Sleep duration and breast cancer risk among black and white women

BackgroundSleep has been suggested to influence breast cancer risk; however, the evidence is mixed. Black women have a higher prevalence of both short (<6 h) and long (≥9 h) sleep duration and are more likely to develop more aggressive, hormone receptor-negative breast cancer. No study has examined the relationship between sleep and breast cancer in blacks. We focused on race-specific associations among the blacks.MethodsIn the Southern Community Cohort Study (SCCS), a prospective study of which two-thirds of the population were black, we prospectively investigated self-reported sleep duration in relation to overall breast cancer risk by estrogen (ER) and progesterone receptor (PR) status in all women and in black women alone.ResultsSleep duration was not associated with risk of total or hormone receptor-positive breast cancer. However, we found an inverse relationship between sleep duration and risk of ER− and PR− breast cancer among all women and in black women alone. Compared to the reference group (8 h), black women who reported shorter sleep duration had an increased risk of ER− PR− breast cancer (odds ratios; ORs (95% confidence intervals; CIs): 2.13 (1.15, 3.93), 1.66 (0.92, 3.02), and 2.22 (1.19, 4.12) for <6, 6, and 7 h, respectively, (p for trend, 0.04).ConclusionsShort sleep duration may be a risk factor for hormone receptor-negative breast cancer among black women.     

Intravenous Fluid Selection for Unruptured Intracranial Aneurysm Clipping : Balanced Crystalloid versus Normal Saline

ObjectiveWhile balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. MethodsThis study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. ResultsA total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. ConclusionThis study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.     

The utility of magnetic resonance spectroscopy in frame-less stereotactic needle biopsy of glioma

ObjectiveProton magnetic resonance spectroscopy (¹H—MRS) can benefit the differentiation of gliomas preoperative grading and facilitate guiding biopsy. This study was to investigate the optimal metabolite or metabolic ratios of MRS for the biopsy target delineating by using the technique of MRS imaging guided frame-less stereotactic biopsy.MethodsDuring a 4 year period between the Sep 2012 and Oct 2016, 57 patients (25 women, 32 men; mean age, 46.4) with histologic diagnosis of glioma, who underwent the ¹H—MRS imaging guided frameless stereotactic biopsy, were retrospectively reviewed. The metabolite or metabolic ratios values of MRS was measured. And the sensitivity, specificity, accuracy as well as the area under the curve (AUC) of those parameters for glioma grading are calculated based on the receiver operating characteristic curve (ROC) analysis.Results65 stereotactic biopsy samples from 57 patients were histopathologically clarified to HGGs (25) or LGGs (40) for quantitative analysis. The Cho, Cho/NAA and Cho/Cr values of LGGs group were significantly lower than that of HGGs (P = 0.09, 0.001, 0.003), and the NAA value of LGGs group was significantly higher than that of HGGs (P = 0.001). The cutoff value of 3.65 for the Cho/NAA ratio provided the best combination of sensitivity (92.0%), specificity (95.0%), and diagnostic accuracy (93.8%) for identifying glioma grade, which was superior to other parameters.ConclusionThe results of our study provided evidence that Cho/NAA ratio had the superior diagnostic performance in distinguishing glioma grade, indicating that the spot of highest Cho/NAA ratio was optimal metabolic targets for spectroscopic guided tissue sampling in homogenous glioma.     

A follow-up study on restless legs syndrome in chronic obstructive pulmonary disease population

