BACKGROUND:Type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) commonly coexist and are associated with an increased risk of ischaemic stroke. Finerenone has demonstrated benefits on composite renal and cardiovascular outcomes in randomised trials; however, ischaemic stroke has generally been evaluated as part of composite endpoints, and real-world evidence focusing on this outcome remains limited. METHODS:We conducted a retrospective cohort study using the TriNetX Global Research Network to evaluate the association between finerenone use and incident ischaemic stroke among adults with newly diagnosed T2DM who subsequently developed CKD. Finerenone users were compared with non-users. Propensity score matching was applied to balance demographic characteristics and baseline comorbidities. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS:A total of 125,086 eligible patients were identified before matching, including 1,990 finerenone users. After 1:1 propensity score matching, 1,990 finerenone users were matched with 1,990 non-users with adequate covariate balance. Finerenone use was associated with a lower observed hazard of ischaemic stroke both before matching (adjusted HR, 0.30; 95% CI, 0.24-0.36) and after matching (adjusted HR, 0.33; 95% CI, 0.26-0.42). CONCLUSIONS:In this real-world cohort of patients with T2DM and CKD, finerenone use was associated with a lower observed hazard of ischaemic stroke.

ObjectivesTo investigate the association between metformin use and risks of incident immune-mediated diseases (IMDs) among patients with type-2 diabetes mellitus (T2DM).MethodsWe conducted a retrospective cohort study using the National Health Insurance Research Database, including patients newly diagnosed with T2DM between 2000 and 2017 and followed until the end of 2018. Patients receiving metformin for ≥28 days were identified as users, and propensity score matching (1:1) was applied to balance baseline characteristics. The primary outcome was incident IMDs. Secondary outcomes included IMD-related hospitalization and all-cause mortality. Dose-response analyses were performed according to cumulative metformin exposure (<182 days, 182–364 days, >364 days). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.ResultsAfter propensity score matching, 20,460 metformin users and 20,460 non-users were included. Metformin use was associated with a higher risk of incident IMDs (adjusted HR 2.36, 95%CI 2.09-2.67). Metformin users also had a higher risk of IMD-related hospitalization (adjusted HR 2.44, 95%CI 1.94-3.05), but a lower observed risk of all-cause mortality (adjusted HR 0.64, 95%CI 0.60-0.68) compared with non-users. Longer cumulative metformin exposure was associated with progressively higher risks of IMDs and IMD-related hospitalization, whereas all-cause mortality decreased with longer use.ConclusionIn patients with T2DM, metformin use was associated with increased risks of incident IMDs and IMD-related hospitalization but a lower observed risk of all-cause mortality. These findings highlight the dual immunometabolic effects of metformin and underscore the need for individualized monitoring and further mechanistic research.

Background: This study aimed to comprehensively investigate the complex association between the use of fluoroquinolone (FQ) antibiotics and cancer risk, with a specific focus on patients with interstitial lung disease (ILD)-a unique clinical population characterized by a high inflammatory burden and a high susceptibility to infections. Methods: We conducted a large-scale retrospective cohort study using a high-quality clinical database. A total of 7906 matched patients (3953 pairs) were included after propensity score matching (PSM). Three complementary statistical models were applied: the standard Cox proportional hazards model, the time-dependent Cox regression model, and the Fine-Gray competing-risks model, to provide a multidimensional assessment of cancer risk. Results: A total of 7906 matched patients (3953 pairs) were followed. After strictly defining the index date to eliminate immortal time bias, FQ exposure was associated with an increased risk of all-cause cancer in the standard Cox model (adjusted HR 1.45; 95% CI, 1.20-1.76) and the competing risk model (adjusted SHR 1.28; 95% CI, 1.06-1.55). Site-specific analyses revealed elevated risks for certain malignancies, notably prostate cancer. Importantly, when modeled as a continuous variable, the cumulative dose of fluoroquinolones showed no significant dose-response relationship with overall cancer risk (adjusted HR 0.99; 95% CI, 0.99-1.00). Conclusions: After correcting for immortal time bias, the previously hypothesized protective effect of fluoroquinolones on cancer risk was not observed. The increased risk observed in categorical models, coupled with a lack of a continuous dose-response, strongly suggests that these findings are driven by confounding by indication and reverse causation (i.e., frequent infections masking undiagnosed malignancies or reflecting severe underlying ILD), rather than a direct pharmacological effect.

