Objectives: The present study analyzed the reciprocal relationships between four common pediatric ophthalmic diseases (i.e., hyperopia, myopia, astigmatism, and strabismus) and attention‐deficit/hyperactivity disorder (ADHD) in children. Methods: This study enrolled 86,028 children with ADHD and 1,798,673 children without ADHD in the Taiwan Maternal and Child Health Database who were born at any time from 2004 to 2017. Cox proportional hazards regression models were used to estimate the bidirectional relationships of the four ophthalmic diseases with ADHD in children after adjusting for age, sex, and gestational age at birth. Survival curves for time-to-event variables were estimated using the Kaplan-Meier method, and the log-rank test was used to compare the curves. Results: The results indicated that ADHD significantly predicted the occurrence of hyperopia, myopia, astigmatism, and strabismus. Furthermore, hyperopia, myopia, astigmatism, and strabismus significantly predicted the occurrence of ADHD. The time between enrollment and ADHD diagnosis was shorter for patients with ophthalmic diseases than for the control group, and the time between enrollment and ophthalmic disease diagnosis was also shorter for ADHD patients than for the control group. Sex differences were found in the associations between ADHD and ophthalmic diseases. Conclusion: Clinicians should monitor children with ADHD for hyperopia, myopia, astigmatism, and strabismus to ensure appropriate treatment, and vice versa.

Abstract The process from high-risk human papillomavirus (HR-HPV) infection to cervical cancer is a continuous and long-term process, but the pathogenesis of the whole process is not completely clear. Here, 59 Chinese women were engaged in this study, and divided into five groups: normal healthy group, HR-HPV infections group, low-grade intraepithelial neoplasia (LSIL) group, high-SIL(HSIL) group, and cervical cancer group. With the occurrence of HR-HPV infection and the development of cervical lesions, the diversity of vaginal microbiota species was increased, and the relative abundance of Lactobacillus (L.), the dominant bacteria in maintaining vaginal microecological balance, was decreased gradually. In contrast, the abundance of Actinobacteria in the four disease groups was significantly higher than that in normal group. Furthermore L. iners may be related to the serious progression of cervical cancer. After analyzing the whole process, we found that Gardnerella(G.), Atopobium(A.) and Dialister(D.) have important effects on both persistent HR-HPV infection and the pathogenesis of cervical cancer. In addition, PICRUSt2 and KEGG results showed that the KEGG pathways enriched by the predicted genes of vaginal microbiota in cancer group included metabolic diseases, endocrine system and immune systems when compared with that in normal group. These findings may provide insights into the pathogenesis of cervical cancer, and help to improve the early detection and prevention of cervical precancerous lesions.

Abstract Improving the aroma of plant-based meat alternatives (PBMAs) is important for consumer acceptance. To explore possible strategies for mimicking the authentic meat-like aroma in plant-based pork mince (PBPM), the volatile flavor compound (VFC) profile of four PBPM samples and two real pork mince (RPM) samples were compared via headspace-gas chromatography-ion mobility spectrometry (HS-GC-IMS). Unprocessed RPM contained fewer aromatic compounds, but raw PBPM contained an abundance of VFCs. A discernible difference in the VFC profile also existed between the raw RPM samples, which were derived from common pig and free-range black pig. Similarly, a variance in the VFC profiles of different raw PBPM samples was observed. Various aromatic compounds, such as alcohols and aldehydes, are formed when RPM is cooked. Although some of these compounds can also be formed when PBPM is cooked, most VFCs present in the raw sample were reduced or eliminated during the same process. Although the impacts of steaming and stir-frying on the VFC profiles of each kind of pork differed, the similarity in the VFC profiles of PBPM and RPM increased after steaming and stir-frying.

RESUMO À medida que os negócios baseados em tecnologia móvel têm crescido e mudado o hábito de leitura de notícias das pessoas, o uso de plataformas móveis de notícias tem se tornado uma nova tendência. Devido a essa mudança, a taxa de utilização da plataforma de notícias Line Today de Taiwan foi a mais alta do mundo em 2018. O estudo utiliza o Modelo Estendido ao Consumo da Teoria Unificada da Aceitação e Uso de Tecnologia (Utaut2) para explorar as intenções comportamentais e o comportamento de uso do Line Today em Taiwan. Foi coletado um total de 199 amostras válidas. Os resultados mostram que a expectativa de desempenho, a expectativa de esforço, a influência social, as condições facilitadoras e o hábito afetam positivamente as intenções de comportamento. As intenções de comportamento e o hábito afetam positivamente o comportamento de uso. Os resultados oferecem ao Line Today e seus similares uma estratégia de aprimoramento, bem como referências para desenvolvimento e pesquisas futuras sobre plataformas móveis de notícias.

