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Zhang HW, Tsai ZR, Kok VC, Peng HC, Chen YH, Tsai JJP, Hsu CY. Long-term ambient hydrocarbon exposure and incidence of urinary bladder cancer. Sci Rep 2022; 12:20799. [PMID: 36460770 PMCID: PMC9718740 DOI: 10.1038/s41598-022-25425-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] [Imported: 10/03/2023] Open
Abstract
Particulate matter and volatile organic compounds, including total hydrocarbons (THCs), are major ambient air pollutants. Primary nonmethane hydrocarbons (NMHCs) originate from vehicle emissions. The association between air pollution and urinary bladder cancer (UBC) is debatable. We investigated whether long-term exposure to ambient hydrocarbons increases UBC risk among people aged ≥ 20 years in Taiwan. Linkage dataset research with longitudinal design was conducted among 589,135 initially cancer-free individuals during 2000-2013; 12 airborne pollutants were identified. Several Cox models considering potential confounders were employed. The study outcomes were invasive or in situ UBC incidence over time. The targeted pollutant concentration was divided into three tertiles: T1/T2/T3. The mean age of individuals at risk was 42.5 (SD 15.7), and 50.5% of the individuals were men. The mean daily average over 10 years of airborne THC concentration was 2.25 ppm (SD 0.13), and NMHC was 0.29 ppm (SD 0.09). Both pollutants show long-term monotonic downward trend over time using the Mann-Kendall test. There was a dose-dependent increase in UBC at follow-up. UBC incidence per 100,000 enrollees according to T1/T2/T3 exposure to THC was 60.9, 221.2, and 651.8, respectively; it was 170.0/349.5/426.7 per 100,000 enrollees, corresponding to T1/T2/T3 exposure to NMHC, respectively. Without controlling for confounding air pollutants, the adjusted hazard ratio (adj.HR) was 1.83 (95% CI 1.75-1.91) per 0.13-ppm increase in THC; after controlling for PM2.5, adj.HR was even higher at 2.09 (95% CI 1.99-2.19). The adj.HR was 1.37 (95% CI 1.32-1.43) per 0.09-ppm increase in ambient NMHC concentration. After controlling for SO2 and CH4, the adj.HR was 1.10 (95% CI 1.06-1.15). Sensitivity analyses showed that UBC development risk was not sex-specific or influenced by diabetes status. Long-term exposure to THC and NMHC may be a risk factor for UBC development. Acknowledging pollutant sources can inform risk management strategies.
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Affiliation(s)
- Han-Wei Zhang
- Program for Aging, China Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Biomedica Corporation, New Taipei, Taiwan
| | - Zhi-Ren Tsai
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Center for Precision Medicine Research, Asia University, Taichung, Taiwan
| | - Victor C Kok
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, 117 Shatien Rd Shalu Dist., Taichung, 43303, Taiwan.
| | | | - Yau-Hung Chen
- Department of Chemistry, Tamkang University, New Taipei City, 25137, Taiwan
| | - Jeffrey J P Tsai
- Center for Precision Medicine Research, Asia University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
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Kok VC. Trop-2-Cells, Their Exosomal Cargo, and the Potential Impact on Diagnostics and Therapeutics in Breast Cancer: The Expanding Frontiers. Explor Res Hypothesis Med 2022; 000:000-000. [DOI: 10.14218/erhm.2022.00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] [Imported: 10/03/2023]
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Sivadas A, Kok VC, Ng KL. Multi-omics analyses provide novel biological insights to distinguish lobular ductal types of invasive breast cancers. Breast Cancer Res Treat 2022; 193:361-379. [PMID: 35348974 DOI: 10.1007/s10549-022-06567-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) treatment is similar to invasive ductal carcinoma (IDC; now invasive carcinoma-no special type, IBC-NST), based on its intrinsic subtype. However, further investigation is required for an integrative understanding of differentially perturbed molecular patterns and pathways in these histotypes. METHODS A dataset of 780 IDC and 201 ILC samples from the TCGA-BRCA project for cross-platform multi-omics was analyzed. We leveraged a consensus approach integrating different bioinformatic algorithms to analyze mutations, CNAs, mRNA, miRNA abundance, methylation, and protein abundance to understand the complex crosstalks that distinguish ILC and IDC samples. A histotype-matched comparison was performed. We performed Cox survival analyses for prognosis based on our identified 53 histotype-specific and four discordant genes. RESULTS Approximately 90% of ILC cases were of the luminal subtype. Somatic mutations in CDH1 were higher in ILC than in IDC (FDR-adjusted p < 0.01). Fifty-three significant oncogenic or tumor-suppressive DEGs were identified in a single histotype. PPAR signaling and lipolysis regulation in adipocytes were significantly enriched in ILC tumors. CDH1 protein had the highest differential abundance (AUC: 0.85). Moreover, BTG2, GSTA2, GPR37L1, and PGBD5 amplification was associated with poorer OS in ILC compared with no alteration. RIMS2, NACA4P, MYC, ZFPM2, and POU5F1B amplification showed a lower overall survival in patients with IDC. miR-195 showed an IDC-specific downregulation, causing overexpression of CCNE1. Integrative multi-omics supervised analysis identified 296 differentially expressed genes that successfully distinguished IDC and ILC histotypes. CONCLUSIONS Our findings identify novel molecular candidates that potentially drive and modify the disease differentially among these histotypes.
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Affiliation(s)
- Ambily Sivadas
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - Victor C Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, 117 Shatien Rd Shalu Dist, Taichung, 43303, Taiwan.
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, 40354, Taiwan.
| | - Ka-Lok Ng
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, 40354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Center for Artificial Intelligence and Precision Medicine Research, Asia University, Taichung, 40354, Taiwan
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Kok VC, Wang CCN, Liao SH, Chen DL. Cross-Platform in-silico Analyses Exploring Tumor Immune Microenvironment with Prognostic Value in Triple-Negative Breast Cancer. Breast Cancer (Dove Med Press) 2022; 14:85-99. [PMID: 35437353 PMCID: PMC9013259 DOI: 10.2147/bctt.s359346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/05/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Only a proportion of triple-negative breast cancer (TNBC) is immunotherapy-responsive. We hypothesized that the tumor microenvironment (TME) influences the outcomes of TNBC and investigated the relevant signaling pathways. MATERIALS AND METHODS Immune score (IS) and stromal score (SS) were calculated using the ESTIMATE and correlated with the overall survival (OS) in TNBC. RNA-seq data from 115 TNBC samples and 112 normal adjacent tissues were retrieved. Validations in the methylation levels in 10 TNBC and five non-TNBC cell lines were obtained. Cox model overall survival (OS) validated the derived transcription factor (TF) genes in cBioPortal breast cancer patients. RESULTS SS-low predicts a higher OS compared with SS-high patients (P = 0.0081 IS-high/SS-low patients had better OS (P = 0.045) than IS-low/SS-high patients. More macrophages were polarized to the M2 state in patients with IS-low/SS-high patients (P < 0.001). Moreover, CIBERSORTx showed more CD8+ cytotoxic T-cells in IS-high/SS-low patients (p = 0.0286) and more resting NK cells in the IS-low/SS-high TME (P = 0.0108). KEGG pathway analysis revealed that overexpressed genes were enriched in the IL-17 and cytokine-cytokine receptor interaction pathways. The lncRNA DRAIC, a tumor suppressor, was consistently deactivated in the 10 TNBC cell lines. On the cBioPortal platform, we validated that 13% of ER-negative, HER2-unamplified BC harbored IL17RA deep deletion and 25% harbored TRAF3IP2 amplification. On cBioPortal datasets, the nine altered TF genes derived from the X2K analysis showed significantly worse relapse-free survival in 2377 patients and OS in 4819 invasive BC patients than in the unaltered cohort. CONCLUSION Of note, the results of this integrated in silico study can only be generalized to approximately 17% of patients with TNBC, in which infiltrating stromal cells and immune cells play a determinant prognostic role.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, 43303, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 41354, Taiwan
- Correspondence: Victor C Kok; Charles CN Wang, Email ;
| | - Charles C N Wang
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 41354, Taiwan
- Center for Artificial Intelligence and Precision Medicine Research, Asia University, Taichung, 41354, Taiwan
| | - Szu-Han Liao
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 41354, Taiwan
| | - De-Lun Chen
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 41354, Taiwan
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Dai MS, Feng YH, Chen SW, Masuda N, Yau T, Chen ST, Lu YS, Yap YS, Ang PCS, Chu SC, Kwong A, Lee KS, Ow S, Kim SB, Lin J, Chung HC, Ngan R, Kok VC, Rau KM, Sangai T, Ng TY, Tseng LM, Bryce R, Bebchuk J, Chen MC, Hou MF. Analysis of the pan-Asian subgroup of patients in the NALA Trial: a randomized phase III NALA Trial comparing neratinib+capecitabine (N+C) vs lapatinib+capecitabine (L+C) in patients with HER2+metastatic breast cancer (mBC) previously treated with two or more HER2-directed regimens. Breast Cancer Res Treat 2021; 189:665-676. [PMID: 34553296 PMCID: PMC8505315 DOI: 10.1007/s10549-021-06313-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Neratinib, an irreversible pan-HER tyrosine kinase inhibitor, has demonstrated systemic efficacy and intracranial activity in various stages of HER2+breast cancer. NALA was a phase III randomized trial that assessed the efficacy and safety of neratinib+capecitabine (N+C) against lapatinib+capecitabine (L+C) in HER2+ metastatic breast cancer (mBC) patients who had received ≥ 2 HER2-directed regimens. Descriptive analysis results of the Asian subgroup in the NALA study are reported herein. METHODS 621 centrally assessed HER2+ mBC patients were enrolled, 202 of whom were Asian. Those with stable, asymptomatic brain metastases (BM) were eligible for study entry. Patients were randomized 1:1 to N (240 mg qd) + C (750 mg/m2 bid, day 1-14) with loperamide prophylaxis or to L (1250 mg qd) + C (1000 mg/m2 bid, day 1-14) in 21-day cycles. Co-primary endpoints were centrally assessed progression-free survival (PFS) and overall survival (OS). Secondary endpoints included time to intervention for central nervous system (CNS) disease, objective response rate, duration of response (DoR), clinical benefit rate, and safety. RESULTS 104 and 98 Asian patients were randomly assigned to receive N+C or L+C, respectively. Median PFS of N+C and L+C was 7.0 and 5.4 months (P = 0.0011), respectively. Overall cumulative incidence of intervention for CNS disease was lower with N+C (27.9 versus 33.8%; P = 0.039). Both median OS (23.8 versus 18.7 months; P = 0.185) and DoR (11.1 versus 4.2 months; P < 0.0001) were extended with N+C, compared to L+C. The incidences of grade 3/4 treatment emergent adverse events (TEAEs) and TEAEs leading to treatment discontinuation were mostly comparable between the two arms. Diarrhea and palmar-plantar erythrodysesthesia were the most frequent TEAEs in both arms, similar to the overall population in incidence and severity. CONCLUSION Consistent with the efficacy profile observed in the overall study population, Asian patients with HER2+ mBC, who had received ≥ 2 HER2-directed regimens, may also benefit from N+C. No new safety signals were noted. CLINICAL TRIAL REGISTRATION NCT01808573.
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Affiliation(s)
- Ming Shen Dai
- Department of Hematology-Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Yin Hsun Feng
- Department of Hematology-Oncology, Chi Mei Medical Center-Yongkang Branch, Tainan, Taiwan
| | - Shang Wen Chen
- Department of Hematology-Oncology, Chi Mei Medical Center-LiouYing Branch, Tainan, Taiwan
| | - Norikazu Masuda
- Department of Surgery and Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Thomas Yau
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shou Tung Chen
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yen Shen Lu
- Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yoon Sim Yap
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Peter C S Ang
- Department of Medical Oncology, OncoCare Cancer Centre, Singapore, Singapore
| | - Sung Chao Chu
- Department of Hematology-Oncology, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Ava Kwong
- Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang-si, South Korea
| | - Samuel Ow
- Department of Haematology and Oncology, National University Cancer Institute, Singapore, Singapore
| | - Sung Bae Kim
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - Johnson Lin
- Department of Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hyun Cheol Chung
- Department of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Roger Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Victor C Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
| | - Kun Ming Rau
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Takafumi Sangai
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ting Ying Ng
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Ling Ming Tseng
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Judith Bebchuk
- Department of Biostatistics, Puma Biotechnology Inc., Los Angeles, USA
| | - Mei Chieh Chen
- Clinical Development and Medical Affairs, CANbridge Pharmaceuticals Inc., Taipei, Taiwan
| | - Ming Feng Hou
- Division of Breast Oncology and Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.
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Kok VC, Wang CCN, Liao SH, Chen DL. Abstract 2719: Interleukin-17 and cytokine-related signalings are determinants for tumor immune microenvironment in triple-negative breast cancer: in silico integrated analysis. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Introduction: Programmed death (PD)-1/PD-ligand 1 immunotherapy increases the pathological complete response rate by 13.6 percentage points when added to neoadjuvant chemotherapy for early triple-negative breast cancer (TNBC) (Schmid et al. 2020). This indicates a proportion of TNBC are immune-responsive while many are not. We hypothesized that the tumor immune microenvironment might influence the clinical outcomes of TNBC patients. We wanted to investigate which signaling pathways could determine the TNBC being immune-hot or cold and have prognostication capability.
Methods: Dataset: TCGA-BRCA. Immune score (IS) and stromal score (SS) were calculated from the ESTIMATE and correlated with the documented overall survival. CIBERSORTx and Timer 2.0 were adopted for fractions of immune cell analysis. Differentially expressed genes (DEGs) were identified. Gene Ontology analysis and KEGG were adopted to study the enrichment of the gene sets. We explored and queried the cBioPortal for cancer genomics.
