1
|
Hsu YC, Chen HL, Cheng CF, Chattopadhyay A, Chen PS, Lin CC, Chiang HY, Liu TY, Huang CH, Kuo CC, Chuang EY, Lu TP, Tsai FJ. The largest genome-wide association study for breast cancer in Taiwanese Han population. Breast Cancer Res Treat 2024; 203:291-306. [PMID: 37851288 DOI: 10.1007/s10549-023-07133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/23/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Breast cancer is a molecularly heterogeneous disease, and multiple genetic variants contribute to its development and prognosis. Most of previous genome-wide association studies (GWASs) and polygenic risk scores (PRSs) analyses focused on studying breast cancers of Caucasian populations, which may not be applicable to other population. Therefore, we conducted the largest breast cancer cohort of Taiwanese population to fill in the knowledge gap. METHODS A total of 152,534 Participants recruited by China Medical University Hospital between 2003 and 2019 were filtered by several patient selection criteria and GWAS quality control steps, resulting in the inclusion of 2496 cases and 9984 controls for this study. We then conducted GWAS for all breast cancers and PRS analyses for all breast cancers and the four breast cancer subtypes, including luminal A, luminal B, basal-like, and HER2-enriched. RESULTS The GWAS analyses identified 113 SNPs, 50 of which were novel. The PRS models for all breast cancers and the luminal A subtype showed positively correlated trends between the PRS and the risk of developing breast cancer. The odds ratios (95% confidence intervals) for the groups with the highest PRS in all breast cancers and the luminal A subtype were 5.33 (3.79-7.66) and 3.55 (2.13-6.14), respectively. CONCLUSION In summary, we explored the association of genetic variants with breast cancer in the largest Taiwanese cohort and developed two PRS models that can predict the risk of developing any breast cancer and the luminal A subtype in Taiwanese women.
Collapse
Affiliation(s)
- Yu-Ching Hsu
- Bioinformatics Program, Taiwan International Graduate Program, National Taiwan University, Taipei, Taiwan
- Bioinformatics Program, Institute of Statistical Science, Taiwan International Graduate Program, Academia Sinica, Taipei, Taiwan
- Institute of Health Data Analytics and Statistics, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hung-Lin Chen
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Fung Cheng
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Amrita Chattopadhyay
- Center for Translational Genomic Research, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Ting-Yuan Liu
- Million-Person Precision Medicine Initiative, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Hao Huang
- Division of Breast Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Eric Y Chuang
- Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Tzu-Pin Lu
- Institute of Health Data Analytics and Statistics, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Fuu-Jen Tsai
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
2
|
Hsieh TF, Chen HL, Hsia YF, Lin CC, Chiang HY, Wu MY, Chen SH, Hsieh PF, Wu HC, Chang H, Kuo CC. Age-specific percentile-based prostate-specific antigen cutoff values predict the risk of prostate cancer: A single hospital observation. Biomedicine (Taipei) 2023; 13:9-24. [PMID: 37937061 PMCID: PMC10627214 DOI: 10.37796/2211-8039.1415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/18/2023] [Accepted: 06/28/2023] [Indexed: 11/09/2023] Open
Abstract
Background Testing for prostate-specific antigen (PSA) is often recommended for men with a potential risk of prostate cancer (PCa) before requiring advanced examination. However, the best PSA cutoff value remains controversial. Object We compared the predictive performance of age-specific percentile-based PSA thresholds with a conventional cutoff of >4 ng/mL for the risk of PCa. Methods We included men who received PSA measurements between 2003 and 2017 in a medical center in Taiwan. Logistic regression modeling was used to assess the association between age-specific percentile-based PSA thresholds and PCa risk in age subgroups. We further applied C-statistic and decision curve analysis to compare the predictive performance of age-specific percentile-based PSA with that of a conventional cutoff PSA. Results We identified 626 patients with PCa and 40 836 patients without PCa. The slope of PSA in patients >60-year-old was almost 3 times that of those <60-year-old (0.713 vs 0.259). The risk effect sizes of the 75th percentile PSA cutoff (<60-year-old: 2.19; 60-70-year-old: 4.36; >70-year-old: 5.84 ng/mL) were comparable to those observed based on the conventional cutoff in all age groups. However, the discrimination performance of the 75th percentile PSA cutoff was better than that of the conventional cutoff among patients aged <60-year-old (C-statistic, 0.783 vs. 0.729, p < 0.05). The 75th percentile cutoffs also correctly identified an additional 2 patients with PCa for every 100 patients with PSA screening at the threshold probability of 20%. Conclusions Our data support the use of the 75th percentile PSA cutoff to facilitate individualized risk assessment, particularly for patients aged <60-year-old.