ABSTRACT As mobile business has flourished and people’s news-reading habits have changed, the use of mobile news platforms has become a new trend. Due to this change, the use rate of LINE TODAY news from Taiwan became the world’s highest in 2018. The study uses the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model to explore behavioral intentions and the use behavior of LINE TODAY in Taiwan. A total of 199 valid samples were collected. Results show that performance expectancy, effort expectancy, social influence, facilitating conditions, and habit have positive impacts on behavior intentions. Behavior intentions and habit have positive impacts on use behavior. Results provide LINE TODAY and its peers with an improvement strategy and a reference for future development and research into mobile news platforms.

RESUMEN A medida que los negocios basados en tecnología móvil han prosperado y cambiado los hábitos de lectura de noticias de las personas, el uso de plataformas móviles de noticias se ha convertido en una nueva tendencia. Debido a este cambio, la tasa de uso de la plataforma de noticias LINE TODAY en Taiwán fue la más alta del mundo en 2018. El estudio utiliza el modelo de teoría unificada de la aceptación y uso de tecnología 2 (UTAUT2) para explorar la intención conductual y el comportamiento de uso de LINE TODAY en Taiwán. Se recogió un total de 199 muestras válidas. Los resultados muestran que la expectativa de desempeño, expectativa de esfuerzo, influencia social, las condiciones facilitadoras y el hábito tienen impactos positivos en la intención conductual. A su vez, la intención conductual y el hábito tienen impactos positivos en el comportamiento de uso. Los resultados proporcionan a LINE TODAY y sus pares una estrategia de mejora, así como referencias para desarrollo e investigación futuros sobre las nuevas plataformas móviles de noticias.

RESUMO OBJETIVO Este estudo visa investigar o valor da aplicação da hidrografia por ressonância magnética (RM) do ouvido interno no implante coclear. MÉTODOS Cento e quarenta e seis pacientes foram inscritos. Os exames da hidrografia por RM e do CT espiral para o canal auditivo intracraniano foram executados antes da cirurgia, e todos os resultados da imagem foram analisados estatisticamente, a fim de explorar o valor da aplicação da hidrografia por RM do ouvido interno no implante coclear. RESULTADOS Centro e quarenta e seis pacientes (292 ouvidos) foram examinados. Dentre esses pacientes, 13 foram diagnosticados com aquedutos vestibulares anormais (20 ouvidos) pela hidrografia por RM, enquanto cinco pacientes foram diagnosticados com esta doença pelo CT; 15 pacientes foram diagnosticados com malformação do ouvido interno (19 ouvidos) pela hidrografia por RM, enquanto 11 pacientes foram diagnosticados por CT (quatro foram diagnosticados erroneamente); cinco pacientes foram diagnosticados com estenose de canal acústico interno (oito ouvidos) pela hidrografia por RM, enquanto dois pacientes foram diagnosticados por CT (três foram diagnosticados erroneamente); e quatro pacientes foram diagnosticados com fibrose coclear (cinco ouvidos) pela hidrografia por RM, enquanto quatro foram diagnosticados por CT (quatro ouvidos). A taxa correta de diagnóstico foi de 77,40% (113/146) com base no CT, enquanto a taxa foi de 93,84% (137/146) com base na hidrografia por RM. CONCLUSÕES A técnica de imagem da hidrografia por RM pode ser aplicada à avaliação pré-operatória do implante coclear, que pode fornecer informações anatômicas precisas e confiáveis sobre o labirinto membranoso interno e os nervos no canal acústico interno, além de uma base exata para o diagnóstico da fibrose coclear e do desenvolvimento do nervo. Isso tem um significado orientador para a seleção de esquemas de tratamento.