RESULTS: 115 patients with triple-negative breast cancer and 112 normal adjacent tissues were retrieved. The stromal score was high in 12 patients, and the immune score was high in another 12 patients. On Kaplan-Meier analyses, SS-low predicts higher overall survival (OS) vis-à-vis SS-high patients (P = 0.0081), while IS-high predicts higher OS as compared with IS-low patients (P = 0.2, too few cases in the IS-high). When compared with IS-low/SS-high patients, IS-high/SS-low patients had better OS (P = 0.045). In the tumor microenvironment (TME), a higher proportion of macrophages are in the M2 state in patients with IS-low/SS-high patients (P < 0.001). More CD8+ cytotoxic T-cells in IS-high/SS-low patients (14.8% vs. 3.7%, p = 0.0286). More resting NK cells in IS-low/SS-high TME (P = 0.0108). DEGs analysis shows 651 DEGs (284 upregulated, 367 down) in IS-high/SS-low TME, whereas there were 370 DEGs (187 upregulated, 183 down) in IS-low/SS-high patients. The KEGG pathway analysis reveals the DEGs were enriched in the IL-17 signaling pathway and the cytokine-cytokine receptor interaction pathway. IL-17 is a proinflammatory cytokine that signals mainly via TRAF3 Interacting Protein 2 (TRAF3IP2), an inflammatory mediator and upstream regulator of several crucial transcription factors such as AP-1 and NF-κB. On the cBioPortal platform, we discovered that 13% of ER-negative, HER2-FISH-unamplified breast cancers harbor IL17RA deep deletion and 25% with TRAF3IP2 amplification.
Conclusions: The tumor microenvironment with each immune cell component determines the impact on women's survival with TNBC. IS-high/SS-low TME portends a better overall survival. We propose further studies to examine if an immune/stromal state also predicts the response to immunotherapy.
Citation Format: Victor C. Kok, Charles C. N. Wang, Szu-Han Liao, De-Lun Chen. Interleukin-17 and cytokine-related signalings are determinants for tumor immune microenvironment in triple-negative breast cancer: in silico integrated analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2719.
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Cash E, Sephton S, Woolley C, Elbehi AM, R I A, Ekine-Afolabi B, Kok VC. The role of the circadian clock in cancer hallmark acquisition and immune-based cancer therapeutics. J Exp Clin Cancer Res 2021; 40:119. [PMID: 33794967 PMCID: PMC8017624 DOI: 10.1186/s13046-021-01919-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/18/2021] [Indexed: 02/07/2023] Open
Abstract
The circadian system temporally regulates physiology to maintain homeostasis. Co-opting and disrupting circadian signals appear to be distinct attributes that are functionally important for the development of a tumor and can enable or give rise to the hallmarks that tumors use to facilitate their initiation, growth and progression. Because circadian signals are also strong regulators of immune cell proliferation, trafficking and exhaustion states, they play a role in how tumors respond to immune-based cancer therapeutics. While immuno-oncology has heralded a paradigm shift in cancer therapeutics, greater accuracy is needed to increase our capability of predicting who will respond favorably to, or who is likely to experience the troubling adverse effects of, immunotherapy. Insights into circadian signals may further refine our understanding of biological determinants of response and help answer the fundamental question of whether certain perturbations in circadian signals interfere with the activity of immune checkpoint inhibitors. Here we review the body of literature highlighting circadian disruption as a cancer promoter and synthesize the burgeoning evidence suggesting circadian signals play a role in how tumors respond to immune-based anti-cancer therapeutics. The goal is to develop a framework to advance our understanding of the relationships between circadian markers, cancer biology, and immunotherapeutics. Bolstered by this new understanding, these relationships may then be pursued in future clinical studies to improve our ability to predict which patients will respond favorably to, and avoid the adverse effects of, traditional and immune-based cancer therapeutics.
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Affiliation(s)
- Elizabeth Cash
- Department of Otolaryngology and Communicative Disorders, University of Louisville School of Medicine, James Graham Brown Cancer Center, 529 S Jackson Street, Louisville, KY, 40202, USA.
| | - Sandra Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Cassandra Woolley
- Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Attia M Elbehi
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Anu R I
- Department of Clinical Biochemistry, MVR Cancer Center and Research Institute, Kerala, India
| | - Bene Ekine-Afolabi
- ZEAB Therapeutic Ltd, London, UK
- Department of Health, Sport & Bioscience, University of East London, Stratford, UK
| | - Victor C Kok
- Department of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
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Tsai ZR, Zhang HW, Tseng CH, Peng HC, Kok VC, Li GP, Hsiung CA, Hsu CY. Late-onset epilepsy and subsequent increased risk of dementia. Aging (Albany NY) 2021; 13:3573-3587. [PMID: 33429365 PMCID: PMC7906153 DOI: 10.18632/aging.202299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023]
Abstract
Inflammation is considered as a key pathogenesis factor of dementia and epilepsy. However, epilepsy's association with dementia, particularly its role in the development of dementia, remains unclear. To evaluate the association between epilepsy and the risk of dementia, in Taiwan, we have now conducted a retrospective cohort study comprising 675 individuals (age, ≥50 years) with epilepsy and 2,025 matched control subjects without epilepsy. In order to match individuals diagnosed with epilepsy with those with no diagnosis of epilepsy (comparison cohort), we utilized exact matching at a ratio of 1:3. Compared with those in the comparison cohort, individuals in the epilepsy cohort had a significantly increased risk of developing dementia (adjusted hazard ratio = 2.87, p < 0.001). A similar result has been observed after stratifying for sex (adjusted hazard ratio in males = 2.95, p < 0.001; adjusted hazard ratio in females = 2.66, p < 0.001). To conclude, based on these data, epileptic individuals ≥50 years were at a greater risk of developing dementia than people who do not have epilepsy, which indicates that a diagnosis of epilepsy presents a greater risk for the development of dementia.
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Affiliation(s)
- Zhi-Ren Tsai
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Taichung City Smart Transportation Big Data Research Center, Taichung, Taiwan
- Pervasive Artificial Intelligence Research (PAIR) Labs, Hsinchu, Taiwan
- Biomdcare Corporation, New Taipei, Taiwan
| | - Han-Wei Zhang
- Biomdcare Corporation, New Taipei, Taiwan
- Program for Aging, China Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Chun-Hung Tseng
- Department of Neurology, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan
| | | | - Victor C. Kok
- Disease Informatics Research Group, Asia University, Taichung, Taiwan
- Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Gao Ping Li
- Zhongshan Hospital, Affiliated Hospital of Fudan University, Shanghai, China
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chun-Yi. Hsu
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
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Kok VC, Lee CK, Chiang YH, Wang MC, Lu YT, Cherng CC, Lee PY, Wang KB. Extensive-Stage Small Cell Carcinoma Transformation From EGFR Del19-Mutant Lung Adenocarcinoma on Gefitinib at the Twelfth-Year Follow-Up Case Report. Front Oncol 2021; 11:564799. [PMID: 33816221 PMCID: PMC8012892 DOI: 10.3389/fonc.2021.564799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The acquired resistance mechanisms in patients with epidermal growth factor receptor (EGFR)-mutant lung cancer, particularly adenocarcinoma (ADC), following treatment with an EGFR tyrosine kinase inhibitor (TKI) have received extensive investigations. The phenotypic transformation to small cell carcinoma (SCCT) has been estimated to occur in approximately 3 to 10% of patients treated with an EGFR-TKI. The prognosis after SCCT is extremely poor. CASE STUDY We report about SCCT that occurred 45 months after the initial diagnosis of ADC in an East Asian never-smoker woman with advanced-stage EGFR Del-19-mutant lung ADC treated with combined chemoradiotherapy before the era of insurance coverage for EGFR-TKIs in this country and subsequently gefitinib; deletion at codon 746-750 in exon 19 of the EGFR gene was ascertained in the original formalin-fixed paraffin-embedded lung biopsy tissue. Spinal cord compression at thoracic-12 level from SCCT was successfully relieved with neurosurgical treatment, chemotherapy with etoposide and cisplatin, and radiotherapy, while gefitinib treatment was maintained. Eleven months later, SCCT relapsed in the lung parenchyma, which was resected and was found to be sensitive to second-line weekly topotecan. Prophylactic cranial irradiation was subsequently administered. SCCT was confirmed by MALDI-TOF MS analysis of formalin-fixed paraffin-embedded tissues demonstrating the same exon 19 deletion. At the 12th-year follow-up, the patient remains relapse free with very good performance status. The novelty of this case is the successful interdisciplinary team effort to correct the spinal cord compression by maintaining the patient in an ambulatory state, non-stop use of gefitinib justified by the presence of activating EGFR mutation in SCCT tumor cells, and aggressive dose-intensive chemotherapy and radiotherapy for the SCCT that leads to an unprecedented prolonged remission and survival. This case also supports the observation that SCCT is chemotherapy sensitive, and thus, re-biopsy or complete tumor excision is recommended to understand the mutation profiles of the current tumor. Aggressive prudent administration of systemic chemotherapy obtaining optimal dose intensity leads to the successful management of the patient.
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Affiliation(s)
- Victor C. Kok
- Division of Medical Oncology, KTGH Cancer Center, Kuang Tien General Hospital, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taichung, Taiwan
- *Correspondence: Victor C. Kok, ; orcid.org/0000-0003-3440-8154
| | - Chien-Kuan Lee
- Department of Pathology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yu-Hsin Chiang
- Division of Chest Surgery, Department of Surgery, Kuang Tien General Hospital, Taichung, Taiwan
| | - Ming-Chih Wang
- Department of Radiation Oncology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yen-Te Lu
- Department of Radiation Oncology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Chiu-Chun Cherng
- Division of Neurosurgery, Department of Surgery, Kuang Tien General Hospital, Taichung, Taiwan
| | - Pei-Yu Lee
- Department of Diagnostic and Intervention Radiology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Ke-Bin Wang
- Department of Nuclear Medicine, Kuang Tien General Hospital, Taichung, Taiwan
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Kok VC, Yu CC, Salvador JA. Editorial: Head & Neck Cancer and Esophageal Cancer: From Biosignatures to Therapeutics. Front Oncol 2021; 11:666103. [PMID: 33816319 PMCID: PMC8017309 DOI: 10.3389/fonc.2021.666103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Victor C. Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- *Correspondence: Victor C. Kok,
| | - Cheng-Chia Yu
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Jorge A.R. Salvador
- Faculdade de Farmácia da Universidade de Coimbra, Pólo das Ciências da Saúde—Azinhaga de Santa Comba, Coimbra, Portugal
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Abstract
Exosomes are a subset of tiny extracellular vesicles manufactured by all cells and are present in all body fluids. They are produced actively in tumor cells, which are released and utilized to facilitate tumor growth. Their characteristics enable them to assist major cancer hallmarks, leveraged by cancer cells in fostering cancer growth and spread while implementing ways to escape elimination from the host environment. This review updates on the latest progress on the roles of cancer-derived exosomes, of 30-100 nm in size, in deregulating paracrine trafficking in the tumor microenvironment and circulation. Thus, exosomes are being exploited in diagnostic biomarker development, with its potential in clinical applications as therapeutic targets utilized in exosome-based nanoparticle drug delivery strategies for cancer therapy. Ongoing studies were retrieved from PubMed® and Scopus database and ClinicalTrials.gov registry for review, highlighting how cancer cells from entirely different cell lines rely on genetic information carried by their exosomes for homotypic and heterotypic intercellular communications in the microenvironment to favor proliferation and invasion, while establishing a pre-metastatic niche in welcoming cancer cells' arrival. We will elaborate on the trafficking of tumor-derived exosomes in fostering cancer proliferation, invasion, and metastasis in hematopoietic (leukemia and myeloma), epithelial (breast cancer), and mesenchymal (soft tissue sarcoma and osteosarcoma) cancers. Cancer-derived exosomal trafficking is observed in several types of liquid or solid tumors, confirming their role as cancer hallmark enabler. Their enriched genetic signals arising from their characteristic DNA, RNA, microRNA, and lncRNA, along with specific gene expression profiles, protein, or lipid composition carried by the exosomal cargo shed into blood, saliva, urine, ascites, and cervicovaginal lavage, are being studied as a diagnostic, prognostic, or predictive cancer biomarker. We reveal the latest research efforts in exploiting the use of nanoparticles to improve the overall cancer diagnostic capability in the clinic.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Correspondence: Victor C Kok Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, 117 Shatien Road, Shalu, Taichung43303, TaiwanTel +886 4 2662 5111 Ext 2263Fax +886 4 2665 5050 Email
| | - Cheng-Chia Yu
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
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Kok VC. Current Understanding of the Mechanisms Underlying Immune Evasion From PD-1/PD-L1 Immune Checkpoint Blockade in Head and Neck Cancer. Front Oncol 2020; 10:268. [PMID: 32185135 PMCID: PMC7058818 DOI: 10.3389/fonc.2020.00268] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/17/2020] [Indexed: 02/05/2023] Open
Abstract
Starting in 2014, large phase III clinical trials began to disclose the study results of using programmed death (PD)-1 immune checkpoint inhibitors (ICIs) (pembrolizumab, nivolumab) and PD-ligand (L)1 (atezolizumab, durvalumab, avelumab) ICIs immunotherapy in patients with advanced head and neck squamous cell carcinoma (HNSCC). In the recurrent and metastatic (R/M), cisplatin-refractory setting, nivolumab achieved a 2.2-fold increase of the median 1-year overall survival as compared with investigators' choice of salvage chemotherapy (36.0 vs. 16.6%). A paradigm shift to the winning regimen, pembrolizumab combined with platinum and infusional fluorouracil, has outperformed the past gold standard of cetuximab-based platinum and fluorouracil combination in terms of overall survival (median, 13.6 vs. 10.1 mo) when administered as the first-line treatment for R/M HNSCC. Nevertheless, many patients still did not respond to the PD-1/PD-L1 checkpoint inhibitor treatment, indicating innate, adapted, or quickly acquired resistance to the immunotherapy. The mechanisms of resistance to ICIs targeting the PD-1/PD-L1 signaling pathway in the context of HNSCC are the focus of this review. The past 5 years have seen improved understanding of the mechanisms underlying checkpoint inhibition resistance in tumor cells, such as: tumor cell adaption with malfunction of the antigen-presenting machinery via class I human leukocyte antigen (HLA), reintroduction of cyclin D-cyclin-dependent kinase (CDK) 4 complex to cell cycles, enrichment of CD44+ cancer stem-like cells, or development of inactivating mutation in IKZF1 gene; impairment of T-cell functions and proliferation through mutations in the interferon-γ-regulating genes, suppression of the stimulator of interferon genes (STING) pathway, or resulted from constitutional nutritional iron deficiency state; metabolic reprogramming by cancer cells with changes in metabolites such as GTP cyclohydrolase 1, tetrahydrobiopterin, kynurenine, indoleamine 2,3-dioxygenase, and arginase 1; defective dendritic cells, CD-69 sufficient state; and the upregulation or activation of the alternative immune checkpoints, including lymphocyte activation gene-3 (LAG3), T-cell immunoglobulin and ITIM domain (TIGIT)/CD155 pathway, T-cell immunoglobulin mucin-3 (TIM-3), and V domain-containing Ig suppressor of T-cell activation (VISTA). Several potential biomarkers or biosignatures, which could predict the response or resistance to the PD-1/PD-L1 checkpoint immunotherapy, are also discussed.