Collapse
Affiliation(s)
- Teng-Fu Hsieh
- Division of Urology, Department of Surgery, Taichung Tzu Chi Hospital, Taichung,
Taiwan
| | - Hung-Lin Chen
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Ying-Fang Hsia
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Min-Yen Wu
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Sheng-Hsuan Chen
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung,
Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung,
Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin,
Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung,
Taiwan
- Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin,
Taiwan
| | - Han Chang
- Department of Pathology, China Medical University Hospital, Taichung,
Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung,
Taiwan
- College of Medicine, China Medical University, Taichung,
Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung,
Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung,
Taiwan
| |
Collapse
|
3
|
Wang MC, Lin CC, Chiang HY, Chen HL, Tsai HC, Lin WY, Ho HC, Kuo CC. Association between coronary artery calcium and all-cause mortality: A large single-center retrospective cohort study. PLoS One 2022; 17:e0276659. [PMID: 36288331 PMCID: PMC9604986 DOI: 10.1371/journal.pone.0276659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Previous studies have revealed that coronary artery calcium is related to cardiovascular diseases and mortality. However, most studies have been conducted in Western countries and have excluded patients with pre-existing heart disease. We investigated the association between coronary artery calcium (CAC) and all-cause mortality in an Asian cohort and in subgroups stratified by age, sex, smoking, obesity, diabetes, cardiovascular disease, blood pressure, and biochemical parameters. METHODS We conducted a retrospective cohort study on 4529 health examinees who underwent multidetector computed tomography in a tertiary medical center in Taiwan between 2011 and 2016. The mean follow-up was 3.5 years. Cox regression was used to estimate the relative hazards of death. Stratified analyses were performed. RESULTS The all-cause mortality rates were 2.94, 4.88, 17.6, and 33.1 per 1000 person-years for CAC scores of 0, 1-100, 101-400, and >400, respectively. The multivariable adjusted hazard ratios (95% confidence intervals [CIs]) for all-cause mortality were 0.95 (0.53, 1.72), 1.87 (0.89, 3.90), and 3.05 (1.46, 6.39) for CAC scores of 1-100, 101-400, and >400, respectively, relative to a CAC score of 0. Compared with CAC ≤ 400, the HRs (95% CIs) for CAC > 400 were 6.46 (2.44, 17.15) and 1.94 (1.00, 3.76) in younger and older adults, respectively, indicating that age was a moderating variable (p = 0.02). CONCLUSION High CAC scores were associated with increased all-cause mortality. Although older adult patients had higher risks of death, the relative risk of death for patients with CAC > 400 was more prominent in people younger than 65 years.