SUMMARY OBJECTIVE This study aims to investigate the application value of magnetic resonance (MR) hydrography of the inner ear in cochlear implantation. METHODS 146 patients were enrolled. MR hydrography and spiral CT examinations for the intracranial auditory canal were performed before surgery, and all imaging results were statistically analyzed in order to explore the application value of MR hydrography of the inner ear in cochlear implantation. RESULTS 146 patients (292 ears) were examined. Among these patients, 13 were diagnosed with abnormal vestibular aqueducts (20 ears) by MR hydrography, while five were diagnosed with this disease by CT; 15 patients were diagnosed with inner ear malformation (19 ears) by MR hydrography, while 11 were diagnosed by CT (four were misdiagnosed); five patients were diagnosed with internal acoustic canal stenosis (eight ears) by MR hydrography, while two were diagnosed by CT (three were misdiagnosed); and four patients were diagnosed with cochlear fibrosis (five ears) by MR hydrography, while four were diagnosed by CT (four ears). The correct rate of diagnosis was 77.40% (113/146) based on CT, while the rate was 93.84% (137/146) based on MR hydrography. CONCLUSIONS MR hydrography imaging technique can be applied to the preoperative evaluation of cochlear implantation, providing accurate and reliable anatomic information on the inner membranous labyrinth and nerves in the internal acoustic canal and an accurate basis for the diagnosis of cochlear fibrosis and nerve development. This has a guiding significance for the selection of treatment schemes.

Abstract Background: Recent evidences indicated that some local anaesthetic agents played a role in inhibiting the proliferation of cancer cells; Whether ropivacaine is able to promote apoptosis of hepatocellular carcinoma (HCC) cells is still unclear. The aim of this study was to investigate the effect of ropivacaine on the apoptosis of HCC cells. Methods: In the present study, we treated the HCC cell lines, Bel7402 and HLE with ropivacaine. MTT, DAPI stain, trypan blue exclusion dye assay, flow cytometry, electron microscopy, computational simulation, laser confocal microscope, Western blotting, and enzyme activity analysis of caspase-3 were applied to detect the growth and apoptosis of HCC cells and to explore the role mechanism of ropivacaine. Results: Ropivacaine was able to inhibit proliferation and promote apoptosis of HCC cells in a dose- and time-dependent manner. Ropivacaine also has a trait to inhibit the migration of HCC cells; ropivacaine damaged the mitochondria of HCC cells. The results also indicated that ropivacaine was able to interact with caspase-3, promote cytoplasmic caspase-3 migration into the nucleus, stimulate cleavage of caspase-3 and PARP-1, caspase-9 proteins, inhibit the expression of Bcl-2, promote expression of Apaf-1 and mitochondria release cytochrome C, and activate the activity of caspase-3. Conclusions: Ropivacaine has a novel role in promoting apoptosis of HCC cells; The role mechanism of ropivacaine maybe involve in damaging the function of mitochondria and activating the caspase-3 signalling pathway in HCC cells. Our findings provide novel insights into the local anaesthetic agents in the therapy of HCC patients.

Abstract Purpose: To investigate the effects of baicalin on inflammatory reaction, oxidative stress and protein kinase D1 (PKD1) and nuclear factor-kappa B (NF-κB) protein expressions in severe acute pancreatitis (SAP) rats. Methods: Sixty rats were divided into sham operation, model, and low-, medium- and high-dose baicalin group. SAP model was established in later 4 groups. The later 3 groups were injected with 0.1, 0.2 and 0.4 ml/100 g 5% baicalin injection, respectively. At 12 h, the serum SAP related indexes and inflammatory factors, peripheral blood CD3 and γδT cell percentages, wet/dry ratio and pancreas ascites volume, oxidative stress indexes and PKD1 and NF-κB protein expressions in pancreatic tissue were determined. Results: Compared with model group, in high-dose baicalin group the wet/dry ratio and ascites volume, serum amylase level, phospholipase A2 activity, TNF-α, IL-1 and IL-6 levels, and pancreatic malondialdehyde level and PKD1 and NF-κB protein expression were significantly decreased (P < 0.05), and peripheral blood CD3 and γδT cell percentages and pancreatic superoxide dismutase and glutathione peroxidase levels were significantly increased (P < 0.05). Conclusion: Baicalin can resist the inflammatory reaction and oxidative stress, and down-regulate protein kinase D1 and nuclear factor-kappa B protein expressions, thus exerting the protective effects on severe acute pancreatitis in rats.