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Affiliation(s)
- Victor C. Kok
- Department of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- *Correspondence: Victor C. Kok
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Kok VC, Chen YC, Chen YY, Su YC, Ku MC, Kuo JT, Yoshida GJ. Sorafenib with Transarterial Chemoembolization Achieves Improved Survival vs. Sorafenib Alone in Advanced Hepatocellular Carcinoma: A Nationwide Population-Based Cohort Study. Cancers (Basel) 2019; 11:cancers11070985. [PMID: 31311148 PMCID: PMC6679028 DOI: 10.3390/cancers11070985] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/06/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023] Open
Abstract
We hypothesized that sorafenib plus transarterial chemoembolization (TACE) would confer survival benefits over sorafenib alone for advanced hepatocellular carcinoma (aHCC). We investigated this while using the population-based All-Cancer Dataset to assemble a cohort (n = 3674; median age, 60; 83% men) of patients receiving sorafenib for aHCC (Child-Pugh A) with macro-vascular invasion or nodal/distant metastases. The patients were classified into the sorafenib-TACE group (n = 426) or the propensity score-matched sorafenib-alone group (n = 1686). All of the participants were followed up until death or the end of the study. Time-dependent Cox model and the Mantel-Byar test were used for survival analysis. During the median follow-ups of 221 and 133 days for the sorafenib-TACE and sorafenib-alone groups, 164 (39%) and 916 (54%) deaths occurred, respectively; the corresponding median overall survivals (OS) were 381 and 204 days, respectively (hazard ratio, HR: 0.74; 95% confidence interval, CI, 0.63-0.88; p = 0.021). The one-year and six-month OS were 53.5% and 80.3% in the sorafenib-TACE group and 32.4% and 54.4% in the sorafenib-alone group, respectively. The major complications were comparable between the two groups. The addition of TACE to sorafenib improves survival, with a 26% reduction in mortality. These findings provide strong real-world evidence that supports this combination strategy for eligible Child-Pugh A aHCC patients.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung 43303, Taiwan.
- Disease Informatics Research Group, Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung 41354, Taiwan.
- Student, Cancer Biology and Therapeutics: High-Impact Cancer Research Postgraduate Certificate Program, Harvard Medical School, Boston, MA 02115, USA.
| | - Yu-Ching Chen
- Disease Informatics Research Group, Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung 41354, Taiwan
| | - Yang-Yuan Chen
- Department of Gastroenterology, Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Yu-Chieh Su
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Ming-Chang Ku
- Interventional Radiology Unit, Department of Radiology, Kuang Tien General Hospital, Taichung 43303, Taiwan
| | - Jung-Tsung Kuo
- Artificial Intelligence Center for Medical Diagnosis, China Medical University Hospital, Taichung 40447, Taiwan
| | - Go J Yoshida
- Department of Pathology and Oncology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
- Faculty of Medical Science, Graduate School Juntendo University, Tokyo 113-8421, Japan
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Huang CC, Tsai HJ, Huang SH, Kok VC. A successfully treated primary peritoneal carcinosarcoma and serous carcinoma of stage IIIC rescued from hypovolemic shock due to tumor rupture. Taiwan J Obstet Gynecol 2019; 58:296-297. [PMID: 30910157 DOI: 10.1016/j.tjog.2019.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Che-Cheng Huang
- Department of Obstetrics and Gynecology, Kuang Tien General Hospital, Shalu Taichung, Taiwan
| | - Horng-Jyh Tsai
- Department of Obstetrics and Gynecology, Kuang Tien General Hospital, Shalu Taichung, Taiwan.
| | - Shih Hsuan Huang
- Department of Pathology, Kuang Tien General Hospital, Dajia Taichung, Taiwan
| | - Victor C Kok
- Department of Medical Oncology, Kuang Tien General Hospital, Shalu Taichung, Taiwan
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Kok VC, Lin CT, Yeh CB, Yang CC, Horng JT. Performance enhancement of procalcitonin by high-sensitivity C-reactive protein at the optimal cutoff in predicting bacteremia in emergency department adult patients. Scand J Clin Lab Invest 2019; 79:25-31. [PMID: 30628465 DOI: 10.1080/00365513.2018.1550808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pathogenic bacteremia portends a high mortality risk in adult patients admitted to an Emergency Department (ED). This study aims to investigate the effect of adding high-sensitivity C-reactive protein (hs-CRP) to procalcitonin (PCT) and lactate in predicting bacteremia, Gram-negative (GNB) and Gram-positive bacteremia (GPB), using the optimal cutoff derived from the receiver operating characteristics analysis. We evaluated the diagnostic measures, including the positive-test likelihood (LR+), the negative-test likelihood (LR-), and the diagnostic odds ratio (DOR) using a single-center retrospective analysis design. This Standards for Reporting Diagnostic-compliant study comprised 886 consecutive adults who were admitted to the ED in 2010; to this cohort, a 22.2% prevalence of true bacteremia was subsequently confirmed. At the cutoff of 3.9 μg/L, PCT had a DOR of 5.3 (95% confidence interval [CI]: 3.76-7.61) and LR + of 2.8 (95% CI: 2.3-3.4) in predicting overall bacteremia. Elevated PCT and lactate (cutoff at 2 mmol/L), increased the DOR and LR + to 6.3 (95% CI: 4.27-9.29) and 4.0 (95% CI: 3.1-5.2). The DOR and LR + were further improved to 7.1 (95% CI: 4.2-11.95) and 5.6 (95% CI: 3.7-8.6), respectively, when hs-CRP at the cutoff of 1238 nmol/L was added to PCT plus lactate. High-sensitivity CRP at the cutoff of 1,255 nmol/L can enhance the discriminative power raising DOR and LR + values for GPB. The elevation of hs-CRP at the optimal cutoff might improve the diagnostic performance to predict unspecified bacteremia and GPB, but not GNB.
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Affiliation(s)
- Victor C Kok
- a Department of Internal Medicine , Kuang Tien General Hospital , Taichung , Taiwan
- b Department of Bioinformatics and Medical Engineering , Asia University , Taichung , Taiwan
| | - Chiung-Tsung Lin
- c Department of Laboratory Medicine , China Medical University Hospital, China Medical University , Taichung , Taiwan
| | - Chao-Bin Yeh
- d Department of Emergency Medicine, School of Medicine , Chung Shan Medical University , Taichung , Taiwan
- e Department of Emergency Medicine , Chung Shan Medical University Hospital , Taichung , Taiwan
| | - Ching-Cheng Yang
- f Division of Infectious Diseases, Department of Internal Medicine , Kuang Tien General Hospital , Taichung , Taiwan
| | - Jorng-Tzong Horng
- g Department of Computer Science and Information Engineering , National Central University , Taoyuan , Taiwan
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Zhang HW, Lin CW, Kok VC, Tseng CH, Lin YP, Li TC, Sung FC, Wen CP, Hsiung CA, Hsu CY. Incidence of retinal vein occlusion with long-term exposure to ambient air pollution. PLoS One 2019; 14:e0222895. [PMID: 31550294 PMCID: PMC6759191 DOI: 10.1371/journal.pone.0222895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023] Open
Abstract
This study aimed to investigate whether long-term exposure to airborne hydrocarbons, including volatile organic compounds, increases the risk of developing retinal vein occlusion (RVO) among the population of Taiwan. A retrospective cohort study involving 855,297 people was conducted. Cox proportional hazards regression analysis fitted the multiple pollutant models for two targeted pollutants, including total hydrocarbons (THC), nonmethane hydrocarbons (NMHC) were used, and the risk of RVO was estimated. The chi-squared test and one-way analysis of variance were used to test differences in demographics and comorbidity distribution among tertiles of the targeted pollutants. Before controlling for multiple pollutants, hazard ratios for the overall population were 19.88 (95% CI: 17.56-22.50) at 0.51-ppm increases in THC and 4.33 (95% CI: 3.97-4.73) at 0.27-ppm increases in NMHC. The highest adjusted hazard ratios for different multiple pollutant models of each targeted pollutant were statistically significant (all p values were ≤0.05) for all patients at 29.67 (95% CI: 25.57-34.42) for THC and 16.24 (95% CI: 14.14-18.65) for NMHC. Our findings suggest that long-term exposure to THC and NMHC contribute to RVO development.
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Affiliation(s)
- Han-Wei Zhang
- PhD Program for Aging, China Medical University, Taichung, Taiwan
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- * E-mail:
| | - Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Victor C. Kok
- Disease Informatics Research Group, Asia University Taiwan, Taichung, Taiwan
- Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Chun-Hung Tseng
- Department of Neurology, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan
| | - Yuan-Pei Lin
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
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Zhang HW, Kok VC, Chuang SC, Tseng CH, Lin CT, Li TC, Sung FC, Wen CP, Hsiung CA, Hsu CY. Long-term ambient hydrocarbons exposure and incidence of ischemic stroke. PLoS One 2019; 14:e0225363. [PMID: 31800599 PMCID: PMC6892494 DOI: 10.1371/journal.pone.0225363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023] Open
Abstract
Exposure to air pollutants is known to have adverse effects on human health; however, little is known about the association between hydrocarbons in air and an ischemic stroke (IS) event. We investigated whether long-term exposure to airborne hydrocarbons, including volatile organic compounds, increased IS risk. This retrospective cohort study included 283,666 people aged 40 years or older in Taiwan. Cox proportional hazards regression analysis was used to fit single- and multiple-pollutant models for two targeted pollutants, total hydrocarbons (THC) and nonmethane hydrocarbons (NMHC), and estimated the risk of IS. Before controlling for multiple pollutants, hazard ratios (HRs) of IS with 95% confidence intervals for the overall population were 2.69 (2.64-2.74) at 0.16-ppm increase in THC and 1.62 (1.59-1.66) at 0.11-ppm increase in NMHC. For the multiple-pollutant models controlling for PM2.5, the adjusted HR was 3.64 (3.56-3.72) for THC and 2.21 (2.16-2.26) for NMHC. Our findings suggest that long-term exposure to THC and NMHC may be a risk factor for IS development.
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Affiliation(s)
- Han-Wei Zhang
- Ph.D. Program for Aging, China Medical University, Taichung, Taiwan
- Department of Electrical and Computer Engineering, Institute of Electrical Control Engineering, National Chiao Tung University, Hsinchu, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- * E-mail:
| | - Victor C. Kok
- Disease Informatics Research Group, Asia University Taiwan, Taichung, Taiwan
- Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Shu-Chun Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chun-Hung Tseng
- Department of Neurology, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Teng Lin
- Brain Research Center, National Chiao Tung University, Hsinchu, Taiwan
- Department of Electrical and Computer Engineering, Institute of Electrical Control Engineering, National Chiao Tung University, Hsinchu, Taiwan
- Centre for Artificial Intelligence School of Software, Faculty of Engineering & IT, University of Technology Sydney Broadway 2007, Sydney, New South Wales, Australia
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
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Kok VC, Winn PR, Hsieh YJ, Chien JW, Yang JM, Yeh GP. A Pilot Survey of Potentially Hazardous Trace Elements in the Aquatic Environment Near a Coastal Coal-Fired Power Plant in Taiwan. Environ Health Insights 2019; 13:1178630219862236. [PMID: 31367176 PMCID: PMC6643181 DOI: 10.1177/1178630219862236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND A limited number of potentially hazardous trace elements were quantified in the aquatic environment near the world's second largest coal-fired power plant (CFPP) and the coal combustion residual (CCR) disposition sites in Central Taiwan. We postulated that contamination from specific trace elements would be present in the abovementioned aquatic environments. METHODS Cross-sectional sampling of trace elements was first performed between September 24, 2017 and October 3, 2017 outside the CFPP, in the effluent sampled from Changhua, a county south of metropolitan Taichung, and at the historical CCR disposal sites, using the intertidal zone surface seawater and the seawater in an oyster farm as controls. Aqueous samples were collected from 12 locations for analysis of 13 trace elements (Al, As, B, Cd, total Cr, Co, Fe, Pb, Mn, Se, Sr, Tl, and V). We used inductively coupled plasma (ICP) optical emission spectrometry to determine B and Fe levels, and ICP mass spectrometry for all other trace elements. The Spearman rank correlation coefficient (Rho) was calculated to examine the pairwise relation among the trace elements. RESULTS Al (50% of all samples), B (66.7%), Fe (25%), Mn (50%), Sr (8.3%), and V (25%) were identified as being above the Environmental Protection Agency (EPA) regulation limit. The oyster farm seawater had no concerns. Mn (96.4 μg/L) in the CFPP drainage effluent was 1.9-fold above the regulation limit. Fe, Mn, and V were detected from the cooling channel at 4379, 625, and 11.3 μg/L, respectively. The effluent and water from the areas surrounding the 2 CCR dump sites revealed similar magnitudes of trace element contamination. B is highly correlated with Sr (Rho = 0.94, 95% confidence interval [CI], 0.80-0.98). Meanwhile, Fe is highly correlated with Al (Rho = 0.77), Pb (Rho = 0.71), Co (Rho = 0.75), and V (Rho = 0.84). CONCLUSIONS The EPA must set an explicit regulation limit for aluminum, boron, iron, and strontium in the aquatic environment. This exploratory research will inform policymaking regarding certain trace elements that could potentially have an adverse impact on public health and wildlife.