BackgroundRestless legs syndrome (RLS) is prevalent in patients with chronic obstructive pulmonary disease (COPD). No large population-based cohort study has assessed the relationship. We evaluated the incidence of RLS among COPD patients by sociodemographic status (SES) and comorbidity using insurance claims data of Taiwan.MethodsFrom the database, we established a cohort consisting of 77,831 individuals aged ≥ 20 years newly diagnosed with COPD from 2000 to 2013. We also identified same number of individuals without COPD as the comparison cohort, frequency matched by sex, age and index year. Both cohorts were followed up to the end of 2013 to estimate the incidence and hazard ratio (HR) of developing RLS.ResultsThe incidence of RLS was 2.2-fold higher in COPD patients than in those free of COPD (6.67 and 3.08 per 10,000 person-years), with an adjusted HR (aHR) 1.68 (95% CI 1.41–2.01) after controlling for covariates. The incidence rates in both cohorts increased with age and higher in low socioeconomic group. The risk of RLS increased further among COPD patients with additional comorbidities. Compared to those without COPD and comorbidity, the aHR was 7.93 (95% CI 1.11–57.8) for those with iron deficiency, 3.95 (96% CI 1.92–8.13) with Parkinson's disease, 2.85 (95% CI 1.05–7.72) with polyneuropathy, or 1.81 (95% CI 1.14–2.87) with diabetes.ConclusionPatients with COPD are at an increased risk of developing RLS regardless of gender, age and occupation. The COPD patients with comorbidities should be particularly cautious about the RLS risk.     

Incidence and Reappraisal of Known Risk Factors Associated with Carpal Tunnel Syndrome: A Nationwide, 11-Year,Population-Based Study in South Korea

Background and PurposePrevious studies have revealed various risk factors for carpal tunnel syndrome (CTS), but few large-scale studies have been conducted. We used data from the 11-year, longitudinal, nationwide population-based National Health Insurance Service–National Health Screening cohort to identify the actual risk factors for CTS.MethodsWe collected patients with CTS newly diagnosed using electrodiagnostic studies while excluding radiculopathy, plexopathy, or polyneuropathy, which can be confused with CTS. The crude and standardized incidence rates of CTS were calculated. Univariate and multivariate Cox analyses and the incidence of CTS were used to identify the risk factors for newly diagnosed CTS.ResultsThe standardized incidence was 130.8/100,000 person-years based on the World Health Organization World Standard Population as a reference. Multivariate Cox analysis identified that the risk factors for CTS were being middle-aged, female, and obese, and having rheumatoid arthritis and Raynaud''s syndrome, whereas gout and hypothyroidism were not risk factors. Diabetes and end-stage renal disease did not show a significant hazard ratio, although it is implicit that the durations of these diseases affect the development of CTS.ConclusionsThis study calculated the incidence of CTS and reappraised the associated risk factors found in previous studies. This information will be helpful for determining the pathophysiology of CTS, and hence aid the establishment of effective new public health policies.     

The increased risk of stroke in early insomnia following traumatic brain injury: a population-based cohort study

ObjectiveInsomnia, a common symptom after traumatic brain injury (TBI), may be a pre-symptom for developing stroke. This study aims to investigate whether insomnia is a potential risk factor for stroke after TBI, especially early insomnia.MethodsTaiwan's Longitudinal Health Insurance Database 2000 from 1999 to 2013 was used in this cohort study. TBI patients with insomnia were selected based on the ICD-9-CM code (TBI: 801–804 and 850–854; insomnia: 307.4, 327, and 780.5). The outcome we were interested in was stroke (ICD-9-CM: 430–438). The incidence rate ratio of stroke between TBI with insomnia and the general population with insomnia was calculated by Poisson regression. The relative risk adjusted for potential confounding variables was estimated by Cox regression.ResultsFor 1174 TBI patients with insomnia and 5870 general patients with insomnia, TBI patients have 209.85 incidence risk of new-onset stroke if they have insomnia. TBI patients have 2.28-fold (95% CI: 1.70–3.06) risk of new-onset stroke compared with the general population, even when controlling for age, gender, socioeconomic status, and comorbidities. The hazard ratio of new-onset stroke among different phases of new-onset insomnia after TBI surgery is 1.95-fold (95% CI: 1.05–3.62), 2.75-fold (95% CI: 1.73–4.37), and 2.66-fold (95% CI: 1.68–4.21) at ≤3, 3–12, and 12–24 months, compared with the general population with insomnia, respectively.ConclusionTBI patients with insomnia have a higher risk of stroke compared with the general population with insomnia. Early new-onset insomnias after TBI will have higher risk of stroke. Therefore, we consider that insomnia could be a signal of the development of new-onset stroke in TBI patients.     