Collapse
Affiliation(s)
- Mu-Cyun Wang
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Lin Chen
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Chen Tsai
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chi Ho
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Cardiovascular Medicine and General Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Chi Kuo
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
4
|
Wang JS, Chiang HY, Wang YC, Yeh HC, Ting IW, Liang CC, Wang MC, Lin CC, Hsiao CT, Shen MY, Kuo CC. Dyslipidemia and coronary artery calcium: From association to development of a risk-prediction nomogram. Nutr Metab Cardiovasc Dis 2022; 32:1944-1954. [PMID: 35752545 DOI: 10.1016/j.numecd.2022.05.006] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The associations between dyslipidemia and coronary artery calcium (CAC) are controversial. We investigated their cross-sectional relationships and developed a predictive scoring system for prognostically significant coronary calcification (PSCC). METHODS AND RESULTS This study evaluated the lipid profiles and the CAC score (CACS) measured through multidetector computed tomography (MDCT) among Taiwanese adult patients in a tertiary hospital between 2011 and 2016. Patients with CACS higher than 100 were classified as having PSCC. Dyslipidemia for each lipid component was defined based on the clinical cutoffs or the use of the lipid-lowering agents. Multivariable logistic regression was used to assess the association between dyslipidemia and PSCC and the model performance was assessed using calibration plot, discrimination, and a decision curve analysis. Of the 3586 eligible patients, 364 (10.2%) had PSCC. Increased age, male sex, higher body mass index (BMI), and higher level of triglyceride (TG) were associated with PSCC. The adjusted odds ratios (95% confidence intervals) of PSCC was 1.15 (0.90-1.47) for dyslipidemia defined by total cholesterol (TC) ≥200 mg/dL, 1.06 (0.83-1.35) for low-density-lipoprotein-cholesterol (LDL-C) ≥130 mg/dL, and 1.36 (1.06-1.75) for TG ≥ 200 mg/dL. The positive association between TG ≥ 200 mg/dL and PSCC was not modified by sex. Incorporating hypertriglyceridemia did not significantly improve the predictive performance of the base model comprising of age, sex, BMI, smoking, hypertension, diabetes, estimated glomerular filtration rate, and fasting glucose. CONCLUSIONS Hypertriglyceridemia was significantly associated with the prevalent odds of PSCC. Our proposed predictive model may be a useful screening tool for PSCC.
Collapse
Affiliation(s)
- Jie-Sian Wang
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, Taichung, Taiwan
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital and College of Medicine, Taichung, Taiwan
| | - Hung-Chieh Yeh
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - I-Wen Ting
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Chia Liang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mu-Cyun Wang
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital and College of Medicine, Taichung, Taiwan
| | - Chiung-Tzu Hsiao
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Yi Shen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Big Data Center, China Medical University Hospital and College of Medicine, Taichung, Taiwan.
| |
Collapse
|
5
|
Huang CM, Sung FC, Chen HJ, Lin CC, Lin CL, Huang PH. Hypothyroidism risk associated with rheumatoid arthritis: A population-based retrospective cohort study. Medicine (Baltimore) 2022; 101:e28487. [PMID: 35029902 PMCID: PMC8735800 DOI: 10.1097/md.0000000000028487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Studies on the thyroid disease risk in patients with rheumatoid arthritis (RA) associated with comorbidities are limited. This population-based retrospective cohort study investigated the hypothyroidism risk in patients with RA and the role of comorbidities.We used Taiwan National Health Insurance Research Database to identify 16,714 RA patients newly diagnosed in 2000 to 2008 and 66,856 control persons without RA, frequency matched by sex, age, and index year. Incidence and the RA group to controls hazard ratio of hypothyroidism were estimated.The hypothyroidism incidence was 1.74-fold higher in the RA group than in controls (16.6 vs 9.52 per 10,000 person-years), with the Cox method estimated adjusted hazard ratio of 1.67 (95% confidence interval = 1.39-2.00) after controlling for covariates. Near 75% of the study population were women, with the incidence 3.6-time higher than men in both groups. The hypothyroidism incidence increased with age, from 12.1 per 1000 person-years in 20 to 39 years to 20.0 per 1000 person-years in 60+ years in RA patients, higher than that in controls (7.17 vs 10.0 per 1000 person-years, respectively by age). Each comorbidity was related to an increased incidence and higher in the RA group than in controls. Among all comorbidities, stroke exerted the greatest impact in the RA group with an adjusted hazard ratio of 3.85 (95% confidence interval = 1.24-12.0).RA patients have an increased risk of developing hypothyroidism; this risk was pronounced in women and the elderly. RA patients should be closely monitored to prevent the development of hypothyroidism.