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Affiliation(s)
- Victor C Kok
- Department of Internal Medicine, Kuang
Tien General Hospital, Taichung, Taiwan
- Disease Informatics Research Group, Asia
University, Taichung, Taiwan
- The Scientific Committee, Air Clean
Taiwan (ACT) Alliance, Changhua, Taiwan
- Victor C Kok, Disease Informatics Research
Group, Asia University; Kuang Tien General Hospital, 117 Shatien Road, Shalu,
Taichung 43303, Taiwan.
| | - Paul R Winn
- Waterkeeper Alliance based in Newcastle,
Newcastle, NSW, Australia
| | - Yi-Jer Hsieh
- The Scientific Committee, Air Clean
Taiwan (ACT) Alliance, Changhua, Taiwan
- Department of Anesthesiology, Changhua
Christian Medical Foundation Changhua Christian Hospital, Changhua, Taiwan
| | - Jien-Wen Chien
- The Scientific Committee, Air Clean
Taiwan (ACT) Alliance, Changhua, Taiwan
- Institute of Occupational Medicine and
Industrial Hygiene, College of Public Health, National Taiwan University, Taipei,
Taiwan
- Division of Pediatric Nephrology,
Changhua Christian Medical Foundation Changhua Christian Children’s Hospital,
Changhua, Taiwan
| | - Jer-Ming Yang
- The Scientific Committee, Air Clean
Taiwan (ACT) Alliance, Changhua, Taiwan
| | - Guang-Perng Yeh
- The Scientific Committee, Air Clean
Taiwan (ACT) Alliance, Changhua, Taiwan
- Department of Obstetrics and Gynecology,
Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua,
Taiwan
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Zhang HW, Kok VC, Chuang SC, Tseng CH, Lin CT, Li TC, Sung FC, Wen CP, Hsiung CA, Hsu CY. Long-Term Exposure to Ambient Hydrocarbons Increases Dementia Risk in People Aged 50 Years and above in Taiwan. Curr Alzheimer Res 2019; 16:1276-1289. [PMID: 31902365 DOI: 10.2174/1567205017666200103112443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/12/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alzheimer's disease, the most common cause of dementia among the elderly, is a progressive and irreversible neurodegenerative disease. Exposure to air pollutants is known to have adverse effects on human health, however, little is known about hydrocarbons in the air that can trigger a dementia event. OBJECTIVE We aimed to investigate whether long-term exposure to airborne hydrocarbons increases the risk of developing dementia. METHOD The present cohort study included 178,085 people aged 50 years and older in Taiwan. Cox proportional hazards regression analysis was used to fit the multiple pollutant models for two targeted pollutants, including total hydrocarbons and non-methane hydrocarbons, and estimated the risk of dementia. RESULTS Before controlling for multiple pollutants, hazard ratios with 95% confidence intervals for the overall population were 7.63 (7.28-7.99, p <0.001) at a 0.51-ppm increases in total hydrocarbons, and 2.94 (2.82-3.05, p <0.001) at a 0.32-ppm increases in non-methane hydrocarbons. The highest adjusted hazard ratios for different multiple-pollutant models of each targeted pollutant were statistically significant (p <0.001) for all patients: 11.52 (10.86-12.24) for total hydrocarbons and 9.73 (9.18-10.32) for non-methane hydrocarbons. CONCLUSION Our findings suggest that total hydrocarbons and non-methane hydrocarbons may be contributing to dementia development.
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Affiliation(s)
- Han-Wei Zhang
- Program for Aging, China Medical University, Taichung, Taiwan
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Victor C Kok
- Disease Informatics Research Group, Asia University, Taichung, Taiwan
- Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Shu-Chun Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chun-Hung Tseng
- Department of Neurology, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Teng Lin
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
- Brain Research Center, National Chiao Tung University, Hsinchu, Taiwan
- Co- Director, Centre for Artificial Intelligence School of Software, Faculty of Engineering & IT, University of Technology Sydney Broadway 2007, New South Wales, Australia
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chi P Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
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Kok VC, Hsiao YH, Horng JT, Wang KL. Association Between Erectile Dysfunction and Subsequent Prostate Cancer Development: A Population-Based Cohort Study With Double Concurrent Comparison Groups. Am J Mens Health 2018; 12:1492-1502. [PMID: 29708021 PMCID: PMC6142143 DOI: 10.1177/1557988318772741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Recent studies indicate that erectile dysfunction (ED) and prostate cancer share common potential risk factors such as chronic inflammation, prostatitis, cigarette smoking, obesity, a high animal fat diet, sedentarism, and depression. There is great interest in knowing if ED is associated with prostate cancer. This study aimed to investigate if men afflicted with ED harbor an increased risk of prostate cancer, utilizing two concurrent comparison groups, constructed from the Taiwan NHIRD, with up to 8 years' follow-up. Among men with no preexisting prostate cancer, an ED group of 3,593 men ≥ 40 years of age and two non-ED comparison groups of 14,372 men from the general population, 1:4 matched by age and index date (GENPOP); and 3,594 men with clinical benign prostatic hyperplasia (BPH), matched by similar criteria were assembled. A Cox model was constructed to calculate the adjusted hazard ratio (aHR) after controlling for age, socioeconomic factors, and various medical comorbidities. During the 11,449 person-year follow-up for the ED group, 24 incident prostate cancer developed. During the 44,486 and 11,221 person-year follow-up for the GENPOP and the BPH group, respectively, there were 33 and 25 incidents of prostate cancer. The ED group demonstrated a 2.6-fold greater risk of prostate cancer than that by the GENPOP with an aHR of 2.63 (95% confidence interval [CI] [1.51, 4.59], p < .001). There was no significant difference in risk between ED and BPH group (aHR = 0.83, 95% CI [0.46, 1.48]). This concurrent, double comparison, longitudinal study revealed a positive association between ED and subsequent prostate cancer incidence.
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Affiliation(s)
- Victor C. Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
- Disease Informatics Research Group, Asia University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Victor C. Kok, Kuang Tien General Hospital Cancer Center, Assistant Professor, Asia University Taiwan, 117 Shatien Road, Shalu District, Taichung 43303, Taiwan.
| | - Yi-Hsuan Hsiao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Jorng-Tzong Horng
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan
| | - Kung-Liang Wang
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan
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Kok VC. Gout as a risk factor for osteoporosis: response to comments by Kostev. Osteoporos Int 2018; 29:1687. [PMID: 29637220 DOI: 10.1007/s00198-018-4478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/06/2018] [Indexed: 02/07/2023]
Affiliation(s)
- V C Kok
- Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan.
- Disease Informatics Research Group, Asia University Taiwan, Taichung, Taiwan.
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Kok VC, Zhang HW, Lin CT, Huang SC, Wu MF. Positive association between hypertension and urinary bladder cancer: epidemiologic evidence involving 79,236 propensity score-matched individuals. Ups J Med Sci 2018; 123:109-115. [PMID: 29911922 PMCID: PMC6055751 DOI: 10.1080/03009734.2018.1473534] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION We hypothesized that hypertensive patients harbor a higher risk of urinary bladder (UB) cancer. MATERIAL AND METHODS We performed a population-based cohort study on adults using a National Health Insurance Research Database (NHIRD) dataset. Hypertension and comparison non-hypertensive (COMP) groups comprising 39,618 patients each were propensity score-matched by age, sex, index date, and medical comorbidities. The outcome was incident UB cancer validated using procedure codes. We constructed multivariable Cox models to derive adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Cumulative incidence was compared using a log-rank test. RESULTS During a total follow-up duration of 380,525 and 372,020 person-years in the hypertension and COMP groups, 248 and 186 patients developed UB cancer, respectively, representing a 32% increase in the risk (aHR, 1.32; 95% CI, 1.09-1.60). Hypertensive women harbored a significantly increased risk of UB cancer (aHR, 1.55; 95% CI, 1.12-2.13) compared with non-hypertensive women, whereas men with hypertension had a statistically non-significant increased risk (aHR, 1.22; 95% CI, 0.96-1.55). The sensitivity analysis demonstrated that the increased risk was sustained throughout different follow-up durations for the entire cohort; a statistical increase in the risk was also noted among hypertensive men. CONCLUSION This nationwide population-based propensity score-matched cohort study supports a positive association between hypertension and subsequent UB cancer development.
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Affiliation(s)
- Victor C. Kok
- Department of Internal Medicine, Division of Medical Oncology, Kuang Tien General Hospital, Taichung, Taiwan (ROC)
- Disease Informatics Research Unit, Asia University Taiwan, Taichung, Taiwan (ROC)
- CONTACT Victor C. Kok, MMedSc, MD, PhD, FACP, Department of Internal Medicine, Kuang Tien General Hospital, 117 Sha-Tien Rd, Taichung 43303, Taiwan (ROC)
| | - Han-Wei Zhang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan (ROC)
- PhD Program for Aging, China Medical University, Taichung, Taiwan (ROC)
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan (ROC)
| | - Chin-Teng Lin
- Brain Research Center, National Chiao Tung University, Hsinchu, Taiwan (ROC)
- Centre for Artificial Intelligence, School of Software, Faculty of Engineering & IT, University of Technology, Sydney, Australia (ROC)
| | - Shih-Chung Huang
- Division of Cardiology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan (ROC)
| | - Ming-Feng Wu
- Department of Medical Intensive Care Unit, Kuang Tien General Hospital, Taichung, Taiwan (ROC)
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Chung HC, Kok VC, Cheng R, Hsu Y, Orlando M, Fuchs C, Cho JY. Subgroup analysis of East Asian patients in REGARD: A phase III trial of ramucirumab and best supportive care for advanced gastric cancer. Asia Pac J Clin Oncol 2018; 14:204-209. [PMID: 29318751 DOI: 10.1111/ajco.12829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 02/05/2023]
Abstract
AIM We describe a subgroup analysis assessing the efficacy and safety of ramucirumab monotherapy in East Asian (EA) patients from the REGARD trial. METHODS Patients with advanced gastric or gastroesophageal junction adenocarcinoma with progressive disease were randomized 2:1 to receive ramucirumab (8 mg/kg) plus best supportive care (BSC) or placebo plus BSC every 2 weeks. Post hoc subset analyses were performed on the EA and non-EA intention-to-treat populations. RESULTS Of 355 intention-to-treat patients, 26 patients from EA were randomized to ramucirumab (n = 18) or placebo (n = 8). Median overall survival was 6.5 months in the ramucirumab arm and 4.8 months in the placebo arm (hazard ratio [HR] 0.69; 95% confidence interval [CI], 0.27-1.82) for EA patients, and 5.2 months in the ramucirumab arm and 3.8 months in the placebo arm (HR 0.78; 95% CI, 0.60-1.02) for non-EA patients. The rate of disease control was numerically higher in ramucirumab patients versus placebo; 61% versus 38% respectively for EA patients, and 48% versus 22% for non-EA patients. The incidence of grade ≥3 treatment emergent adverse events was higher in the ramucirumab arm compared to placebo (39% vs 13%). CONCLUSION Despite limitations, this subgroup analysis suggests that ramucirumab monotherapy improves efficacy outcomes with a tolerable safety profile in EA patients with previously treated advanced gastric cancer.
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Affiliation(s)
- Hyun Cheol Chung
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Victor C Kok
- Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | | | - Yanzhi Hsu
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Jae Yong Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Gangnam Severance Cancer Hospital, Seoul, Korea
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Kok VC. Hepatic metastasectomy and paclitaxel provide long-term survival for a young woman with recurrent triple-negative metastatic breast cancer: 16 years follow-up. J Cancer Res Ther 2018; 14:722-723. [PMID: 29893352 DOI: 10.4103/0973-1482.179087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Cancer Center of Kuang Tien General Hospital, Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
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Kok VC, Horng JT, Wang MN, Chen ZY, Kuo JT, Hung GD. Gout as a risk factor for osteoporosis: epidemiologic evidence from a population-based longitudinal study involving 108,060 individuals. Osteoporos Int 2018; 29:973-985. [PMID: 29383389 DOI: 10.1007/s00198-018-4375-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/02/2018] [Indexed: 02/07/2023]
Abstract
UNLABELLED Is gout a risk factor for future osteoporosis? This large population-based study comprising two matched groups of individuals with and without gout demonstrates that patients with gout have a 20% increase in the risk of developing osteoporosis in future through an 8-year follow-up. INTRODUCTION To examine if gout is associated with an increased risk of osteoporosis. METHODS We conducted a nationwide population-based retrospective matched-cohort study. Two matched cohorts (n = 36,458 with gout and 71,602 without gout) assembled and recruited from the Longitudinal Health Insurance Dataset containing 1 million subjects. Exclusion criteria were missing data, age < 20 years, short follow-up period, and pre-existing osteoporosis. Both cohorts were followed up until incident osteoporosis, death, or the end of the study. Person-year data and incidence rates were evaluated. A multivariable Cox model was used to derive an adjusted hazard ratio (aHR) after controlling for socioeconomic proxy, geographical difference, glucocorticoid and allopurinol exposure, various prespecified medical conditions, and comorbidities. RESULTS Men comprised 72.8% of the cohorts. With a follow-up of 183,729 and 359,900 person-years for the gout and non-gout cohorts, 517 and 811 incidents of osteoporosis occurred, respectively, after excluding osteoporosis incidents in the first 3 years of follow-up. The cumulative incidence of osteoporosis was statistically higher in the gout cohort than in the non-gout cohort, at 3.3 versus 2.1% (P = 0.0036, log-rank). Our Cox model showed a 1.2-fold increase in the incidence of osteoporosis in the gout cohort, with an aHR of 1.2 (95% confidence interval, 1.06-1.35). CONCLUSIONS This first population-based epidemiologic study supports the hypothesis that compared with individuals without gout; those with gout have a modest increase in the risk of developing osteoporosis in future.
