Background: The purpose of this study is to investigate the epidemiology and medical expenses of myasthenia gravis (MG) in Taiwan. Methods: Cases of MG were identified from the National Health Insurance Research Database with corresponding codes of the International Classification of Diseases, ninth revision (ICD-9), from January 2000 to December 2007. Age- and sex-specific incidences were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior. Results: During the study period, 5,211 cases were identified. The incidence ratio of males to females was 0.68. The average annual incidence rate was 2.1/100,000. MG occurred in all age groups with a higher incidence in older individuals and the lowest incidence in the 10- to 14-year-olds for both sexes. Among the 5,211 cases, 615 (12%) had a neoplasm of the thymus. The prevalence increased steadily during the study period from 8.4/100,000 in 2000 to 14.0/ 100,000 in 2007. Conclusions: This is the first population-based epidemiological study of MG in Taiwan. The incidence rate and prevalence were higher than in most published studies, especially in old age groups.

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BackgroundTaiwan has the highest incidence of end-stage renal disease (ESRD) in the world. The epidemiologic features of ESRD, however, have not been investigated. In this case–control study, we evaluated the risk of ESRD associated with a number of putative risk factors.MethodsWe studied 200 patients among whom ESRD had been newly diagnosed between 1 January 2005 and 31 December 2005; 200 controls were selected from among relatives of patients treated in the general surgery unit. Using a structured questionnaire, we collected information related to socioeconomic factors, history of disease, regular blood or urine screening, lifestyle, environmental exposure, consumption of vitamin supplements, and regular drug use at 5 years before disease onset.ResultsOur primary multivariate risk models indicated that low socioeconomic status was a strong predictor of ESRD (education: odds ratio [OR], 2.78; 95% confidence interval [CI], 1.49–5.19; income: OR, 2.86, 95% CI, 1.48–5.52), even after adjusting for other risk factors. Other significant predictors for ESRD were a history of hypertension (OR, 3.63–3.90), history of diabetes (OR, 3.85–5.50), and regular intake of folk remedies or over-the-counter Chinese herbs (OR, 10.84–12.51). Regular intake of a multivitamin supplement 5 years before diagnosis was associated with a decreased risk of ESRD (OR, 0.12–0.14).ConclusionsOur findings indicate that low socioeconomic status, history of hypertension, diabetes, and regular use of folk remedies or over-the-counter Chinese herbs were significant risk factors for ESRD, while regular intake of a multivitamin supplement was associated with a decreased risk of ESRD.

Many single nucleotide polymorphisms (SNPs) have been found to be associated with breast cancer, but their SNP interactions are seldom addressed. In this study, we focused on the joint effect for SNP combinations of seven CXCL12-related genes involved in major cancer-related pathways. SNP genotyping was determined by PCR-restriction fragment length polymorphism (RFLP) in this study (case = 220, control = 334). Different numbers of combinational SNPs with genotypes called the SNP barcodes from different chromosomes were used to evaluate their joint effect on breast cancer risk. Except for vascular endothelial growth factor (VEGF) rs3025039-CT, none of these SNPs were found to individually contribute to breast cancer risk. However, for two combined SNPs, the proportion of subjects with breast cancer was significantly low in the SNP barcode with CC-GG genotypes in rs2228014-1801157 (CXCR4-CXCL12) compared to those with non-CC-GG genotypes. Similarly, the SNP barcode of rs12812942-rs2228014-rs3025039 (CD4-CXCR4-VEGF) and rs12812942-rs3136685-rs2228014-rs1801157 (CD4- CCR7-CXCR4-CXCL12) with specific genotype patterns (AT-CC-CC and AT-AG-CC-GG) among three and four combinational SNPs were significantly low in breast cancer occurrence. More SNP combinations larger than five SNPs were also addressed, and these showed similar effects. After controlling for age, and comparing their corresponding non-SNP barcodes, the estimated odds ratios for breast cancer ranged between 0.20 and 0.71 for specific SNP barcodes with two to seven SNPs. In conclusion, we have associated the potential combined CXCL12-related SNPs with genotypes that were protective against breast cancer, and that may contribute to identification of a low-risk population for the development of breast cancer.

The HCIP improved accessibility, enriched local medical care resources, changed the utilization pattern of some residents, and increased residents' satisfaction level. A well-managed program with stabilized financial resources is more likely to succeed if it also respects cultural differences and responds to community needs.

We investigated possible changes in bioenergetics at the rostral ventrolateral medulla (RVLM), a medullary site where sympathetic vasomotor tone originates and where the organophosphate poison mevinphos (Mev) acts to elicit cardiovascular intoxication. In Sprague-Dawley rats maintained under propofol anesthesia, microinjection bilaterally of Mev (10 nmol) into the RVLM induced progressive hypotension that was accompanied by an early augmentation (80-100 min post-Mev; Phase I), followed by a decrease (>100 min post-Mev; Phase II) in the power density of the vasomotor components (0-0.8 Hz) in systemic arterial pressure (SAP) signals. Enzyme assay revealed that local application of Mev into the RVLM also significantly and progressively depressed the activity of NADH cytochrome c reductase (marker for Complexes I and III) and cytochrome c oxidase (marker for Complex IV) in the mitochondrial respiratory chain of the RVLM, but not the heart. On the other hand, the activity of succinate cytochrome c reductase (marker for Complexes II and III) remained unaltered. Both the cardiovascular consequences and depression of mitochondrial respiratory chain enzymes elicited by Mev were significantly antagonized on comicroinjection of atropine (3.5 or 7 nmol) bilaterally into the RVLM. We conclude that Mev adversely effects cardiovascular control by acting as a cholinesterase inhibitor in the RVLM, whose neuronal activity is intimately related to the death process. The resulting accumulation of acetylcholine and prolonged activation of muscarinic receptors in the RVLM is manifested by a selective dysfunction of respiratory enzyme Complexes I and IV in the mitochondrial respiratory chain that underlies cardiovascular toxicity associated with organophosphate poisons such as Mev.

Background: The purpose of the study is to investigate the epidemiology of Creutzfeldt-Jakob disease (CJD) and multiple sclerosis (MS) in Taiwan. Methods: Cases of CJD and MS were identified from the National Health Insurance Research Database from January 2000 to December 2005. Age- and sex-specific incidences of these diseases were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior. Results: During the study period, 79 cases of CJD, 41 women and 38 men, were identified. The average annual incidence rate was 0.63/million. Most cases were older than 60 years. There were 1,262 cases of MS. The male-to-female ratio was 0.4. The average annual incidence rate was 0.79/100,000. The incidence reached a peak at the age group of 40–60 years for females and at the age group of over 55 years for males. The prevalence of MS was 2.96/100,000 in 2005, which is higher than those of previous studies in Taiwan. Conclusions: The annual incidence rate of CJD in Taiwan is lower than in western countries. The annual incidence rate and prevalence of MS in Taiwan are low. The prevalence of MS in Taiwan increased in recent decades.