Collapse
Affiliation(s)
- Chung-Ming Huang
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University College of Chinese Medicine, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- China Medical University College of Medicine, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Po-Hao Huang
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
6
|
Lu YC, Chen PT, Lin MC, Lin CC, Wang SH, Pan YJ. Nonsteroidal Anti-Inflammatory Drugs Reduce Second Cancer Risk in Patients With Breast Cancer: A Nationwide Population-Based Propensity Score-Matched Cohort Study in Taiwan. Front Oncol 2021; 11:756143. [PMID: 34900705 PMCID: PMC8651993 DOI: 10.3389/fonc.2021.756143] [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: 08/10/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce mortality in patients with cancer, especially breast cancer, but their influence on second cancer risk is uncertain. This study aimed to examine whether NSAID use is associated with second cancer risk in patients with breast cancer. This population-based propensity score-matched cohort study using Taiwan’s National Health Insurance Research Database enrolled patients with newly diagnosed breast cancer (n = 7356) with and without (n = 1839) NSAID therapy from 2000 to 2009. They were followed up until the diagnosis of second cancer, death, or end of 2011. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR). The NSAID cohort had a lower incidence rate of second cancer than the non-NSAID cohort (5.57 vs. 9.19 per 1,000 person-years), with an aHR of 0.63 (95% confidence interval (CI) 0.46–0.87). When compared with the non-NSAID cohort, the second cancer incidence was lower in patients taking non-cyclooxygenase 2 inhibitors (aHR 0.67, 95% CI 0.47–0.94) and in those receiving multiple NSAIDs during follow-up (aHR 0.55, 95% CI 0.37–0.84). A dose–response relationship existed in NSAID cumulative days. The findings demonstrate that NSAID use reduces second cancer risk in a dose-dependent manner in patients with primary breast cancer.
Collapse
Affiliation(s)
- Yin-Che Lu
- Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Pin-Tzu Chen
- Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Shi-Heng Wang
- Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Yi-Jiun Pan
- School of Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
7
|
Liang HY, Hsiao YL, Yeh HC, Ting IW, Lin CC, Chiang HY, Kuo CC. Associations Between Myocardial Diastolic Dysfunction and Cardiovascular Mortality in Chronic Kidney Disease: A Large Single-Center Cohort Study. J Am Soc Echocardiogr 2021; 35:395-407. [PMID: 34915133 DOI: 10.1016/j.echo.2021.12.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The clinical burden and prognostic role of diastolic dysfunction (DD), based on the latest American Society of Echocardiography (ASE) 2016 guidelines, remains unclear in patients with chronic kidney disease (CKD). Moreover, risk mapping of concomitant systolic dysfunction and DD to evaluate the hazard of cardiovascular (CV) mortality in CKD remains unexplored. METHODS This retrospective cohort study identified 20,257 adult patients who underwent comprehensive echocardiography between 2008 and 2016 at a tertiary medical center in central Taiwan. The patients were stratified by CKD stage, and the 3-year CV mortality risk in each CKD stratum was estimated through multivariable Cox proportional hazard modeling using left ventricular ejection fraction (LVEF) and DD grades based on ASE 2016 guideline as the main risk factors. RESULTS Compared with patients with CKD stages 1 and 2, those with CKD stages 4 and 5 had a significantly lower LVEF and more severe DD. Both LVEF (LVEF < 40% vs. ≥ 60%; adjusted hazard ratio [aHR] 3.17, 95% confidence interval [CI] 2.54-3.97) and DD grade (severe DD vs. normal diastolic function; aHR 3.33, 95% CI 2.33-4.76) were independently associated with 3-year CV mortality in the entire study population and had comparable effect sizes. The corresponding aHRs further increased to 4.20 (2.45-7.21) and 4.54 (2.20-9.38) in patients with CKD stages 4 and 5. Systolic and diastolic dysfunction demonstrated mutually augmentative effects on CV mortality. CONCLUSIONS These findings suggest that the current practice of cardioprotection for patients with CKD should be prioritized at an early stage along with conventional nephroprotection.