缺血性脑血管病患者脑微出血相关因素及其对抗血小板单药治疗的影响分析

目的 研究缺血性脑血管病患者脑微出血（CMB）危险因素及其对抗血小板单药治疗的影响。方法 选取2018年1月至2018年6月该院神经内科接受抗血小板单药治疗的急性缺血性脑血管病患者300例为样本，入院后采集基本资料并完善相关检查，根据梯度回波T2^*加权成像（GRE-T2^*WI）检查结果将患者分为CMB组（176例）和非CMB组（124例），均给予抗血小板聚集治疗，比较两组临床资料及治疗1年内再发梗死、脑出血和病死率，分析影响CMB发病的危险因素以及CMB对抗血小板单药治疗的影响。结果 高龄、高血压、肥胖、脑卒中病史、ACI和脑白质疏松为CMB发生的危险因素（P<0.05）。CMB组和非CMB组抗血小板单药治疗期间脑出血率分别为14.20%和6.45%，差异有统计学意义（P<0.05）。轻度组、中度组和重度组脑出血率分别为9.18%、10.64%和35.48%，差异有统计学意义（P<0.05）。不同部位CMB患者抗血小板单药治疗期间再发脑梗死、脑出血及病死率比较，差异无统计学意义（P>0.05）。结论 高龄、高血压、肥胖、脑卒中病史、ACI及脑白质疏松为缺血性脑血管疾病合并CMB的危险因素。CMB可导致抗血小板单药治疗期间脑出血风险增加，重度CMB者更甚。     

Risk of stroke in patients with idiopathic Parkinson disease

PurposeLarge population based studies on the association of Parkinson disease (PD) with stroke are scarce. This study aimed to quantify the risk of a first-time diagnosis of idiopathic PD in patients with a history of stroke, and to assess incidence rates for stroke in PD patients.MethodsWe used the UK-based General Practice Research Database to compare the prevalence of stroke/TIA in newly diagnosed PD patients and in a matched comparison group without PD between 1994 and 2005. We conducted a follow-up study with a nested case-control analysis to quantify the risk of incident stroke/TIA in relation to a previous PD diagnosis.ResultsA history of stroke/TIA was associated with a significantly increased relative risk of being diagnosed with PD compared to patients without such a history (adj. odds ratio [OR] 1.65, 95% confidence intervals [CI] 1.47–2.00). In the cohort study, the crude incidence rate ratios (IRRs) for incident hemorrhagic stroke, ischemic stroke or TIA were 0.66 (95% CI 0.26–1.72), 1.46 (95% CI 1.03–2.07) and 1.86 (95% CI 1.40–2.47), respectively.ConclusionsIn this large observational study the risk of a PD diagnosis was significantly increased after a previous stroke event, as was the risk of a first-time ischemic stroke in newly diagnosed PD patients compared to persons free of PD.     

Incidence and mortality of Parkinson's disease in older Canadians

ObjectiveTo estimate the age-specific incidence of Parkinson’s disease (PD) in elderly persons in the Canadian province of British Columbia (BC). All-cause and injury mortalities and relative risk of death for those persons with PD were also examined.MethodsA historical cohort study was conducted using 5 provincial administrative databases from 1991/92 to 2000/2001. A series of algorithms based on the databases were created for case ascertainment of PD for persons 65 years or older. Crude and age-specific incidence and mortality rates were calculated using person-years of follow-up as the denominator. The impact of PD on all-cause and injury mortalities was examined using multivariate Cox regression models to provide adjusted hazard ratios.Results10,910 incidence cases over 6,051,682 person-years of follow-up were identified. The crude annual incidence rate was 252 per 100,000 person-years. Over the nine year period, age standardized incidence for males ranged from 207 to 396 per 100,000 person-years and 127 to 259 per 100,000 person-years for females. Persons with PD were at a 43% greater risk of all-cause mortality and specifically, 51% greater risk of injury mortality.ConclusionsIncidence of PD is substantially higher in advanced age with age adjusted increases for both all-cause and injury mortalities. These findings also highlight falls as a primary factor for injury mortality in PD.     