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Affiliation(s)
- V C Kok
- Department of Internal Medicine, Kuang Tien General Hospital, 117 Sha-Tien Road, Taichung, 43303, Taiwan.
- Disease Informatics Research Group, Asia University Taiwan, Taichung, 41354, Taiwan.
| | - J-T Horng
- Disease Informatics Research Group, Asia University Taiwan, Taichung, 41354, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, 32001, Taiwan
| | - M N Wang
- Department of Orthopedic Surgery, Kuang Tien General Hospital, Tachia, Taichung, 43761, Taiwan
- College of Medicine & Nursing, Hungkuang University, Taichung, 43302, Taiwan
| | - Z-Y Chen
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, 32001, Taiwan
| | - J-T Kuo
- Division of Biostatistics, Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
| | - G-D Hung
- Division of Rheumatology, Immunology, and Allery, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, 43303, Taiwan
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Abstract
Primary vaginal melanoma is a rare mucosal neoplasm, which is more aggressive than cutaneous melanoma. Information regarding its morphologic patterns is limited. In particular, the rhabdoid phenotype, mostly observed in metastatic or recurrent cutaneous melanomas, has yet to be reported at this anatomic location. Hence, a potential diagnostic difficulty may arise because of the inability to recognize this unusual histologic variant and its immunohistochemical aberrance. In this report, we describe the case of a primary vaginal melanoma in a 62-year-old woman, who exhibited both rhabdoid and small blue round cell morphologies, absence of S100 protein, and aberrant expression of desmin, CD56, and FLI-1. This report can facilitate the task of expanding the morphologic spectrum of vaginal melanoma, and prevent misdiagnosis and inadequate medical treatment.
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Affiliation(s)
- Chien-Kuan Lee
- Departments of Pathology (C.-K.L., H.L.)Obstetrics & Gynecology (C.-F.S.)Division of Medical Oncology (V.C.K.), Kung Tien General Hospital, Shalu, Taichung, Taiwan
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Ku MC, Kok VC, Lee CK. An Unusual Cause of Ischemic Change of Long Segment of Colon. Gastroenterology 2017; 152:e12-e13. [PMID: 28384451 DOI: 10.1053/j.gastro.2016.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Ming-Chang Ku
- Department of Radiology, Kuang Tien General Hospital, Taichung, Taiwan; Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Victor C Kok
- Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chien-Kuan Lee
- Department of Pathology, Kuang Tien General Hospital, Taichung, Taiwan
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Kok VC. Genomic mutational profiles of metastatic breast cancer: obtaining them early and during the continuum of oncological care. Transl Cancer Res 2017. [DOI: 10.21037/tcr.2017.03.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Chen ST, Huang CH, Kok VC, Huang CYF, Ciou JS, Tsai JJP, Kurubanjerdjit N, Ng KL. Drug repurposing and therapeutic anti-microRNA predictions for inhibition of oxidized low-density lipoprotein-induced vascular smooth muscle cell-associated diseases. J Bioinform Comput Biol 2017; 15:1650043. [PMID: 28150521 DOI: 10.1142/s0219720016500438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Drug repurposing is a new method for disease treatments, which accelerates the identification of new uses for existing drugs with minimal side effects for patients. MicroRNA-based therapeutics are a class of drugs that have been used in gene therapy following the FDA's approval of the first anti-sense therapy. This study examines the effects of oxLDL on vascular smooth muscle cells (VSMCs) and identifies potential drugs and antimiRs for treating VSMC-associated diseases. The Connectivity Map (cMap) database is utilized to identify potential new uses of existing drugs. The success of the identifications was supported by MTT assay, clonogenic assay and clinical trial data. Specifically, 37 drugs, some of which are undergoing clinical trials, were identified. Three of the identified drugs exhibit IC50 activities. Among the 37 drugs' targets, three differentially expressed genes (DEGs) are identified as drug targets by using both the DrugBank and the NCBI PubChem Compound databases. Also, one DEG, DNMT1, which is regulated by 17 miRNAs, where these miRNAs are potential targets for developing antimiR-based miRNA therapy, is found.
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Affiliation(s)
- Shun-Tsung Chen
- * Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan 41354, R.O.C
| | - Chien-Hung Huang
- † Department of Computer Science and Information Engineering, National Formosa University, Yun-Lin, Taiwan 63205, R.O.C
| | - Victor C Kok
- * Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan 41354, R.O.C
- ‡ Division of Medical Oncology, Kuang Tien General Hospital Cancer, Center Taichung, Taiwan 43303, R.O.C
| | - Chi-Ying F Huang
- § Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan 112, R.O.C
| | - Jin-Shuei Ciou
- * Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan 41354, R.O.C
| | - Jeffrey J P Tsai
- * Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan 41354, R.O.C
| | - Nilubon Kurubanjerdjit
- ¶ School of Information Technology, Mae Fah Luang University, Chiang Rai, Thailand 57100, Thailand
| | - Ka-Lok Ng
- * Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan 41354, R.O.C
- ∥ Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan 40402, R.O.C
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Ku MC, Lee PY, Kok VC. An Unusual Case of Cholangitis. Gastroenterology 2017; 152:e12-e13. [PMID: 28061340 DOI: 10.1053/j.gastro.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Ming-Chang Ku
- Department of Radiology, Kuang Tien General Hospital, Taichung, Taiwan; Department of Nursing, Jente Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Pei-Yu Lee
- Department of Radiology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Victor C Kok
- Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Kok VC. Bidirectional risk between venous thromboembolism and cancer in East Asian patients: synthesis of evidence from recent population-based epidemiological studies. Cancer Manag Res 2017; 9:751-759. [PMID: 29263699 PMCID: PMC5724426 DOI: 10.2147/cmar.s151331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Unprovoked (idiopathic) venous thromboembolism (VTE) with no obvious antecedent risk factors, is associated with a significant risk of subsequent occult cancer. Conversely, there is a heightened risk of VTE in cancer patients. This bidirectional risk can be estimated from population-based cohort studies conducted in East Asians. METHODS A literature search using medical subject heading terms and Boolean logic in PubMed and MedLine was performed in April 2017. Twenty-two papers reported from East Asia were retrieved for study and data synthesis. Proportional meta-analysis with a random-effects model was used to synthesize data with 95% confidence intervals (CIs) when appropriate. RESULTS Synthesis of data on VTE incidence in the East Asian population (I2 = 76.2%) showed that pooled incidence was 20.3 (95% CI, 11.2-32) per 100,000 person-years. VTE incidence steadily increased with age. Unprovoked VTE accounted for 35% (95% CI, 24%-48%) of all cases of incident VTE (I2 = 99.7%). The overall cancer risk was significantly higher (2.3-fold) in the VTE cohort than in comparators. Among the patients with unprovoked VTE, approximately 7% had a subsequent cancer diagnosis within 2 years of the first episode of idiopathic VTE. The risk of VTE recurrence was increased in cancer patients (adjusted odds ratio, 1.64; 95% CI, 1.26-1.99). VTE incidence was 9.9 per 1,000 person-years in cancer patients, particularly in liver, pancreas, and lung cancer patients. CONCLUSION Newly diagnosed VTE incidence is estimated at approximately 4,400 new cases annually in Taiwan and 7,100 in South Korea. Similar to the trend in VTE incidence among the general population, VTE risk in East Asian cancer patients is markedly lessened.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Cancer Center, Kuang Tien General Hospital
- Asia University, Taichung, Taiwan
- Correspondence: Victor C Kok, Division of Medical Oncology, Kuang Tien General Hospital, 117 Sha-Tien Road, Shalu, Taichung 43303, Taiwan, Tel +886 4 2662 5111 extension 2263, Fax +886 4 2665 5050, Email
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Lin CT, Lu JJ, Chen YC, Kok VC, Horng JT. Diagnostic value of serum procalcitonin, lactate, and high-sensitivity C-reactive protein for predicting bacteremia in adult patients in the emergency department. PeerJ 2017; 5:e4094. [PMID: 29201568 PMCID: PMC5708183 DOI: 10.7717/peerj.4094] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/06/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Few studies compared the diagnostic value of procalcitonin with a combination of other tests including lactate and high-sensitivity C-reactive protein in the prediction of pathogenic bacteremia in emergency department adult patients. METHODS We performed a retrospective study assessing the differences in performances of procalcitonin at a cutoff of 0.5 ng/mL, lactate at a cutoff of 19.8 mg/dL, high-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL and their combinations for predicting bacteremia in emergency department adult patients. Sensitivity, specificity, overall accuracy, positive-test and negative-test likelihood, and diagnostic odds ratio with 95% confidence interval for each test combination were calculated for comparison. The receiver operating characteristic curve for every single test were compared using DeLong's method. We also performed a sensitivity analysis in two expanded patient cohorts to assess the discriminative ability of procalcitonin or test combination. RESULTS A total of 886 patients formed the initial patient cohort. The area under the receiver operating characteristic curve for discriminating positive blood culture was: procalcitonin = 0.72 (95% CI [0.69-0.75]) with a derived optimal cutoff at 3.9 ng/mL; lactate 0.69 (0.66-0.72) with an optimal cutoff at 17.9 mg/dL; high-sensitivity C-reactive protein 0.56 (0.53-0.59) with an optimal cutoff of 13 mg/dL; with pairwise comparisons showing statistically significant better performance of either procalcitonin or lactate outperforming high-sensitivity C-reactive protein. To predict positive blood cultures, the diagnostic odds ratio for procalcitonin was 3.64 (95% CI [2.46-5.51]), lactate 2.93 (2.09-4.14), and high-sensitivity C-reactive protein 0.91 (0.55-1.55; P = 0.79). About combined tests, the diagnostic odds ratio for procalcitonin and lactate increases were 3.98 (95% CI [2.81-5.63]) for positive blood culture prediction. Elevated procalcitonin level rendered a six-fold increased risk of positive gram-negative bacteremia with a diagnostic odds ratio of 6.44 (95% CI [3.65-12.15]), which showed no further improvement in any test combinations. In the sensitivity analysis, as a single test to predict unspecified, gram-negative and gram-positive bacteremia, procalcitonin performed even better in an expanded cohort of 2,234 adult patients in terms of the diagnostic odds ratio. DISCUSSIONS For adult emergency patients, procalcitonin has an acceptable discriminative ability for bacterial blood culture and a better discriminative ability for gram-negative bacteremia when compared with lactate and high-sensitivity C-reactive protein. High-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL performed poorly for the prediction of positive bacterial culture.
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Affiliation(s)
- Chiung-Tsung Lin
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jang-Jih Lu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ching Chen
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taichung, Taiwan
| | - Victor C. Kok
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taichung, Taiwan
- Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Jorng-Tzong Horng
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taichung, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan
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Kok VC, Horng JT, Hung GD, Xu JL, Hung TW, Chen YC, Chen CL. Risk of Autoimmune Disease in Adults with Chronic Insomnia Requiring Sleep-Inducing Pills: A Population-Based Longitudinal Study. J Gen Intern Med 2016; 31:1019-26. [PMID: 27130621 PMCID: PMC4978676 DOI: 10.1007/s11606-016-3717-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/11/2016] [Accepted: 04/13/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent studies indicate that chronic insomnia is associated with the development of certain somatic diseases. Whether it would be associated with the development of an autoimmune disease (AID) was unknown. OBJECTIVE We aimed to examine the association and quantify the magnitude of risk for AID in individuals suffering from chronic insomnia requiring sleep-inducing pills. DESIGN This was a population-based, nationwide longitudinal study. PARTICIPANTS Using a claims data set containing 1 million randomly sampled, insured subjects derived from the National Health Insurance Research Database, we assembled a chronic insomnia group and a 1:3 propensity score-matched comparison group (CP), which were balanced in terms of sex, age, insurance premium, urbanization, alcohol use disorder, smoking-related diagnoses, and morbid obesity. MAIN MEASURES Person-time data with incidence rate, adjusted hazard ratios (aHR) by the Cox model, AID-free survival functions compared with the log-rank test, and a sensitivity analysis on the time lag effect were presented. Incident AID within the first year of follow-up were excluded. The error rate was controlled using the Benjamini-Hochberg procedure. KEY RESULTS With 39,550 and 129,914 person-years' follow-up for the chronic insomnia and CP groups (n = 5,736 and 17,208), respectively, we found an increased risk for subsequent AID, representing a 70 % increase in the aHR (1.7; 95 % confidence interval [CI], 1.5-1.9, p < 0.0001). A positive association between chronic insomnia and primary Sjögren's syndrome (pSS) was observed (aHR, 1.3; 95 % CI, 1.1-1.6). Sensitivity analysis disclosed that AID risk was even stronger after 5 years of follow-up (aHR, 2.0; 95 % CI, 1.7-2.4). CONCLUSION Chronic insomnia requiring sleep-inducing pills may be associated with a 70 % increased risk for future AID, particularly pSS.
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Affiliation(s)
- Victor C Kok
- Department of Internal Medicine, Kuang Tien General Hospital, 117 Shatien Road, Taichung, 43303, Taiwan.