INTRODUCTION:This study aims to investigate the association between sodium-glucose cotransporter-2 inhibitors (SGLT2I) use and the risk of total knee joint replacement (TKR) among patients with type 2 diabetes mellitus (T2D). METHODS:282311 T2D patients who used SGLT2I and 282311 T2D patients who did not use SGLT2I were included. Univariable and multivariable Cox proportion hazards regression models were used to examine the effect of risk factors on the risk of developing total knee replacement, presented as a hazard ratio (HR) with a 95% confidence interval (CI). The multivariable models were adjusted for gender, age, diabetes complications severity index (DCSI), comorbidities, and anti-diabetic drugs. RESULTS:After adjusting for potential confounders, SGLT2I users had a significantly higher risk of undergoing TKR compared to non- SGLT2I users (adjusted HR = 1.33; 95% CI: 1.25-1.42; p < 0.001). The incidence rate of TKR was 2.93 per 1000 person-years for SGLT2I users and 2.33 per 1000 person-years for non- SGLT2I users, respectively. CONCLUSION:In our study, patients with T2D with SGLT2I use exhibited a significantly higher risk of TKR compared to the DM population without SGLT2I.

The association between psoriasis and type 2 diabetes mellitus is documented, yet validation using large-scale, real-world data remains essential. This study aimed to examine this association in patients aged 20–84 years. A retrospective cohort study was conducted using the 2006–2025 TriNetX Network database. Patients aged 20–84 were categorized into two groups: those diagnosed with psoriasis and those without (control group). Propensity score matching was applied to balance baseline characteristics. The primary outcome was the incidence of type 2 diabetes mellitus. Cumulative incidence, hazard ratio, and 95

This study examined patients who underwent solid organ transplantation (SOT) within a large healthcare system in Taiwan, with the objective of comparing the risks of adverse outcomes, specifically end-stage renal disease (ESRD) and mortality. The study aimed to assess whether type 2 diabetes mellitus (T2DM), occurring either before or after SOT, serves as a prognostic factor in this particular population. The study cohort comprised 3,675 non-T2DM patients, 2,261 patients with pre-existing T2DM, and 358 patients who developed T2DM post-SOT. Univariable and multivariable Cox proportional hazards regression models were employed to evaluate the impact of risk factors on the likelihood of developing ESRD or death, with results expressed as hazard ratios (HR) accompanied by 95

BackgroundAutoimmune diseases pose an increasing global health burden. The detection of antinuclear antibodies (ANA) via indirect immunofluorescence (IIF) is central to diagnosing systemic autoimmune conditions. This study aimed to assess the prevalence and distribution of ANA patterns in a Taiwanese population.MethodsWe conducted a retrospective, cross-sectional study of 8,299 patients who underwent ANA testing at Asia University Hospital between January 2021 and December 2023. ANA patterns were classified based on fluorescence staining characteristics. Demographic variables, including age and gender, were analyzed.ResultsANA positivity was observed in 35.3% of patients. The most frequent pattern was homogeneous (33.0%), followed by speckled (24.1%). Female patients had a significantly higher positivity rate (female-to-male ratio 2.7:1), and the ≥66-year age group accounted for 34.6% of ANA-positive cases. Mixed ANA patterns were identified in 22.8% of ANA-positive patients, with homogeneous-speckled being the most common combination (27.4%).ConclusionThis large-scale study provides valuable epidemiological data on ANA prevalence and pattern distribution in Taiwan. The predominance of homogeneous and speckled patterns, particularly among older female patients, aligns with established trends in autoimmune diseases. The high proportion of mixed ANA patterns suggests the need for further investigation into their clinical significance and diagnostic value.

Inflammation significantly influences thrombosis development, with venous thromboembolism (VTE) risk linked to various systemic inflammatory diseases, but not fully established in inflammatory bowel disease (IBD). Using a population-based cohort study conducted in Taiwan, we investigated the impact of IBD on the risk of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE), as well as the impact of anti-IBD treatments. A study was conducted on a cohort of patients with IBD diagnosed between 2010 and 2019 using the National Health Insurance database. The risks of VTE, DVT, and PE, as well as anti-IBD treatment use, were examined using Cox proportional hazard regression analysis. The overall number of person-years recorded for 12,126 patients with IBD (mean age: 49.18 years; 55.31