The Mn2+ and Mg2+ (or Zn2+) co-doped Li2Fe0.8-xMn0.2MxSiO4 (x = 0.05 and 0.1) are synthesized by a solid-state reaction route. Compared with the single doped Li2Fe0.8Mn0.2SiO4, the co-doped samples show improved cycling performance. The capacity retention can stay above 50% after 50 cycles, which is significantly higher than 30.4% for Li2Fe0.8Mn0.2SiO4. This phenomenon could be attributed to the increased structural stability caused by the incorporation of the electrochemically inactive M2+ ions. However, except for Li2Fe0.75Mn0.2Mg0.05SiO4, the other samples show decreased capacities, especially in the case of the Mn/Zn co-doping. Further tests indicate that the promotion of Li+ diffusivity may be a key reason for the improved rate and cycling performances. By contrast, the incorporation of Zn2+ impaired the cell performances such as increased internal polarization, hindered charge transfer, decreased Li+ diffusivity. In this work, the Mg2+ with smaller radius seems to be a better choice as the co-doping element at Fe sites than Zn2+.

OBJECTIVE: To estimate the incidence and prevalence of thromboangiitis obliterans in Taiwan in the period spanning from 2002 to 2011. METHODS: We identified all incident and prevalent cases with a diagnosis of thromboangiitis obliterans (International Classification of Diseases, Ninth Revision code 443.1) in the period spanning from 2002 to 2011 using Taiwan’s National Health Insurance Research Database. We calculated the age- and sex-specific incidence and prevalence rates of thromboangiitis obliterans during the study period. RESULTS: From 2002 to 2011, 158 patients were diagnosed with thromboangiitis obliterans; of these, 76% were men. Most (63%) of the patients were <50 years old when they were first diagnosed. After reaching 20 years of age, the incidence rate increased with age and peaked among those aged ≥60 years. The average incidence rate of thromboangiitis obliterans during the 2002–2011 period was 0.068 per 105 years. The incidence of thromboangiitis obliterans decreased with time, from 0.10 per 105 years in 2002 to 0.04 per 105 years in 2011. The prevalence increased from 0.26 × 10−5 in 2002 to 0.65 × 10−5 in 2011. CONCLUSION: This is the first epidemiologic study of thromboangiitis obliterans using claims data from a general population in Taiwan. This nationwide, population-based study found that the incidence and prevalence of thromboangiitis obliterans in Taiwan in the 2002–2011 period were lower than those in other countries before 2000. This study also revealed a trend of decreasing incidence with simultaneous increasing prevalence of thromboangiitis obliterans in Taiwan from 2002 to 2011.

The purpose of this study is to clarify the association between serum Fe levels and Obesity using a meta-analysis approach. We searched eligible papers on the relevance published between 2006 and 2014 from the PubMed and the Chinese National Knowledge Infrastructure. Review Manage software was used to collect and analysis the date cited in the papers.6 eligible articles with 934 subjects from 40 case-control studies were identified. Overall,polled analysis indicated that subjects with obesity had lower Fe levels than healthy controls [standardized mean difference (SMD) = -0.738,95%confidence interval (CI) = (-1.228,-0.247)]. Thus, dietary supplement of Fe is recommended to prevent obesity.

El objetivo de este estudio es determinar la asociación entre los niveles séricos de hierro y la obesidad mediante un metaanálisis. Hemos buscado los documentos sobre la pertinencia, publicados entre 2006 y 2014 por PubMed y China National Knowledge Infrastructure. El examen se utiliza para recoger y gestionar el software de análisis de la fecha citada en los documentos. Se eligieron seis artículos en los que se identificaron 934 sujetos de entre 40 estudios de casos y controles. En general, los encuestados indicaron que los sujetos con obesidad tenían menores niveles de hierro que los controles sanos [diferencia de promedios estandarizados (DPE) = - 0.738,95% intervalo de confianza (IC) = (-1.228,-0.247)]. Por lo tanto, se recomienda un suplemento dietético de hierro para prevenir la obesidad.