- Disease Informatics Research Group, Asia University, Taichung, Taiwan.
| | - Jorng-Tzong Horng
- Disease Informatics Research Group, Asia University, Taichung, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan
| | - Guo-Dung Hung
- Division of Rheumatology & Immunology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Jia-Li Xu
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan
| | - Tzu-Wei Hung
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan
| | - Yu-Ching Chen
- Disease Informatics Research Group, Asia University, Taichung, Taiwan
| | - Chien-Lung Chen
- Division of Nephrology, Department of Internal Medicine, Taiwan Landseed Hospital, Taoyuan, Taiwan
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Kok VC, Kuo JT. Pazopanib as a second-line treatment for non-cytokine-treated metastatic renal cell carcinoma: a meta-analysis of the effect of treatment. BMC Urol 2016; 16:34. [PMID: 27377922 PMCID: PMC4932732 DOI: 10.1186/s12894-016-0156-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 06/16/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The currently recommended treatment algorithm for patients with advanced renal cell carcinoma who fail the first-line targeted therapy does not normally include pazopanib as a second-line treatment option. It would therefore be of interest to determine the efficiency of pazopanib in this setting in terms of the partial response rate (PRR), disease control rate (DCR), and progression-free survival (PFS). METHODS Peer-reviewed clinical reports without language restriction, both full papers and conference abstracts, which assessed the second-line use of pazopanib following failure of first-line non-cytokine-targeted therapy, were included. After the literature retrieval, we conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-compliant systematic review of the literature and meta-analysis of the size of the effect of each outcome measure (PRR, DCR, and PFS). The effect size and 95 % confidence interval (CI) were calculated using fixed-effect or random-effects models based on the heterogeneity represented by I(2) of selected studies. Meta-analysis forest plots with a fixed-effect model showing the PRR and DCR were created. RESULTS Our results show that there are no available comparative studies on pazopanib second-line treatment. Only phase II trials or retrospective analysis reports were retrievable. Six studies (comprising 217 patients) were included in the qualitative and quantitative analysis. Pazopanib as a second-line treatment resulted in a PRR of 23 % (95 % CI, 17-31 %; I(2) = 52.6 %) and a DCR of 73 % (95 % CI, 65-80 %; I(2) = 0.00 %). The meta-analysis with fixed-effect model revealed that PFS was 6.5 months (95 % CI, 5.6-7.5 months; I(2) = 86.2 %). CONCLUSIONS In conclusion, the effectiveness and indication of pazopanib for use in the second-line setting has not yet been examined in-depth; however, this meta-analysis has shown that the treatment effects in terms of PRR, DCR, and PFS may be similar to other well-studied second-line targeted therapies. Rigorous comparative phase III trials testing this hypothesis are required.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Cancer Center of Kuang Tien General Hospital, 117 Shatien Rd, Taichung, 43303, Taiwan.
- Department of Biomedical Informatics, Asia University, Taichung, 41354, Taiwan.
| | - Jung-Tsung Kuo
- Division of Biostatistics, Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
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Kok VC, Sung FC, Kao CH, Lin CC, Tseng CH. Cancer risk in East Asian patients associated with acquired haemolytic anaemia: a nationwide population-based cohort study. BMC Cancer 2016; 16:57. [PMID: 26846920 PMCID: PMC4743105 DOI: 10.1186/s12885-016-2098-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/28/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study investigated whether patients with acquired haemolytic anaemia (AHA) would have elevated cancer risk including that for non-haematological solid tumours. We further examined whether the cancer risk would be different between patients with autoimmune type AHA (AIHA) and patients of non-AIHA. METHODS Using nationwide population-based insurance claims data of Taiwan we identified a cohort of patients with AHA with no pre-existing cancer, (n = 3902) and a comparison cohort (n = 39020) without AHA, frequency-matched by gender, age, urbanization of residency and diagnosis date. Incidence and Cox method estimated adjusted hazard ratios (aHR) of cancers controlling covariates by the end of 2010 were calculated. Risks between patients with AIHA and non-AIHA were compared. Sensitivity analysis was carried out to measure the risk of cancer between patients with and without AHA by follow-up years. RESULTS Patients with AHA had a 90% greater incidence of cancer than controls, with an aHR of 1.78 (95% confidence interval (CI), 1.50-2.12)]. The overall aHRs of cancer for patients with AIHA and non-AIHA were 2.01 (95% CI, 1.56-2.59) and 1.87 (95% CI, 1.53-2.29), respectively, compared with the comparison cohort. The aHRs for lymphatic-haematopoietic malignancy were 19.5 and 9.59 in the AIHA and non-AIHA cohorts, respectively. No hazard of colorectal, lung, liver or breast cancer was significant. CONCLUSIONS There is a near 2-fold elevated risk for subsequent cancer in patients with AHA, particularly for lymphatic-haematopoietic malignancy, which is much greater for patients with AIHA than non-AIHA. These findings can help clinicians decide patient-centred personalized long-term management.
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Affiliation(s)
- Victor C. Kok
- Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, 43303 Taiwan
- Department of Biomedical Informatics, Asia University, Taichung, 41354 Taiwan
| | - Fung-Chang Sung
- Department of Health Services Administration, China Medical University, Taichung, 40402 Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, 40402 Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Centre, China Medical University Hospital, Taichung, 40402 Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 40402 Taiwan
| | - Chun-Hung Tseng
- Department of Neurology, China Medical University Hospital, Taichung, 40447 Taiwan
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Lee PH, Kok VC, Chou PL, Ku MC, Chen YC, Horng JT. Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study. PeerJ 2016; 4:e2634. [PMID: 27812429 PMCID: PMC5088616 DOI: 10.7717/peerj.2634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/30/2016] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Osteoporosis is becoming an impending epidemic in the Asia-Pacific region. The association between risk of osteoporotic fracture (OTPF) and chronic obstructive pulmonary disease (COPD) in East Asian patients is yet to be fully examined. We conducted a nationwide population-based retrospective cohort study of 98,700 patients aged ≥50 years with or without COPD using a national administrative claims dataset. MATERIALS AND METHODS The patients were divided into COPD and comparison groups comprising 19,740 and 78,960 patients, respectively. The groups were 1 to 4 matched for age, gender, index date, diabetes mellitus, pre-existing osteoporosis and chronic kidney disease. Information such as the geographic area where southern part represented more sunshine exposure, smoking-related diagnoses, alcohol use disorder, whether there was regular use of inhaled corticosteroids and oral corticosteroids, vitamin D prescriptions, Charlson-Deyo comorbidity index score, and other relevant medical comorbidities were extracted for analysis. They were followed up until OTPF or the end of the year 2013. The outcome measure was an osteoporotic vertebral fracture and other long-bone fractures. A multivariate Cox model was constructed to derive adjusted hazard ratios (aHR) for OTPF with corresponding 95% confidence intervals (CI) after controlling for age, sex, insurance premium category, vitamin D prescription, osteoporosis, and coronary heart disease (CHD). Kaplan-Meier curves of the probability of OTPF-free survival for each cohort were compared using the log-rank test. Patients with OTPF during the first follow-up year were excluded from the overall risk calculation. Contributing factors to the increased risk of OTPF in COPD patients were examined in a sensitivity analysis. RESULTS After a total follow-up of 68,743 patient-years for the COPD group and 278,051 patient-years for the matched comparison group, the HR for OTPF was 1.24 (95% CI [1.02-1.51]; P = 0.0322) in COPD patients. The aHR was increased by 30% for vertebral OTPF (aHR = 1.297, 95% CI [1.020-1.649]; P = 0.0339). Differential lag time sensitivity analysis revealed a progressively elevated risk up to 8-fold increase in women (aHR = 8.0 (95% CI [1.81-35.4]; P < 0.01)) during the fifth follow-up year. COPD patients with pre-existing osteoporosis or given vitamin D prescription harbor a sustained increased risk up to the 5th (aHR, 4.1; 95% CI [1.61-10.35]) and third (aHR, 2.97; 95% CI [1.48-5.97]) follow-up year, respectively. CONCLUSIONS Our nationwide population-based cohort study demonstrates that East Asian COPD patients aged 50 and beyond do harbor a modestly increased risk for osteoporotic vertebral fractures particularly for those who are female, have pre-existing osteoporosis or require vitamin D prescription.
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Affiliation(s)
- Ping-Hsueh Lee
- Department of Geriatric Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
| | - Victor C. Kok
- KTGH Cancer Center, Kuang Tien General Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Po-Liang Chou
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
| | - Ming-Chang Ku
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
- Department of Diagnostic Radiology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yu-Ching Chen
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Jorng-Tzong Horng
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
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Ku MC, Kok VC, Lee MY, Hsu SM, Lee PY, Chang CW, Tyan YS, Juan CW. Clinical analysis of contributors to the delayed gallbladder opacification following the use of water-soluble contrast medium. Ther Clin Risk Manag 2016; 12:1357-64. [PMID: 27660453 PMCID: PMC5019449 DOI: 10.2147/tcrm.s116899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Gallbladder opacification (GBO) on computed tomography (CT) imaging may obscure certain pathological or emergent conditions in the gallbladder, such as neoplasms, stones, and hemorrhagic cholecystitis. This study aimed to investigate the clinical contributing factors that could predict the presence of delayed GBO determined by CT. METHODS This study retrospectively evaluated 243 consecutive patients who received enhanced CT or intravenous pyelography imaging and then underwent abdominal CT imaging within 5 days. According to the interval between imaging, the patients were divided into group A (1 day), group B (2 or 3 days), and group C (4 or 5 days). Three radiologists evaluated CT images to determine GBO. Fisher's exact test and multivariate backward stepwise elimination logistic regression were performed. RESULTS Positive GBO was significantly associated with the interval between imaging studies, contrast type, contrast volume, renal function, and hypertransaminasemia (P<0.05). Multivariate backward stepwise elimination logistic regression analysis of the three groups identified contrast type and hypertransaminasemia as independent predictors of GBO in group B patients (odds ratio [OR], 13.52, 95% confidence interval [CI], 1.72-106.38 and OR, 3.43, 95% CI, 1.31-8.98, respectively; P<0.05). Hypertransaminasemia was the only independent predictor of GBO in group C patients with an OR of 7.2 (95% CI, 1.62-31.73). Hypertransaminasemia was noted in three patients (100%) who initially underwent imaging 5 days prior to GBO. CONCLUSION Delayed GBO on CT imaging may be associated with laboratory hypertransaminasemia, particularly in patients receiving contrast medium over a period of ≥4 days. A detailed clinical history, physical examination, and further workup are of paramount importance for investigating the underlying cause behind the hypertransaminasemia.
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Affiliation(s)
- Ming-Chang Ku
- Department of Radiology, Kuang Tien General Hospital, Taichung; Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli
| | - Victor C Kok
- Department of Internal Medicine, Division of Medical Oncology, Kuang Tien General Hospital; Department of Bioinformatics and Medical Engineering, Asia University
| | - Ming-Yung Lee
- Department of Statistics and Informatics Science, Providence University
| | - Soa-Min Hsu
- Department of Radiology, Kuang Tien General Hospital, Taichung
| | - Pei-Yu Lee
- Department of Radiology, Kuang Tien General Hospital, Taichung
| | - Che-Wei Chang
- Department of Radiology, Kuang Tien General Hospital, Taichung
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital
| | - Chi-Wen Juan
- Department of Emergency Medicine, Kuang Tien General Hospital; Department of Nursing, HungKuang University, Taichung, Taiwan
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Huang CH, Ciou JS, Chen ST, Kok VC, Chung Y, Tsai JJP, Kurubanjerdjit N, Huang CYF, Ng KL. Identify potential drugs for cardiovascular diseases caused by stress-induced genes in vascular smooth muscle cells. PeerJ 2016; 4:e2478. [PMID: 27703845 PMCID: PMC5045879 DOI: 10.7717/peerj.2478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/23/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Abnormal proliferation of vascular smooth muscle cells (VSMC) is a major cause of cardiovascular diseases (CVDs). Many studies suggest that vascular injury triggers VSMC dedifferentiation, which results in VSMC changes from a contractile to a synthetic phenotype; however, the underlying molecular mechanisms are still unclear. METHODS In this study, we examined how VSMC responds under mechanical stress by using time-course microarray data. A three-phase study was proposed to investigate the stress-induced differentially expressed genes (DEGs) in VSMC. First, DEGs were identified by using the moderated t-statistics test. Second, more DEGs were inferred by using the Gaussian Graphical Model (GGM). Finally, the topological parameters-based method and cluster analysis approach were employed to predict the last batch of DEGs. To identify the potential drugs for vascular diseases involve VSMC proliferation, the drug-gene interaction database, Connectivity Map (cMap) was employed. Success of the predictions were determined using in-vitro data, i.e. MTT and clonogenic assay. RESULTS Based on the differential expression calculation, at least 23 DEGs were found, and the findings were qualified by previous studies on VSMC. The results of gene set enrichment analysis indicated that the most often found enriched biological processes are cell-cycle-related processes. Furthermore, more stress-induced genes, well supported by literature, were found by applying graph theory to the gene association network (GAN). Finally, we showed that by processing the cMap input queries with a cluster algorithm, we achieved a substantial increase in the number of potential drugs with experimental IC50 measurements. With this novel approach, we have not only successfully identified the DEGs, but also improved the DEGs prediction by performing the topological and cluster analysis. Moreover, the findings are remarkably validated and in line with the literature. Furthermore, the cMap and DrugBank resources were used to identify potential drugs and targeted genes for vascular diseases involve VSMC proliferation. Our findings are supported by in-vitro experimental IC50, binding activity data and clinical trials. CONCLUSION This study provides a systematic strategy to discover potential drugs and target genes, by which we hope to shed light on the treatments of VSMC proliferation associated diseases.
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Affiliation(s)
- Chien-Hung Huang
- Department of Computer Science and Information Engineering, National Formosa University, Yun-Lin, Taiwan
| | - Jin-Shuei Ciou
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Shun-Tsung Chen
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Victor C. Kok
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
| | - Yi Chung
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Jeffrey J. P. Tsai
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | | | - Chi-Ying F. Huang
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Ka-Lok Ng
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Kok VC, Lee PH. Management of Hypoglycemia in Nondiabetic Palliative Care Patients: A Prognosis-Based Approach. Palliat Care 2016; 10:1-5. [PMID: 27920549 PMCID: PMC5123827 DOI: 10.4137/pcrt.s38956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023] Open
Abstract
Hypoglycemia due to underlying terminal illness in nondiabetic end-of-life patients receiving palliative care has not been fully studied. For example, we do not have adequate information on the frequency of spontaneous hypoglycemia in patients as occurs during the different stages of palliative care. Depending on the case-mix nature of the palliative care ward, at least 2% of palliative care patients may develop hypoglycemia near the end of life when the remaining life expectancy counts down in days. As many as 25%-60% of these patients will neither have autonomic response nor have neuroglycopenic symptoms during a hypoglycemic episode. Although it is not difficult to diagnose and confirm a true hypoglycemia when it is suspected clinically, an episode of hypoglycemic attack may go unnoticed in some patients in a hospice setting. Current trends in palliative care focus on providing treatments based on a prognosis-based framework, involving shared decision-making between the patient and caregivers, after considering the prognosis, professional recommendations, patient's autonomy, family expectations, and the current methods for treating the patient's physical symptoms and existential suffering. This paper provides professional care teams with both moral and literature support for providing care to nondiabetic patients presenting with hypoglycemia.