Background/purpose: Epidemio logic research has linked periodontitis to several types of cancer, particularly breast cancer. Although clinical evidence indicates a higher risk of breast cancer in women with periodontitis than in those without, few studies have explored whether the risk of periodontitis is higher in women with breast cancer than in those without. In this study, we examined the incidence of periodontitis in patients with breast cancer and identified potential interventions for its prevention. Materials and methods: This retrospective cohort study included data from the National Health Insurance Research Database of Taiwan. We identified women who received a diagnosis of breast cancer between 2010 and 2019 and included a 1:1 matched control cohort with no breast cancer. Subsequently, we analyzed the risk of periodontitis by using Cox proportional-hazards models while adjusting for sociodemographic factors, comorbidities, and treatment regimens. Results: In 82,146 matched pairs, the breast cancer cohort was at a 51 % higher risk of periodontitis compared with the control cohort (adjusted hazard ratio = 1.51, 95 % confidence interval = 1.43-1.60). The stratified analysis revealed the same results. The risk of breast cancer was higher in younger patients than in older patients, whereas the risk of periodontitis was significantly lower in patients who underwent surgery, radiotherapy, chemotherapy, or hormone therapy compared with those who did not. Conclusion: Breast cancer increases the risk of periodontitis, particularly in younger patients. These patients should receive regular dental care to prevent and manage periodontitis. Anticancer treatments may mitigate the risk of periodontitis in patients with breast cancer. 2025 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/).

Purpose: This study aimed to develop an educational tool to improve breast cancer patients' understanding of radiation therapy (RT) and analyze its usage. Methods and Materials: A single-arm trial was conducted at a tertiary hospital in Taiwan with newly diagnosed breast cancer patients scheduled for RT. Patients viewed a 4-minute educational video explaining RT mechanisms, self-care for irradiated skin, treatment precautions, and radiation dermatitis toxicity grading. A QR code provided video access. The Skindex-16 (traditional Chinese version) questionnaire assessed skin reactions before, during, and after RT. A satisfaction survey was also administered post-RT. Results: Of the 57 enrolled patients, 51 completed the study. Most found the video satisfactory (90.2%) and easy to understand (86.3%). The video provided emotional support (90.2%) and reduced anxiety (84.3%). Nearly all patients (96.1%) found the QR code helpful. Skindex-16 outcomes indicated increasing discomfort throughout treatment, with a significant rise midway through RT. Patient characteristics, such as age, education, occupation, and social support, were not correlated with satisfaction, emotional support efficacy, or video-watching frequency. Subgroup analysis showed no significant differences in Skindex-16 scores between conventional and hypofractionated RT. Most patients (82.4%) watched the video most frequently during the first 2 weeks of RT, with 25.5% replaying it when dermatitis worsened. Conclusions: The in-house educational video enhanced patients' understanding of RT and provided emotional support, with efficacy unaffected by patient characteristics or fractionation. Patients valued QR code access. The timing of watching the video was crucial. Continuous, accessible educational materials were important as symptoms worsened at the first follow-up. This study paved the way for future clinical trials and educational tools for breast cancer patients in radiation oncology departments. (c) 2025 The Author(s). Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

In this population-based retrospective cohort study, we investigated the relationship between osteoporosis and the risk of hyperlipidemia, the main risk factor for cardiovascular disease (CVD). Despite extensive research on both conditions, the association between osteoporosis and hyperlipidemia remains unclear, particularly in Asian populations. Using information from Taiwan’s Longitudinal Generation Tracking Database, we conducted a retrospective population-based cohort study spanning 2000–2021. Patients in the comparison cohort were chosen at random and frequency-matched in a 1:1 ratio based on age, sex, month, and year of the index date. Both cohorts were monitored from the index date until a new diagnosis of hyperlipidemia was established. Data on baseline characteristics, comorbidities, and prescription of anti-osteoporotic treatment (AOTs) were gathered. The osteoporosis cohort consisted of 67,628 patients aged ≤ 34 years or older, diagnosed with osteoporosis, and without a history of hyperlipidemia. With a mean follow-up of 8.81 years and 9.78 years, respectively, the total incidence of hyperlipidemia was 36.7 (per 1000 person-years) for the osteoporosis cohort and 28.4 for the comparison cohort, after controlling for age, sex, and comorbidities. Without treatment, the hazard ratio (HR) for developing hyperlipidemia was 1.58 (95

We investigated whether there is an association between using antidiabetic agents (ADAs) or insulin and hemorrhoid risk among people with diabetes mellitus (DM). We have essentially used a massive dataset to identify a statistical association between ADAs and hemorrhoidal disease. The hazard ratios (HRs) and 95

This study aims to define the association of heart transplantation with incident stroke, cardiovascular (CV) and all-cause death. The incidence rate (IR) was calculated by dividing the number of outcomes by the summed person-years in the group during the follow-up period. Crude and adjusted hazard ratios (HRs) and the corresponding 95