Objetivo:Examinar se uma história de periodontite (PD) antes do tratamento antidiabético está associada a risco de ocorrência de artrite reumatoide (AR) em pacientes com diabetes melittus (DM) tratados de novo.Métodos:Fizemos um estudo retrospectivo populacional com os dados de reivindicações do National Health Insurance (NHI) de 1997-2009 referentes a um milhão de indivíduos representativos da totalidade de matriculados. Adultos com DM (≥ 20 anos) que iniciaram o tratamento antidiabético durante 2001-2009 foram classificados como pacientes DM tratados de novo. Identificamos 7.097 indivíduos DM com história de PD em um intervalo de um ano antes do tratamento antidiabético (data-índice). Na equiparação desses 7.097 indivíduos para idade por ocasião da data-índice, gênero e ano da data-índice, extraímos aleatoriamente 14.194 pacientes DM sem história de PD em um intervalo de um ano antes do tratamento antidiabético. As razões de risco ajustadas (aRR) com um intervalo de confiança (IC) de 95% foram calculadas mediante a aplicação do modelo de riscos proporcionais de Cox com o objetivo de quantificar a associação entre história de PD e risco de AR.Resultados:Em comparação com pacientes DM sem exposição à PD no intervalo de um ano antes do tratamento antidiabético, RR bruta e RR ajustada para AR entre pacientes DM e com exposição à PD no intervalo de um ano antes do tratamento antidiabético foram, respectivamente, 4,51 (IC 95%, 1,39-14,64) e 3,77 (IC 95%, 1,48-9,60).Conclusão:A exposição à PD no intervalo de um ano antes do tratamento antidiabético foi associada a maior risco de AR em pacientes DM tratados de novo. A ausência do status de tabagismo em nível individual é importante limitação desse estudo.

Objective:To examine whether a history of periodontitis (PD) before anti-diabetic treatment is associated with risk of rheumatoid arthritis (RA) development in newly-treated diabetes mellitus (DM) patients.Methods:We conducted a population-based retrospective cohort study using the 1997-2009 National Health Insurance (NHI) claims data of one million representative individuals from all NHI enrollees. Adults with DM (aged ≥20 years) starting anti-diabetic treatment during 2001-2009 were classified as newly-treated DM patients. We identified 7097 DM subjects with PD history within one year before initiating anti-diabetes treatment (index date). By matching these 7097 subjects for age on the index date, sex, and year of the index date, we randomly extracted 14,194 DM subjects without PD history within one year before antidiabetic treatment. Adjusted hazard ratios (aHRs) with a 95% confidence interval (CI) were calculated by applying Cox proportional hazards models to quantify the association between PD history and RA risk.Results: Compared with DM patients without PD exposure within one year before anti-diabetic treatment, crude HR and adjusted HR of RA among DM patients with PD exposure within one year before anti-diabetic treatment were 4.51 (95% CI, 1.39-14.64) and 3.77 (95% CI, 1.48-9.60).Conclusion: PD exposure within one year before anti-diabetic treatment was associated with increased RA risk in newly treated DM patients. The lack of knowledge about individual smoking status is a major limitation of this study.

From the apparent magnitude-limited main galaxy sample of the Sloan Digital Sky Survey Data Release 7 (SDSS DR7), we construct a paired galaxy sample and an isolated galaxy sample, and compare the star formation rate (SFR) and the specific star formation rate (SSFR) of paired galaxies with those of isolated galaxies. It is found that isolated galaxies preferentially have higher SFR and SSFR than paired galaxies. We also investigate the dependence of the SFR and SSFR on the three-dimensional separation between two members of pairs, but do not find evidence for the dependence of SFR enhancement on this separation.

A partir de la muestra de galaxias limitada por magnitud aparente proveniente del Sloan Digital Sky Survey, versión 7 (SDSS DR7) construimos una muestra de pares de galaxias y una muestra de galaxias aisladas, y comparamos la tasa de formación estelar (SFR) y la tasa específica de formación estelar (SSFR) entre ambas muestras. Encontramos que las galaxias aisladas tienen SFRs y SSFRs mayores que las galaxias en pares. También investigamos la dependencia de la SFR y la SSFR de las separaciones tri-dimensionales entre los miembros de los pares de galaxias, pero no encontramos evidencia de que la SFR dependa de las separaciones.