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Affiliation(s)
- Victor C. Kok
- Division of Palliative Medicine, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Division of Medical Oncology, Cancer Center of Kuang Tien General Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- CORRESPONDENCE:
| | - Ping-Hsueh Lee
- Division of Palliative Medicine, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Division of Geriatric Medicine, Department of Family Medicine, Kuang Tien General Hospital, Taichung, Taiwan
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Kok VC, Tsai HJ, Su CF, Lee CK. The Risks for Ovarian, Endometrial, Breast, Colorectal, and Other Cancers in Women With Newly Diagnosed Endometriosis or Adenomyosis: A Population-Based Study. Int J Gynecol Cancer 2015; 25:968-76. [PMID: 25893280 DOI: 10.1097/igc.0000000000000454] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Recent studies report a link between endometriosis and ovarian cancer (OC). Using a population-based cohort study to confirm the association between endometriosis and cancer is desirable. We thus examined the magnitude of the risks of OC, endometrial cancer (EC), breast cancer, colorectal cancer (CRC), and other cancers in women with newly diagnosed endometriosis or adenomyosis (internal endometriosis). METHODS/MATERIALS Women older than 20 years with claims data between 2003 and 2005 were identified from the Longitudinal Health Insurance Dataset containing 1 million individuals randomly sampled from the National Health Insurance Research Database. Those with preexisting malignancies, hysterectomy, or oophorectomy were excluded. The endometriosis cohort (n = 2266, including 768 cases of pure adenomyosis) and comparison cohort (n = 9064), formed by 1:4 matching, were followed up until incidence cancer, dropout, or December 31, 2008. Outcome measures included cancer incidence and adjusted hazard ratio by Cox model adjusted for age group, comorbidities, and endometriosis medication use. RESULTS With 9842 person-years of follow-up in endometriosis cohort and 36,274 person-years of follow-up in comparison cohort, there were increased risks of all cancers (adjusted hazard ratio, 1.8; 95% confidence interval, 1.4-2.4), OC (4.56, 1.72-12.11), and EC (4.05, 1.20-13.66). The ovarian endometriosis group was associated with increased risk of subsequent OC (4.37, 1.07-17.83). The adenomyosis group was strongly associated with both OC (5.50, 1.95-15.50) and EC (5.13, 1.36-19.40). Increased risk of subsequent CRC was observed in women with adenomyosis with coexistent endometriosis at other sites (13.04, 2.21-77.04). However, no statistically significant increased risk of breast or other cancers was observed. CONCLUSIONS Having limitations such as lacking of parity information which may affect the magnitude of risk estimates, this study demonstrates that ovarian endometriosis has a 4-fold increased risk of OC. Adenomyosis may associate with a 4- to 5-fold increased risk of OC and EC, and unexpectedly, a 13-fold increased risk of CRC.
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Affiliation(s)
- Victor C Kok
- *Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Shalu, Taichung, Taiwan; †Department of Biomedical Informatics, Asia University, Wufeng, Taichung, Taiwan; and Departments of ‡Obstetrics & Gynecology and §Pathology, Kuang Tien General Hospital, Shalu, Taichung, Taiwan
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Abstract
BACKGROUND The use of compassionate extubation (CE) to alleviate suffering by terminating mechanical ventilation and withdrawing the endotracheal tube requires professional adherence and efficiency. The Hospice Palliative Care Act, amended on January 9, 2013, legalizes the CE procedure in Taiwan. METHODS From September 20, 2013 to September 2, 2014, the hospice palliative care team at a community hospital received 20 consultations for CE. Eight cases were excluded because of non-qualification. Following approval from the Ethics Committee, the medical records of the remaining 12 patients were reviewed and grouped by the underlying disease: A, "terminal-stage cancer"; B, "non-cancer out-of-hospital cardiac arrest"; and C, "non-cancer organ failure". Time to extubation using a cut-off at 48 hours was assessed. RESULTS The mean ages of patients (standard deviation) in groups A, B, and C were 66.3 (14.9) years, 72 (19.1) years, and 80.3 (4.0) years, respectively. The mean number of days of intubation at consultation were 6.8 (4.9), 7.3 (4.9), and 179.3 (271.6), respectively. The mean total doses of opioids (as morphine-equivalent dose) in the 24 hours preceding CE were 76 (87.5) mg, 3.3 (5.8) mg, and 43.3 (15.3) mg. The median times from extubation (range) to death were 97 (0.2-245) hours, 0.3 (0.2-0.4) hours, and 6.1 (3.6-71.8) hours. Compared to those requiring <48-hour preparatory time, patients requiring >48 hours to the moment of CE were younger (62.8 years vs 75.5 years), required a mean time of 122 hours (vs 30 hours) to CE (P=0.004), had shorter length of stay (33.3 days vs 77.8 days), required specialist social worker intervention in 75% of cases (vs 37.5%), and had a median duration of intubation of 11.5 days (vs 5.5 days). CONCLUSION CE was carried out according to protocol, and the median time from extubation to death varies determined by the underlying disease which was 0.3 hour in patients admitted after out-of-hospital cardiac arrest and 97 hours in patients with advanced cancer.
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Affiliation(s)
- Victor C Kok
- Division of Palliative Medicine and Hospice Palliative Care Team, Kuang Tien General Hospital, Asia University Taiwan, Taichung, Taiwan
- Department of Biomedical Informatics, Asia University Taiwan, Taichung, Taiwan
- Correspondence: Victor C Kok, Division of Palliative Medicine and Hospice Palliative Care Team, Kuang Tien General Hospital, Taichung 43303, Taiwan, Email
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Chen YC, Kok VC, Chien CH, Horng JT, Tsai JJP. Cancer risk in patients aged 30 years and above with type 2 diabetes receiving antidiabetic monotherapy: a cohort study using metformin as the comparator. Ther Clin Risk Manag 2015; 11:1315-23. [PMID: 26357479 PMCID: PMC4559233 DOI: 10.2147/tcrm.s91513] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Accumulating evidence suggests that metformin reduces incident cancer development. Few cohort studies have evaluated the risk of subsequent cancer development in diabetic cohorts receiving antidiabetic monotherapy. We conducted a population-based study in patients with new-onset type 2 diabetes treated with antidiabetic monotherapy. METHODS We identified a cohort of patients with type 2 diabetics aged ≥30 years receiving hypoglycemic monotherapy (n=7,325) from the 1998-2007 Longitudinal Health Insurance Dataset. Patients were grouped according to the antidiabetic therapy they received into metformin (n=2,223), sulfonylurea (n=3,965), glitazone (n=53), meglitinide (n=128), acarbose (n=150), and insulin (n=806) groups. Patients with preexisting cancer were excluded. All patients were followed up until cancer development, dropout, death, or until December 31, 2008. Cox's model was used to estimate multivariable hazard ratios (HRs) adjusted for age, sex, Charlson comorbidity index, smoking-related comorbidities, alcohol use disorders, morbid obesity, pancreatitis, hypertension, monthly income, and urbanization level. The log-rank test was used to compare cumulative cancer incidence. Two-sided P-values <0.05 were required to reject the null hypothesis. RESULTS The overall median follow-up duration was 2.5 years (interquartile range, 3.6 years). Totally, 367 and 124 cancers developed in the sulfonylurea and metformin groups, respectively, representing an adjusted HR of 1.36 (95% confidence interval [CI], 1.11-1.67; P<0.005). No significant differences were observed between other groups. Increased adjusted HRs were observed for colorectal cancer (adjusted HR, 1.94; 95% CI, 1.15-3.27; P<0.05) and lung cancer (adjusted HR, 1.76; 95% CI, 1.00-3.07; P<0.05). CONCLUSION Metformin monotherapy may be associated with a reduction in the risk for cancer development compared with sulfonylurea monotherapy. Moreover, the use of an average defined daily dose of >0.25 of metformin when compared to lower dose will contribute to a reduction of 80% risk.
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Affiliation(s)
- Yu-Ching Chen
- Department of Biomedical Informatics, Asia University, Taichung, Taiwan
- Yu-Ching Chen, Department of Biomedical Informatics, Asia University Taiwan, 500 Lioufeng Rd, Wufeng, Taichung 41354, Taiwan, Email
| | - Victor C Kok
- Department of Biomedical Informatics, Asia University, Taichung, Taiwan
- Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Correspondence: Victor C Kok, Department of Internal Medicine, Kuang Tien General Hospital, 117 Shatien Rd, Shalu, Taichung 43303, Taiwan, Email
| | - Ching-Hsuan Chien
- Department of Biomedical Informatics, Asia University, Taichung, Taiwan
| | - Jorng-Tzong Horng
- Department of Biomedical Informatics, Asia University, Taichung, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan
| | - Jeffrey J P Tsai
- Department of Biomedical Informatics, Asia University, Taichung, Taiwan
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Kok VC, Horng JT, Huang HK, Chao TM, Hong YF. Regular inhaled corticosteroids in adult-onset asthma and the risk for future cancer: a population-based cohort study with proper person-time analysis. Ther Clin Risk Manag 2015; 11:489-99. [PMID: 25848295 PMCID: PMC4381893 DOI: 10.2147/tcrm.s80793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recent studies have shown that inhaled corticosteroids (ICS) can exert anti-inflammatory effects for chronic airway diseases, and several observational studies suggest that they play a role as cancer chemopreventive agents, particularly against lung cancer. We aimed to examine whether regular ICS use was associated with a reduced risk for future malignancy in patients with newly diagnosed adult-onset asthma. METHODS We used a population-based cohort study between 2001 and 2008 with appropriate person-time analysis. Participants were followed up until the first incident of cancer, death, or to the end of 2008. The Cox model was used to derive an adjusted hazard ratio (aHR) for cancer development. Kaplan-Meier cancer-free survival curves of two groups were compared. RESULTS The exposed group of 2,117 regular ICS users and the nonexposed group of 17,732 non-ICS users were assembled. After 7,365 (mean, 3.5 years; standard deviation 2.1) and 73,789 (mean, 4.1 years; standard deviation 2.4) person-years of follow-up for the ICS users and the comparator group of non-ICS users, respectively, the aHR for overall cancer was nonsignificantly elevated at 1.33 with 95% confidence interval (CI), 1.00-1.76, P=0.0501. The Kaplan-Meier curves for overall cancer-free proportions of both groups were not significant (log-rank, P=0.065). Synergistic interaction of concurrent presence of regular ICS use was conducted using "ICS-negative and chronic obstructive pulmonary disease (COPD)-negative" as the reference. The aHR for the group of "ICS-positive, COPD-negative" did not reach statistically significant levels with aHR at 1.38 (95% CI, 0.53-3.56). There was a statistically significant synergistic interaction of concurrent presence of regular ICS use and COPD with aHR at 3.78 (95% CI, 2.10-6.81). CONCLUSION The protective effect of regular ICS use in the studied East Asian patients with adult-onset asthma was not detectable, contrary to reports of previous studies that ICS might prevent the occurrence of future cancer.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Department of Biomedical Informatics, Asia University Taiwan, Taichung, Taiwan
- Correspondence: Victor C Kok, Kuang Tien General Hospital, 117 Shatien Road, Shalu, Taichung 43303, Taiwan, Tel +886 919 524 909, Email
| | - Jorng-Tzong Horng
- Department of Biomedical Informatics, Asia University Taiwan, Taichung, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan
- Jorng-Tzong Horng, National Central University, 300 Jhongda Road, Jhongli, Taoyuan 32001, Taiwan, Tel +886 919 057 555, Email
| | - Hsu-Kai Huang
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan
| | - Tsung-Ming Chao
- Statistics Unit, Department of Applied Geomatics, Chien Hsin University, Jhongli, Taiwan
| | - Ya-Fang Hong
- Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan
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Kok VC. Eribulin in the Management of Advanced Breast Cancer: Implications of Current Research Findings. Breast Cancer (Auckl) 2015; 9:109-15. [PMID: 26691012 PMCID: PMC4681420 DOI: 10.4137/bcbcr.s32787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/22/2015] [Accepted: 11/24/2015] [Indexed: 02/07/2023] Open
Abstract
The search for cytotoxic agents from marine natural products ultimately led to the production of eribulin, which is a synthetic macrocyclic ketone analog of halichondrin B. Eribulin binds to tubulin to induce mitotic arrest and gained approval in Japan in May 2010; it was approved by the US Food and Drug Administration in November 2010 and the European Medicines Agency in March 2011 and was reimbursed by the Taiwan National Health Insurance in December 2014 for patients with metastatic breast cancer who had received at least one anthracycline and one taxane. The recommended regimen for eribulin mesylate comprises intravenous administration of 1.4 mg/m(2) (equivalent to 1.23 mg/m(2) eribulin) over two to five minutes on days 1 and 8 of a three-week cycle. Since 2011, various clinical investigations of eribulin monotherapy with dose or schedule modifications, combined use with other antineoplastic therapeutics, or head-to-head comparisons with specific agents have been performed in the management of advanced breast cancer. Ethnic-specific data from Japan and Korea indicate higher rates (>85%) of grade 3 or 4 neutropenia. Some anecdotal evidence suggests that eribulin can shrink brain and retinal metastases, which warrants further detailed studies. In this review, current observations of the effects of eribulin monotherapy are summarized and eribulin-backbone combination (bio-) chemotherapy is investigated.