Collapse
Affiliation(s)
- Hsin-Yueh Liang
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Ya-Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hung-Chieh Yeh
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Wen Ting
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
8
|
Chiang HY, Chen TC, Lin CC, Ho LC, Kuo CC, Chi CY. Trend and Predictors of Short-term Mortality of Adult Bacteremia at Emergency Departments: A 14-Year Cohort Study of 14 625 Patients. Open Forum Infect Dis 2021; 8:ofab485. [PMID: 34805430 PMCID: PMC8598924 DOI: 10.1093/ofid/ofab485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Bacteremia is a life-threatening condition with a high mortality rate in critical care and emergency settings. The current study investigated the trend of mortality and developed predictive models of mortality for adults with bacteremia at emergency departments (EDs). METHODS We conducted a retrospective cohort study of adults with bacteremia at the ED of China Medical University Hospital. Patient data were obtained from the Clinical Research Data Repository, and mortality information was obtained from the National Death Registry. We developed a new model to predict 7-day mortality in the derivation population and compared the model performance of the new model with Pitt Bacteremia Score (PBS) and Bloodstream Infection Mortality Risk Score (BSIMRS) in the validation population. RESULTS We identified 14625 adult patients with first-time bacteremia at the ED, of whom 8.4% died within 7 days. From 2003 to 2016, both the cumulative incidence and 7-day mortality rate of bacteremia decreased significantly. The ED bacteremia mortality (ED-BM) model included PBS parameters, age, infection source, baseline steroid use, and biochemical profiles (estimated glomerular filtration rate, platelet, blood urea nitrogen, potassium, and hemoglobin) for predicting 7-day mortality. The discrimination performance of the ED-BM model (area under curve [AUC], 0.903) was significantly better than that of PBS (AUC, 0.848) or BSIMRS (AUC, 0.885). CONCLUSIONS Although the cumulative incidence and mortality of ED bacteremia decreased, its mortality burden remains critical. The proposed ED-BM model had significantly better model performance than other scoring systems in predicting short-term mortality for adult patients with bacteremia at EDs.
Collapse
Affiliation(s)
- Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Tsung-Chia Chen
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Lu-Ching Ho
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yu Chi
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
9
|
Ho TC, Chen YC, Lin CC, Tai HC, Wei CY, Yeh YH, Hsu CY. Reduced Risk of Atrial Fibrillation Following Cholecystectomy: A Nationwide Population-Based Study. Front Aging Neurosci 2021; 13:706815. [PMID: 34539379 PMCID: PMC8445074 DOI: 10.3389/fnagi.2021.706815] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/08/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Gallstone disease (GD) is associated with a high risk of cardiovascular disease. However, it is unknown whether GD contributes to atrial fibrillation (AF). We aimed to investigate the association between GD and AF. Methods: We performed a population-based cohort study using data from the Taiwan National Health Insurance Research Database between 2001 and 2011. A GD cohort of 230,076 patients was compared with a control cohort consisting of an equal number of patients matched for age, sex, cardiovascular and gastrointestinal comorbidities. Results: In total, 5,992 (49.8/10,000 person-years) patients with GD and 5,804 (44.5/10,000 person-years) controls developed AF. GD increased AF risk with a hazard ratio (HR) of 1.20 [95% confidence interval (CI), 1.16-1.25]. In patients with GD but without cholecystectomy, the HR of AF reached 1.57 (95% CI = 1.50-1.63). After cholecystectomy, the HR of AF significantly decreased to 0.85 (95% CI = 0.81-0.90). Among the three age groups with GD (<45, 45-64, and ≥65 years), the adjusted HRs of AF were 1.59 (95% CI = 1.08-2.33), 1.31 (95% CI = 1.18-1.45), and 1.18 (95% CI = 1.13-1.22), respectively. Compared with patients with a CHA2DS2-VASc score equal to 0, the HRs of AF risk among total cohort patients and a score equal to 1, 2, 3, and ≥ 4 were 1.28 (95% CI = 1.15-1.43), 2.26 (95% CI = 2.00-2.56), 3.81 (95% CI = 3.35-4.34), and 5.09 (95% CI = 4.42-5.87), respectively. Conclusion: This population-based longitudinal follow-up study showed that patients with GD had an increased AF risk. Moreover, cholecystectomy was related to reduced AF risk. Cardiovascular checkups may be necessary for patients with GD, especially those who are young and have other typical risk factors.