The authors report a retrospective cohort study based on a national dataset that explores the association between the prescription of three beta-blockers (BB) and a diagnosis of heart failure (HF) readmission, cardiovascular (CV) death, and all-cause death. Patients with HF who received nebivolol, carvedilol, and bisoprolol between 2016 and 2020 were identified. Univariate and multivariate Cox proportional hazard regression analyses were employed to assess and examine the crude and adjusted hazard ratio of the outcomes associated with the three BBs, demographics, comorbidities, and concomitant medications. We further performed Cox proportional hazards regression analyses for the three BBs stratified by age. A total of 109,466 BB patients including 85,166 bisoprolol patients, 19,741 carvedilol patients, 4559 nebivolol patients, and 109,466 non-BB patients were enrolled in our study. Both carvedilol and bisoprolol cohorts had a higher risk of readmission for HF than the non-BB cohort (carvedilol: adjusted HR = 1.13, 95% CI = 1.10-1.15; bisoprolol: adjusted HR = 1.17, 95% CI = 1.16-1.19). Nebivolol cohorts had a lower risk of readmission for HF than the non-BB cohort (adjusted HR = 0.78, 95% CI = 0.74-0.83). There were higher risks of CV (carvedilol: adjusted HR = 1.31, 95% CI = 1.26-1.36; bisoprolol: adjusted HR = 1.17, 95% CI = 1.14-1.2) and all-cause (carvedilol: adjusted HR = 1.26, 95% CI = 1.23-1.29; bisoprolol: adjusted HR = 1.18, 95% CI = 1.17-1.20) deaths in the carvedilol and bisoprolol cohorts in contrast to the non-BB nebivolol cohort. Nebivolol cohorts had a lower risk of CV deaths and all-cause deaths than the non-BB cohort (adjusted HR = 0.77, 95% CI = 0.69-0.85; adjusted HR = 0.78, 95% CI = 0.73-0.83). The authors concluded that the use of nebivolol was associated with better outcomes in patients with HF.

(1) Background: The relationship between air pollution and the risk of developing aphasia is still unclear. We aimed to evaluate air pollution exposure as a risk factor for developing aphasia in Taiwan. (2) Methods: This retrospective population-based cohort study used the Longitudinal Generation Tracking Database (LGTD) and the Taiwan Air Quality Monitoring Database (TAQMD). The incidence rate ratio (IRR) and adjusted hazard ratio (aHR) were calculated to examine the association between aphasia and exposure to six air pollutants: sulfur oxide (SO2), carbon monoxide (CO), nitric oxide (NO), nitrogen oxide (NOx), and particulate matter (PM2.5, PM10) from 2003 to 2017. (3) Results: The incidence rate ratio (IRR) of aphasia showed that individuals with high levels of SO2, CO, and NO were at a higher risk of developing aphasia. Increased exposure to airborne particulate matter (PM2.5 and PM10) also increased the risk of developing aphasia. The adjusted HRs of the aphasia risk were statistically significant for all the air pollutants at higher concentrations. (4) Conclusions: Individuals exposed to ambient air pollutants have a significantly higher risk of developing aphasia. The greater the exposure to airborne particulate matter and gaseous pollutants, the more likely individuals are to develop aphasia.

(1) Background: The role of air pollutants as risk factors for tinnitus remains unclear. To address this gap in research, we conducted a nationwide retrospective cohort study in Taiwan by integrating patients’ clinical data with daily air quality data to evaluate the environmental risk factors associated with tinnitus. (2) Methods: The Taiwan National Health Research Database (NHIRD) includes medical records for nearly all residents of Taiwan. To assess pollution levels, we used daily air quality data from the Taiwan Environmental Protection Agency regarding SO2, CO, NO, NOX, and particulate matter (PM2.5 and PM10). We merged the NHIRD data with air quality information based on the residents’ locations and the positions of air quality monitoring stations. Pollutant levels were then categorized into quartiles (Q1, Q2, Q3, and Q4). (3) Results: This study included 284,318 subjects. After controlling for covariates, the adjusted HR (95 CI%) for tinnitus increased with increasing SO2, CO, NO, NOX, PM2.5, and PM10 exposure levels, specifically from 1.24 (95 CI% = 1.18, 1.30) to 1.35 (95 CI% = 1.28–1.41); from 1.15 (95 CI% = 1.09, 1.21) to 1.90 (95 CI% = 1.81, 2.00); from 0.86 (95 CI% = 0.82, 0.91) to 1.69 (95 CI% = 1.62, 1.77); from 1.62 (95 CI% = 1.54, 1.71) to 1.69 (95 CI% = 1.60, 1.77); from 0.16 (95 CI% = 0.15, 0.18) to 2.70 (95 CI% = 2.57, 2.84); and from 2.53 (95 CI% = 2.38, 2.69) to 3.58 (95 CI% = 3.39, 3.78), respectively, compared to the Q1 concentrations for all air pollutants. (4) Conclusions: During the 15-year follow-up period, we found a significant positive correlation between air pollutant exposure and the risk of tinnitus.