OBJECTIVES: To investigate the association of body cell mass loss with disease activity and disability in rheumatoid arthritis patients. INTRODUCTION: Rheumatoid cachexia, defined as the loss of body cell mass, is important but under-recognized and contributes to morbidity and mortality in patients with rheumatoid arthritis. METHODS: One hundred forty-nine rheumatoid arthritis patients and 53 healthy, non-rheumatoid arthritis control subjects underwent anthropometric measurements of body mass index and waist and hip circumferences. Bioelectrical impedance analysis was used to determine the subjects' body compositions, including fat mass, skeletal lean mass, and body cell mass. The disease activity of rheumatoid arthritis was assessed using C-reactive protein serum, the erythrocyte sedimentation rate and the 28-joint disease activity score, while disability was evaluated using a health assessment questionnaire. RESULTS: Rheumatoid arthritis patients had lower waist-to-hip ratio (0.86 ± 0.07 vs. 0.95 ± 0.06; p<0.001) and lower skeletal lean mass indexes (14.44 ±1.52 vs. 15.18 ± 1.35; p = 0.002) than those in the healthy control group. Compared with rheumatoid arthritis patients with higher body cell masses, those with body cell masses lower than median had higher erythrocyte sedimentation rates (40.10 ± 27.33 vs. 25.09 ± 14.85; p<0.001), higher disease activity scores (5.36 ± 3.79 vs. 4.23 ± 1.21; p = 0.022) and greater disability as measured by health assessment questionnaire scores (1.26 ± 0.79 vs. 0.87 ± 0.79; p = 0.004). CONCLUSIONS: The loss of body cell mass is associated with higher disease activity and greater disability in rheumatoid arthritis patients. Body composition determined by bioelectrical impedance analysis can provide valuable information for a rheumatologist to more rapidly recognize rheumatoid cachexia in rheumatoid arthritis patients.

OBJECTIVE: The goal of the present study was to estimate the risk ratio of herpes zoster among systemic lupus erythematosus patients after disease onset compared with a cohort of patients without systemic lupus erythematosus over a three-year period. METHODS: A nationwide population-based cohort study using the National Health Insurance Research Database identified 10,337 new cases of systemic lupus erythematosus as the study cohort. In addition, 62,022 patients without systemic lupus erythematosus, who were matched for age, gender, and date of systemic lupus erythematosus diagnosis, were used as the comparison cohort. These cohorts were followed-up for three years. A Cox proportional hazard regression was performed to estimate the risk ratio of herpes zoster, with adjustments for age, gender, level of insurance, urbanization level, geographic region, comorbid medical conditions, average daily dosage of corticosteroids, and the use of immune-modulation agents. RESULTS: Compared to patients without systemic lupus erythematosus, the crude risk ratio and adjusted risk ratio of herpes zoster among systemic lupus erythematosus patients were 7.37 (95% confidence interval 6.75-8.04) and 2.45 (95% confidence interval 1.77-3.40), respectively. Stratified by gender, the adjusted risk ratio of herpes zoster was 2.10 (95% confidence interval 1.45-2.99) in women and 7.51 (95% confidence interval 2.89-19.52) in men. Stratified by age, the adjusted risk ratio peaked in systemic lupus erythematosus patients who were aged 18 to 24 years (risk ratio 8.78, 95% confidence interval 3.08-24.97). CONCLUSION: Based on nationwide population-based data, there is an increased risk of herpes zoster in systemic lupus erythematosus patients compared with non-systemic lupus erythematosus patients, particularly among males and patients aged 18 to 24 years. Further research on the associated risk factors for herpes zoster in systemic lupus erythematosus patients is needed.

BACKGROUND: Ankylosing spondylitis (AS) is one of the most common rheumatic diseases with gender differences in prevalence and clinical presentation. This study aimed to examine whether such gender differences are correlated with cumulative healthcare utilization in Taiwan. METHODS: The National Health Insurance Research Database supplied claim records of one million individuals from 1996 to 2007. Selected cases included patients aged >16 years. Certified rheumatologists diagnosed the patients in three or more visits and gave prescriptions for AS. Multivariate adjusted logistic regression analyses were used to calculate the influence of gender on cumulative healthcare utilization associated with AS. RESULTS: The study included 228 women and 636 men. After adjustment for potential confounding factors, men had more cumulative outpatient visits associated with AS (odds ratio, 1.59; 95% confidence interval, 1.13 -2.23; p = 0.008). Men also exhibited a trend for higher frequency of AS-related hospitalization (p = 0.054). CONCLUSION: Men are more likely to have high cumulative AS-associated healthcare utilization than women. Further investigation of the causal factors is warranted.