold adjusted hazard ratio after age, sex, and comorbidities were adjusted. However, the overall adjusted hazard ratio of ACS increased with increasing age with a 3.11 to 8.24 adjusted hazard ratio among the various age groups. Several comorbidities, such as diabetes, hyperlipidemia, and COPD exhibited synergistic effects for ACS risk. We determined a significant association between ACS and comorbidities and provide evidence to encourage clinicians to observe ACS-related comorbidities.

Correlation between use of simvastatin and lovastatin and female lung cancer risk: a nationwide case-control study.

BACKGROUND: The objective of this study was to determine the association between statin use and female lung cancer in Taiwan. METHODS: In this case-control study, we used information from the Taiwan National Health Institute Research Database on 17,329 patients (cases) aged 20 years or older recently diagnosed with lung cancer between 2005 and 2010 and 17,329 patients without lung cancer to assess the association between female lung cancer and statin use, even adjustment for its comorbidities. RESULTS: After adjusting for age and associated risk factors, we determined that women who engaged in long-term use of simvastatin at a defined daily dose (DDD) of over 150 have a reduced risk of lung cancer compared with those who did not use statins (odds ratio: 0.77, 95% confidence interval: 0.62-0.97) in women. However, lovastatin was not significantly associated with lung cancer in women. Among female patients with pre-existing comorbidities of respiratory diseases such as chronic obstructive pulmonary disease, hypertension, stroke and pulmonary tuberculosis, statins reduced the risk of lung cancer. CONCLUSIONS: Simvastatin use at a DDD of more than 150 is correlated with an approximately 20% reduction in the risk of lung cancer in women.

Increased risk of varicella zoster virus infection in inflammatory bowel disease in an Asian population: a nationwide population-based cohort study.

PURPOSE: Whether patients with inflammatory bowel disease (IBD) exhibit a high risk of developing varicella zoster virus (VZV) infection in Asian populations remains inconclusive. We investigated the causal relationship between two diseases by analysing the Taiwan National Health Insurance Research Database. PATIENTS AND METHODS: Based on a universal insurance claims database, we enrolled 7055 IBD patients and 28,220 age- and sex-matched controls. We calculated the hazard ratios (HRs) and 95% confidence intervals (CIs) of the herpes zoster virus (HZV) in the IBD and comparison cohorts, using the Cox proportional hazards regression model. RESULTS: Patients with IBD exhibited significantly higher risk of the HZV compared with the controls (adjusted HRs, 1.42; 95% CI, 1.27-1.60). Further analysis indicated that male patients (adjusted HRs, 1.61; 95% CI, 1.35-1.92), aged 35-44 (adjusted HRs, 1.47; 95% CI, 1.08-2.01) and aged 65 years and older (adjusted HRs, 1.47; 95% CI, 1.19-1.80), and patients without comorbidities (adjusted HRs, 1.44; 95% CI, 1.26-1.66), exhibited excessive risks of VZV infection. Moreover, our findings show that the overall risk of developing VZV infection increased risk from 1.03 (95% CI, 0.90-1.18) (≤ 2 visits) to 9.76 (95% CI, 7.60-12.5) (> 4 visits), which correlates positively with the frequency of medical visits (trend test p < 0.0001). CONCLUSION: Patients with IBD, particularly men aged 35-44/65 years and over, and patients without comorbidities, are associated with a long-term risk of VZV infection. The excessive risk of VZV infection should be considered for administering vaccines to IBD patients.

Increased risk of chronic fatigue syndrome following herpes zoster: a population-based study.

Chronic fatigue syndrome (CFS) is a complex disorder accompanied by unexplainable persistent fatigue, in which several etiological factors exist, such as viral infections. Using the National Health Insurance Research Database (NHIRD) of Taiwan, this study evaluated the association between herpes zoster (HZ) infection and the risk of CFS, and examined the possibility of patients developing postviral fatigue effects, including the possibility of developing other unexplainable chronic fatigue conditions. In this prospective cohort study using the NHIRD, we identified 9,205 patients with HZ infection [ICD-9 (International Classification of Disease, Ninth Revision), code 053] and 36,820 patients without HZ infection (non-HZ) from 2005 to 2007, and followed up to the end of 2010. The incidence rate of CFS was higher in the HZ cohort than in the non-HZ cohort (4.56 vs. 3.44 per 1,000 person-years), with an adjusted hazard ratio of 1.29 [95 % confidence interval (CI) = 1.09-1.53]. It was shown that the risk of CFS without comorbidity for each patient increased from 1.25- to 1.36-fold between the CFS and non-CFS cohorts; with long-term follow-up, the HZ cohort showed a significantly higher cumulative incidence rate of developing CFS than the non-HZ patients. We propose that patients with chronic fatigue might exist in a subset of patients that would be associated with HZ infection. The actual mechanism of development of CFS that is attributed to HZ infection remains unclear. The findings of this population cohort study provide pivotal evidence of postviral fatigue among patients with HZ infection.