Background/Objective:Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality among patients with diabetes mellitus (DM). Although ASCVD risk is elevated in diabetic populations, the effect of acute kidney injury (AKI), especially when chronic kidney disease (CKD) is present, on post-ASCVD outcomes remain unclear. This study investigates the association between AKI-with or without co-existing CKD-and short-term adverse outcomes in diabetic patients following their first ASCVD event. Methods:This retrospective cohort study analyzed data from the Taipei Medical University Clinical Research Database (2004-2020), which includes anonymized electronic health records from three affiliated hospitals. Patients with DM who experienced the first ASCVD event were categorized by kidney function: no known kidney disease (NKD), AKI, CKD, and acute-on-CKD (AoCKD). The impact of kidney dysfunction on outcomes was assessed using Cox proportional-hazards models, with hazard ratios (HRs) and 95% confidence intervals (CIs). Results:Out of 4525 patients, those with CKD and AoCKD exhibited significantly higher 1-year all-cause mortality (HR: 1.24 and 1.68, respectively) and risks of cardiovascular death, recurrent ASCVD-related hospitalizations, and heart failure, compared with NKD patients. Diuretic use was associated with increased all-cause mortality in AoCKD and CKD groups. In the contrary, the use of metformin was associated with a lower risk of all-cause mortality in AoCKD and CKD groups. Conclusion:AoCKD significantly increases short-term mortality and cardiovascular complications in diabetic patients post-ASCVD period, whereas AKI alone does not confer additional risk. These findings highlight the need for dedicated case-managed, personalized and multidisciplinary interventions for cardiorenal health. The early nephrologist consultation, echocardiography with speckle-tracking strain, urine albumin-to-creatinine ratio, pharmacologic strategies, such as cautious use of diuretics, use of sodium-glucose transport protein 2 inhibitors, statin or metformin are recommended to improve outcomes in this high-risk group.

BackgroundSerum uric acid (SUA) and lipid metabolism disorders are closely associated with atrial fibrillation (AF) and its prognosis. In patients with non-valvular AF (NAF), we evaluated the combined predictive value of SUA, triglycerides (TG), and low-density lipoprotein (LDL) for stroke to enhance stroke risk prediction and management.Methods and resultsWe included 3,176 NAF patients treated at the First Affiliated Hospital of Dalian Medical University from January 2020 to December 2023. We analyzed SUA concentration and lipid profile, along with relevant clinical data, to assess their impact on the occurrence of ischemic stroke (IS) in NAF patients. Due to gender differences in TG (1.39 mmol/L vs. 1.28 mmol/L for males, P = 0.031;1.57 mmol/L vs. 1.28 mmol/L for females, P = 0.001) and SUA levels (424 µmol/L vs. 397 µmol/L for males, P = 0.008; 361 µmol/L vs. 328 µmol/L for females, P = 0.004), we determined the thresholds for SUA (400 µmol/L in males and 330 µmol/L in females) and TG (1.28 mmol/L in males and 1.29 mmol/L in females) that predict stroke events in NAF patients by restricted cubic spline curves. Kaplan–Meier cumulative risk analysis indicates that a gender-based combined assessment of SUA and TG enhances stroke risk stratification in NAF patients. Compared to patients with low levels of SUA and TG, those with high levels of these biomarkers have a higher risk of IS (HR = 1.98). On multivariable Cox regression analysis with potential confounders, elevated SUA and low-density lipoprotein (LDL) levels were significantly associated with an increased risk of stroke. In summary, we developed the CHA2DS2-VASc+SUA+TG+LDL stroke risk prediction model. Its clinical predictive value was assessed using Harrell's C-statistic (C-index), integrated discrimination improvement (IDI) statistics, and net reclassification index (NRI) analysis.ConclusionsSUA, TG and LDL were strongly associated with stroke for NAF. The combination of SUA, TG, and LDL effectively enhanced the predictive value of the CHA2DS2-VASc score for IS.