Obstructive sleep apnea is associated with liver disease: a population-based cohort study

BackgroundThe association between obstructive sleep apnea (OSA) and the risk of liver disease is unclear. Moreover, population-based studies on the risk of liver disease among people with OSA have not yet been conducted. This study aimed to investigate the risk of subsequent development of liver disease among people with OSA.MethodsUsing Taiwan National Health Insurance claims data, this study collected subjects from a cohort of 17,374 people with OSA who were diagnosed between 2000 and 2008. A control group of 69,496 people was selected from the same database and matched by age, gender, urbanization, income, and date of initial admission. All subjects were followed up until 2010. Liver disease incidence and risk were calculated.ResultsThe overall risk of liver disease among people with OSA was significantly higher than in the control group (aHR = 5.52, p <0.001). Non-alcoholic fatty liver disease, cirrhosis, and hepatitis C had significant aHRs of 5.29, 7.50, and 7.19 (all at p <0.001), respectively. In contrast, hepatitis B had the smallest aHR of 3.71.ConclusionsThe risk of liver disease was more than five times higher among people with OSA compared with the control group; this was particularly for cirrhosis and hepatitis C. Liver disease is thus a very important health issue among people with OSA.     

Variable incidence of cyclosporine and FK-506 neurotoxicity in hematopoeitic malignancies and marrow conditions after allogeneic bone marrow transplantation

Introduction: This study examines whether malignant disease under treatment influences the incidence of cyclosporine or FK-506 neurotoxicity after myeloablative conditioning and allogeneic bone marrow transplantation (allo-BMT). Methods: Review of 290 patients who received myeloablative conditioning prior to allo-BMT and cyclosporine/FK-506 identified 21 (7.2%) patients with neurotoxicity confirmed by computed tomography or magnetic resonance. Underlying malignancy necessitating allo-BMT included leukemias (67%), lymphoma (10%), myelodysplastic syndrome (10%), and multiple myeloma (MM). Frequency of neurotoxicity by disease was compared. Results: The highest incidence of neurotoxicity was present with MM (25%), whereas the lowest incidence was present with lymphoma (2.7%). Other diseases demonstrated intermediate incidence, including acute leukemias (10%), myelodysplastic syndrome (6.4%), and chronic myelogenous leukemia (4.9%). Conclusion: Cyclosporine/FK-506 neurotoxicity varied according to the underlying malignancy. The variable susceptibility to the development of neurotoxicity in this population may depend on the interaction of host vasculature with disease specific factors. Understanding the cause of neurotoxicity could improve survival after allo-BMT.     

“Does one size fit all?” moderators in psychosocial interventions for breast cancer patients: A meta-analysis

Background: A variety of psychosocial interventions have been developed to promote better adjustment to breast cancer (BC) and their efficacy has been demonstrated repeatedly. However, the effect sizes (ES) vary considerably across studies.Purpose: This article intends to shed light on potential moderators of intervention efficacy for BC patients, such as the intervention type (e.g., education, supportive), the composition of the sample (only BC patients or BC mixed with other cancer types), and the practitioner of the intervention (psychologist, nonpsychologist).Methods: Fifty-six randomized-controlled studies investigating the effectiveness of psychosocial interventions with adult BC patients were meta-analytically reviewed.Results: The overall ES of d=0.26 was similar to previous meta-analyses and moderated by several variables. The ES varied notably based on the composition of the sample, the profession offering the intervention, and the type of intervention. Studies with samples consisting of only BC patients and studies with nonpsychologist-led interventions showed lower ES. Psychoeducation yielded the strongest ES. These moderators maintained their significance even when controlling for the nature of the control group, the format of the intervention, the timing of the intervention, or the stage of disease.Conclusions: These results suggest that among current interventions, psychoeducation is a treatment of choice for BC patients, preferably prior to surgery and led by individuals with a medical expertise. Other psychosocial interventions appear most effective when administered individually and led by a psychologist. In addition, there is a need for improved psychosocial interventions to enhance the present ES for women with BC. Part of this research was supported by the Christoph-Dornier-Foundation for Clinical Psychology, a grant from the German Research Foundation (DFG-He61481994) to Nina Heinrichs, Principal Investigator, and grant R01 CA107477-01 from the National Cancer Institute to Donald Baucom, Principal Investigator. We are greatly indebted to Dr. Jennifer L. Scott for her help and support in accumulating the literature for this analysis.     