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Affiliation(s)
- Victor C. Kok
- Division of Medical Oncology, Cancer Center of Kuang Tien General Hospital, Taichung, Taiwan
- Department of Biomedical Informatics, Asia University, Taichung, Taiwan
- CORRESPONDENCE:
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Kok VC, Horng JT, Huang JL, Yeh KW, Gau JJ, Chang CW, Zhuang LZ. Population-based cohort study on the risk of malignancy in East Asian children with juvenile idiopathic arthritis. BMC Cancer 2014; 14:634. [PMID: 25174953 PMCID: PMC4161919 DOI: 10.1186/1471-2407-14-634] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 08/21/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the association and magnitude of risk between JIA, its associated treatment and cancer development in Taiwanese children. METHODS Nationwide population-based 1:4 age- and gender-matched retrospective cohort study was designed using the National Health Insurance Research Database of Taiwan. A cohort of 2,892 children <16 years old with JIA was formed as well as a non-JIA cohort of 11,568 in year 2003 to 2005. They were followed up till a diagnosis of malignancy or up to 8 years until 2010. Relative risk (RR), incidence rate ratio (IRR), and adjusted hazard ratio (aHR) of developing malignancy were calculated. RESULTS The female to male ratio was 0.79:1. There were 3 cases of incident cancer in the "MTX use, biologics-naïve" group, only 1 in the anti-TNF biologics-containing group and 29 in the "both MTX- and biologics-naïve" group, in comparison, there were 50 cases of cancer in the non-JIA comparator group. During a 16114.16 patient-years follow-up, the RR and IRR for developing a malignancy in both methotrexate- and anti-tumor necrosis factor (TNF) biologics-naïve JIA children were 2.75 (95% confidence interval, 1.75 - 4.32) and 3.21 (2.01 - 5.05), respectively. For leukemia, the IRR was 7.38 (2.50 - 22.75); lymphoma, 8.30 (1.23 - 69.79); and soft tissue sarcoma, 11.07 (0.84 - 326.4). The IRR of other cancers was 2.08 (1.11 - 3.71). The aHR on cancer risk was 3.14 (1.98 - 4.98) in methotrexate- and biologics-naïve group. There were no statistically significant increased risk in JIA patients treated with methotrexate and/or anti-TNF biologics. CONCLUSIONS Compared with children without JIA, children with JIA have 3-fold increase of risk on malignancy in East Asia. Seemingly neither methotrexate nor anti-TNF biologics increases the risk further.
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Affiliation(s)
- Victor C Kok
- />Population-Health and Clinical Informatics Research Group, Department of Biomedical Informatics, Asia University Taiwan, Taichung, Taiwan
- />Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Jorng-Tzong Horng
- />Population-Health and Clinical Informatics Research Group, Department of Biomedical Informatics, Asia University Taiwan, Taichung, Taiwan
- />Department of Computer Science and Information Engineering, National Central University, Chungli, Taiwan
| | - Jing-Long Huang
- />Division of Paediatric Allergy Asthma and Rheumatology, Department of Paediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- />Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- />Division of Paediatric Allergy Asthma and Rheumatology, Department of Paediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jia-Jing Gau
- />Department of Computer Science and Information Engineering, National Central University, Chungli, Taiwan
| | - Cheng-Wei Chang
- />Department of Information Management, Hsing Wu University, New Taipei City, Taiwan
| | - Lai-Zhen Zhuang
- />Department of Computer Science and Information Engineering, National Central University, Chungli, Taiwan
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Kok VC, Lee CK, Horng JT, Lin CC, Sung FC. Reappraisal of the etiology of extracorpuscular non-autoimmune acquired hemolytic anemia in 2657 hospitalized patients with non-neoplastic disease. Clin Med Insights Pathol 2014; 7:11-4. [PMID: 24808725 PMCID: PMC3999811 DOI: 10.4137/cpath.s14875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/09/2014] [Accepted: 03/11/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Unlike autoimmune hemolytic anemia (AIHA), literature on the etiological study of non-autoimmune hemolytic anemia (non-AIHA) is scarce. The incidence and prevalence of non-AIHA in different geographic regions are largely unknown perhaps owing to the lack of perspective investigation and different profiles of etiologies from different geographic regions. We aimed to examine the real-world etiology or mechanisms of the non-hereditary non-AIHA from a nationwide population-based administrative claim database in Taiwan. PATIENTS AND METHODS The National Health Insurance Research Database of Taiwan was adopted for this research. The studied population was total inpatient claim records including both pediatric and adult patients, contributed by a population of 23 million insured individuals in Taiwan. From 2002 to 2008, we retrieved 3,903 patients having no pre-existing malignancy discharged after inpatient management for acquired hemolytic anemia, which was defined as coding in discharge diagnoses containing ICD-9-CM code 283. By contrast, ICD-9-CM code 282 and all of the sub-codes are for hereditary hemolytic anemias. RESULTS AIHA accounted for 32% of the total cases. Among 2,657 patients with non-AIHA, mechanical or microangiopathic mechanism accounted for 19% of cases; hemolytic-uremic syndrome (HUS) 4%, hemoglobinuria because of hemolysis from external causes such as paroxysmal nocturnal hemoglobinuria (PNH) and march hemoglobinuria 7%, and chronic idiopathic hemolytic anemia or other unspecified non-AIHA 69%. We looked further for specific etiology or mechanism for this group of patients with non-hereditary extrinsic non-AIHA (n = 2,657). The explanatory disease states or conditions were splenomegaly; alcohol use disorder (spur cell hemolysis); heart-valve prosthesis; malignant hypertension; disseminated intravascular coagulation; transfusion reaction; dengue fever-induced hemolytic anemia; direct parasitization; snake, lizard, or spider bite; and Wilson's disease with internal toxin mechanism. All these cases can explain up to 34.6% of all the non-hereditary extrinsic non-AIHA cases. Fragmentation hemolysis (HUS, heart-valve prosthesis, malignant hypertension, and disseminated intravascular coagulation) accounted for 7.4% of non-AIHA hospitalized patients with non-neoplastic disease. CONCLUSIONS This article is the first one to clearly demonstrate that the non-neoplastic-induced HUS requiring hospitalization cases in Taiwan, which has a population of over 23 million were 110 over a span of seven years, 16 cases per year. Although the etiologies of non-AIHA are well known and described in the literature, this work added the statistical percentages of the various etiologies of non-AIHA in Taiwan.
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Affiliation(s)
- Victor C Kok
- Department of Biomedical Informatics, Asia University, Wufeng, Taichung, Taiwan
- Department of Internal Medicine, Kuang Tien General Hospital, Shalu, Taichung, Taiwan
- CORRESPONDENCE: ;
| | - Chien-Kuan Lee
- Department of Pathology, Kuang Tien General Hospital, Shalu, Taichung, Taiwan
| | - Jorng-Tzong Horng
- Department of Biomedical Informatics, Asia University, Wufeng, Taichung, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan County, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Institute of Environmental Health, China Medical University College of Public Health, Taichung, Taiwan
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Kok VC, Wu SC, Lee CK. Successful Remission of Hemolytic-Uremic Syndrome During the Third-line Weekly Gemcitabine for Metastatic Breast Cancer. Breast Cancer (Auckl) 2014; 8:57-9. [PMID: 24701120 PMCID: PMC3972075 DOI: 10.4137/bcbcr.s14920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 02/07/2023] Open
Abstract
Sequential palliative chemotherapy for metastatic breast cancer incorporating weekly gemcitabine administered as three-weeks-on, one-week-off schedule is widely adopted throughout the East Asia region. Hemolytic-uremic syndrome (HUS) associated with weekly gemcitabine for a breast cancer patient is extremely rare. We report here a case of 43-year-old woman with metastatic breast cancer who received weekly gemcitabine as a third-line palliative chemotherapy for her disease. She developed HUS after a cumulative dose of 11,000 mg/m(2) gemcitabine, evidenced by microangiopathic hemolytic anemia (MAHA) with schistocytes seen in peripheral blood smear, decreased haptoglobin level (<0.29 mmol/L), thrombocytopenia, negative direct Coombs test, and acute kidney injury. Owing to the ease of administration of weekly gemcitabine, gemcitabine-induced thrombocytopenia, multifactorial anemia in metastatic breast cancer, and possibility of cancer progression, HUS could have gone unnoticed. Breast cancer oncologist should be cognizant of this rare HUS even during weekly gemcitabine treatment.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Shalu, Taichung, Taiwan
- Department of Biomedical Informatics, Asia University, Wufeng, Taichung, Taiwan
- CORRESPONDENCE: ;
| | - Sheng-Chung Wu
- Division of Breast Surgery, Department of Surgery, Kuang Tien General Hospital, Tachia, Taichung, Taiwan
| | - Chien-Kuang Lee
- Department of Pathology, Kuang Tien General Hospital, Shalu, Taichung, Taiwan
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Kok VC, Horng JT, Chang WS, Hong YF, Chang TH. Allopurinol therapy in gout patients does not associate with beneficial cardiovascular outcomes: a population-based matched-cohort study. PLoS One 2014; 9:e99102. [PMID: 24897240 PMCID: PMC4045898 DOI: 10.1371/journal.pone.0099102] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/11/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Previous studies have shown an association between gout and/or hyperuricemia and a subsequent increase in cardiovascular disease (CVD) outcomes. Allopurinol reduces vascular oxidative stress, ameliorates inflammatory state, improves endothelial function, and prevents atherosclerosis progression. Accordingly, we tested the hypothesis that a positive association between allopurinol therapy in gout patients and future cardiovascular outcomes is present using a population-based matched-cohort study design. METHODS Patients aged ≥40 years with newly diagnosed gout having no pre-existing severe form of CVD were separated into allopurinol (n = 2483) and non-allopurinol (n = 2483) groups after matching for age, gender, index date, diabetes mellitus, hypertension, hyperlipidemia, and atrial fibrillation. The two groups were also balanced in terms of uric acid nephrolithiasis, acute kidney injury, hepatitis, and Charlson comorbidity index. RESULTS With a median follow-up time of 5.25 years, the allopurinol group had a modest increase in cardiovascular risk [relative risk, 1.20; 95% confidence interval (CI), 1.08-1.34]. A Cox proportional hazard model adjusted for chronic kidney disease, uremia, and gastric ulcer gave a hazard ratio (HR) for cardiovascular outcomes of 1.25 (95% CI, 1.10-1.41) in gout patients receiving allopurinol compared with the non-allopurinol group. In further analysis of patients receiving urate-lowering therapy, the uricosuric agent group (n = 1713) had an adjusted HR of 0.83 (0.73-0.95) for cardiovascular events compared with the allopurinol group. CONCLUSIONS The current population-based matched-cohort study did not support the association between allopurinol therapy in gout patients with normal risk for cardiovascular sequels and beneficial future cardiovascular outcomes. Several important risk factors for cardiovascular disease, such as smoking, alcohol consumption, body mass index, blood pressure were not obtainable in the current retrospective cohort study, thus could potentially bias the effect estimate.
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Affiliation(s)
- Victor C. Kok
- Public Health and Clinical Informatics Research Group, Department of Biomedical Informatics, Asia University, Wufeng, Taichung, Taiwan
- Department of Internal Medicine, Kuang Tien General Hospital, Shalu, Taichung, Taiwan
- * E-mail: (VCK); (J-TH)
| | - Jorng-Tzong Horng
- Public Health and Clinical Informatics Research Group, Department of Biomedical Informatics, Asia University, Wufeng, Taichung, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
- * E-mail: (VCK); (J-TH)
| | - Wan-Shan Chang
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
| | - Ya-Fang Hong
- Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
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Chiang PH, Wang HC, Lai YL, Chen SC, Yen-Hwa W, Kok CK, Ou YC, Huang JS, Huang TC, Chao TY. Zoledronic acid treatment for cancerous bone metastases: a phase IV study in Taiwan. J Cancer Res Ther 2013; 9:653-9. [PMID: 24518712 DOI: 10.4103/0973-1482.126471] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM OF STUDY To investigate the features, adverse effects, bone marker changes in patients with breast cancer, prostate cancer, and multiple myeloma with bone metastases under Zometa® therapy. MATERIALS AND METHODS This post-marketing study included 414 Taiwanese patients with bone metastases secondary to breast cancer, prostate cancer, or multiple myeloma who received Zometa® for 48 weeks. The patients' characteristics, medication and adverse events were recorded, meanwhile changes in four serum bone metabolic markers and pain reduction were assessed every three months for one year. RESULTS A total of 3,711 doses of Zometa® were infused, accounting for 294.5 patient-years. Adverse events occurred in 9.4% of patients, with bone pain, insomnia, constipation, and pyrexia as the most frequently reported. There was no osteonecrosis of the jaw. The incidence of skeletal-related events decreased significantly from 44.9% to 18.8%. Serum NTx, BAP, and TRACP5b steadily decreased to nadir at six months, but serum OPG was persistently elevated until the end of one year. The average decrease in pain score was 14.1, 14.3, and 16.7 for prostate cancer, breast cancer, and multiple myeloma patients, respectively. CONCLUSION Zometa® can be safely administered in Taiwanese patients with bone metastases secondary to breast cancer, prostate cancer, and multiple myeloma. There are concomitant decreases in skeletal-related events and bone pain.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tsu-Yi Chao
- Medicine, Shuang Ho Hospital, Taipei Medical University, Taiwan
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Tsai HJ, Ruan CW, Kok VC, Li MC. A large primary vaginal leiomyosarcoma diagnosed postoperatively and uterine leiomyomas treated with surgery and chemotherapy. J OBSTET GYNAECOL 2013; 33:643-4. [PMID: 23919878 DOI: 10.3109/01443615.2013.795136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- H J Tsai
- Department of Obstetrics and Gynecology, Kuang Tien General Hospital, Shalu Taichung, Taiwan.
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