Seizure incidence among neuromyelitis optica spectrum disorder patients

BackgroundNeuromyelitis optica spectrum disorders (NMOSDs) are a group of neuroinflammatory diseases, which mainly affect the optic nerve and spinal cord. NMOSD is an astrocytic channelopathy involving the aquaporin-4 (AQP4) water channels in the central nervous system. Patients can present with seizure attacks as a first manifestation or relapse. However, compared with multiple sclerosis (MS) or myelin oligodendrocyte glycoprotein encephalomyelitis (MOG-EM), seizure attacks are less frequent in NMOSD.MethodsIn this study, we aimed to find out the incidence of seizure attacks during the disease course of 137 NMOSD patients who were registered in our centre from January 2011 till January 2020. Furthermore, we reviewed the literature for NMOSD cases with seizure attacks during their follow-up, in order to investigate the reason for this low incidence of seizures.ResultsOnly one of our patients (0.72%) experienced an episode of generalised tonic-clonic seizure during his follow-up.ConclusionReviewing the literature revealed that although seizures are rare in NMOSD, AQP4 disruption possibly increases the risk of seizure attacks. We therefore concluded that the role of AQP4 in seizures is controversial and needs more investigation.     

Exposure to estrogen and women's risk for Parkinson's disease: A prospective cohort study in Denmark

BackgroundStudies have suggested that estrogen is protective against Parkinson's disease; however, the results have been inconsistent.MethodsOur cohort comprised 27,466 women from the prospective Diet, Cancer and Health study. At inclusion, all the cohort members filled in questionnaires on diet and lifestyle, including reproductive factors, use of hormone products, and smoking habits. The cohort was followed up for Parkinson's disease in the Danish Hospital Register, and risks associated with indicators of exposure to estrogen were estimated in a Cox proportional hazards model.ResultsNo significant association was found between reproductive factors and risk for Parkinson's disease. Use of oral contraceptives was associated with a nonsignificantly increased risk (hazard ratio, 1.30; 95% confidence interval, 0.81–2.09), as was use of hormone replacement therapy (1.41; 0.90–2.21).ConclusionsOur data do not support the hypothesis of a protective effect of estrogen on the risk for Parkinson's disease in women.     

Obstructive sleep apnea and the risk of autoimmune diseases: a longitudinal population-based study

BackgroundObstructive sleep apnea (OSA) has been associated with chronic inflammation. However, no data regarding the risk for autoimmune disease in patients with OSA has been reported. This study aims to investigate the longitudinal risk for the development of certain autoimmune diseases in patients with OSA.MethodsFor the study cohort, we identified 1411 patients from the Taiwan Longitudinal Health Insurance Database who had a diagnosis of OSA. For controls, 7055 subjects matched in terms of sex, age, and the index year were randomly extracted from the same database. Each patient was tracked for a five-year period to identify those patients who had received a diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS), or systemic lupus erythematous (SLE). Stratified Cox proportional hazard regression was performed on the two cohorts to compute the risk of autoimmune diseases during follow-up period.ResultsOf 8466 patients, 1.76% had developed autoimmune diseases during the five-year follow-up period; 2.91% and 1.53% for the study cohort and the controls, respectively. The stratified Cox proportional analysis revealed that, after eliminating individuals who died during the follow-up period and adjusting for geographic and socioeconomic factors, the hazard for developing autoimmune disease during the five-year follow-up period was 1.91 (95% CI = 1.32–2.77, p < 0.001) times greater for patients with OSA than for controls.ConclusionPatients with OSA have a higher risk of developing certain autoimmune diseases. Further study is advised to confirm our findings and explore the underlying pathomechanism.     

Daylight saving time shifts and incidence of acute myocardial infarction--Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA)

BackgroundDaylight saving time shifts can be looked upon as large-scale natural experiments to study the effects of acute minor sleep deprivation and circadian rhythm disturbances. Limited evidence suggests that these shifts have a short-term influence on the risk of acute myocardial infarction (AMI), but confirmation of this finding and its variation in magnitude between individuals is not clear.MethodsTo identify AMI incidence on specific dates, we used the Register of Information and Knowledge about Swedish Heart Intensive Care Admission, a national register of coronary care unit admissions in Sweden. We compared AMI incidence on the first seven days after the transition with mean incidence during control periods. To assess effect modification, we calculated the incidence ratios in strata defined by patient characteristics.ResultsOverall, we found an elevated incidence ratio of 1.039 (95% confidence interval, 1.003–1.075) for the first week after the spring clock shift forward. The higher risk tended to be more pronounced among individuals taking cardiac medications and having low cholesterol and triglycerides. There was no statistically significant change in AMI incidence following the autumn shift. Patients with hyperlipidemia and those taking statins and calcium-channel blockers tended to have a lower incidence than expected. Smokers did not ever have a higher incidence.ConclusionsOur data suggest that even modest sleep deprivation and disturbances in the sleep–wake cycle might increase the risk of AMI across the population. Confirmation of subgroups at higher risk may suggest preventative strategies to mitigate this risk.     

Polycystic ovary syndrome in patients with epilepsy: A study in 102 Chinese women

PurposeThe incidence of polycystic ovary syndrome (PCOS) increases in women with epilepsy (WWE), which appears to vary with ethnicity. This study was conducted to determine the incidence and risk factors of PCOS in Chinese WWE.MethodsThe study was carried out in 102 of 139 Chinese WWE at reproductive ages, with 32 receiving valproic acid (VPA), 40 receiving other antiepileptic drugs (AEDs), and 30 without AEDs therapy. PCOS was defined as having 2 or more of the following components: polycystic ovaries, hyperandrogenism, and amenorrhoea or oligomenorrhoea (a/oligomenorrhoea).ResultsOne or more isolated components of PCOS were found in 56 (54.9%) patients, with 29 (28.4%) having polycystic ovaries, 20 (19.6%) with a/oligomenorrhea, 7 (6.9%) with hyperandrogenism, and 13 (12.7%) with defined PCOS. Their average age at the start of seizure was 13.8 ± 6.5 years, younger than that of patients without these disorders (16.9 ± 8.6 years, p < 0.05). VPA therapy increased the incidence of PCOS (11/32, 34.4%), in addition to increased blood levels of testosterone and luteinizing hormone (LH) as well as LH to FSH (follicle-stimulating hormone) ratio. No significant relationship was found between the incidence of PCOS and the type, duration, or frequency of seizures in these WWE.ConclusionThere is an increased incidence of PCOS in Chinese WWE at reproductive ages, by more than 2 times of that in the general population. Risk factors include seizures starting at a young age and VPA therapy.     

Gender-related protection from or vulnerability to severe CNS diseases: Gonado-structural and/or gonado-activational? A meta-analysis of relevant epidemiological studies

BackgroundA vast scientific literature has dealt with gender-specific risk for brain disorder. That field is evolving toward a consensus to the effect that the estrogen hormone family is outstandingly and uniquely neuroprotective. However, the epidemiology relevant to this general outlook remains piecemeal.MethodThe present investigation strategically formats the relevant epidemiological findings around the world in order to quantitatively meta-analyze gender ratio of risk for a variety of relevant severe central nervous system (CNS) diseases at all three gonadal stages of the life cycle, pre pubertal, post adolescent/pre menopausal, and post menopausal.ResultsThe data quantitatively establish that (1) no single epidemiological study should be cited as evidence of gender-specific neuroprotection against the most common severe CNS diseases because the gender-specific risk ratios are contradictory from one study to the other; (2) risk for severe CNS disease is indeed significantly gender-specific, but either gender can be protected: it depends on the disease, not at all on the age bracket.ConclusionOur assay of gender-specific risk for severe brain disease around the world has not been able to support the idea according to which any one gender-prevalent gonadal steroid hormone dominates as a neuroprotective agent at natural concentrations.     

Risk of bone fractures in patients with narcolepsy: a nationwide population-based cohort study

ObjectivesNarcolepsy symptoms, such as excessive daytime sleepiness or cataplexy, can pose a risk to safety. Stimulants or antidepressants have been used to treat these symptoms. The study investigated the risk of bone fractures in narcolepsy patients. Also, the exposure pattern of stimulants and antidepressants to the risk of bone fractures was examined.MethodsIn all, 493 narcolepsy patients and 490 controls matched by gender, age, index year, and comorbidity severity were enrolled between 1998 and 2012, then followed until the end of 2013 using Taiwan's National Health Insurance Research Database. During the follow-up period, participants who developed bone fractures were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) for the incidence rates of bone fractures between narcolepsy patients and unaffected controls.ResultsNarcolepsy patients had a significantly increased risk of bone fractures compared with unaffected controls (19.6 versus 12.3 per 1000 person-years, HR: 1.74, 95% CI: 1.29–2.35). In addition, the use of stimulants in narcolepsy patients showed lower incidence rates of bone fractures compared to non-users (incidence rates were 14.2, 11.9, and 20.0 per 1000 person-years, respectively, among frequent users, infrequent users, and non-users), but the risk estimate was not statistically significant. The evidence for associations between antidepressant use in narcolepsy patients and bone fractures was contradictory.ConclusionThis study highlights the need to pay attention to the risk of bone fractures in narcolepsy patients, and the importance of adequate stimulants use might reduce the risk of bone fractures.     

Age Effect on Incidence,Physical, and Psychiatric Comorbidity for Sudden Cardiac Death in Schizophrenia: Effet de l’âge sur l’incidence,la comorbidité physique et psychiatrique de la mort cardiaque subite dans la schizophrénie

Objective:The pathogenesis of sudden cardiac death may differ between younger and older adults in schizophrenia, but evidence remains scant. This study investigated the age effect on the incidence and risk of the physical and psychiatric comorbidity for sudden cardiac death.Methods:Using 2000 to 2016 data from the Taiwan National Health Insurance Research Database and Department of Health Death Certification System, we identified a national cohort of 170,322 patients with schizophrenia, 1,836 of whom had a sudden cardiac death. Standardized mortality ratios (SMRs) were estimated. Hazard ratios and population attributable fractions of distinctive comorbidities for sudden cardiac death were assessed.Results:The SMRs of sudden cardiac death were all >1.00 across each age group for both sexes, with the highest SMR in male patients aged <35 years (30.88, 95% CI: 26.18–36.18). The fractions of sudden cardiac death attributable to hypertension and congestive heart failure noticeably increased with age. By contrast, the fraction attributable to drug-induced mental disorder decreased with age. Additionally, chronic hepatic disease and sleep disorder increased the risk of sudden cardiac death in patients aged <35 years. Dementia and organic mental disorder elevated the risk in patients aged between 35–54 years. Ischemic heart disease raised the risk in patients aged ≥55 years.Conclusions:The risk is increased across the lifespan in schizophrenia, particularly for younger male patients. Furthermore, physical and psychiatric comorbidities have age-dependent risks. The findings suggest that prevention strategies targeted toward sudden cardiac death in patients with schizophrenia must consider the age effect.