Collapse
Affiliation(s)
- Tung Ching Ho
- Department of Cardiology, Chang Hua Hospital, Changhua County, Taiwan.,Department of Bioinformatics and Medical Engineering, College of Information and Electrical Engineering, Asia University, Taichung, Taiwan
| | - Yu-Ching Chen
- Department of Bioinformatics and Medical Engineering, College of Information and Electrical Engineering, Asia University, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hsu-Chih Tai
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan.,Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Yung-Hsiang Yeh
- Digestive Disease Center, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
10
|
Chan SL, Lin CC, Chau PH, Takemura N, Fung JTC. Evaluating online learning engagement of nursing students. Nurse Educ Today 2021; 104:104985. [PMID: 34058645 DOI: 10.1016/j.nedt.2021.104985] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Previous studies suggest that increased learning satisfaction may encourage learning engagement in an online learning environment. OBJECTIVES To evaluate the level of learning engagement and its relationship with students' perceived learning satisfaction in an online clinical nursing elective course. DESIGN A prospective interventional study. SETTINGS A nursing course was converted to an online format because of the coronavirus disease COVID pandemic. PARTICIPANTS Part-time post-registration nursing undergraduates enrolled in an elective online clinical course. METHODS Related teaching and learning strategies were deployed in the course using the Community of Inquiry framework. All students who completed the course were invited to complete an online survey that included a validated Online Student Engagement questionnaire (OSE). Pearson's correlations were used to determine the association between perceived learning satisfaction and learning engagement. A logistic regression model was used to explore the associations of gender, age, working experience and perceived learning satisfaction with higher learning engagement. RESULTS The questionnaires were completed by 56 of 68 students (82%). The Pearson's correlation coefficient between the mean perceived learning satisfaction and OSE scores was 0.75 (p < .001). Twenty-five students (45%) were identified as highly engaged, using a cut-off of ≥3.5 for the mean OSE score. The mean perceived learning satisfaction (SD) score differed significantly between highly engaged and not highly engaged students [4.02 (0.49) vs. 3.27 (0.62), p < .001]. The logistic regression model showed that a greater perceived learning satisfaction [adjusted odds ratio (OR): 17.2, 95% C.I.: 3.46-86.0, p = .001] was associated with an increased likelihood of higher learning engagement, and >1 year of working experience (adjusted OR: 0.11, 95% C.I.: 0.01-0.89, p = .0039) was associated with a decreased likelihood of higher learning engagement. CONCLUSIONS The study findings suggest that perceived learning satisfaction predicts learning engagement among nursing students in this online learning course.
Collapse
Affiliation(s)
- S L Chan
- University of Hong Kong School of Nursing, Hong Kong.
| | - C C Lin
- University of Hong Kong School of Nursing, Hong Kong.
| | - P H Chau
- University of Hong Kong School of Nursing, Hong Kong.
| | - N Takemura
- University of Hong Kong School of Nursing, Hong Kong.
| | - J T C Fung
- University of Hong Kong School of Nursing, Hong Kong.
| |
Collapse
|
11
|
Lin CC, Lai CH, Lin WS, Lin CS. Severe myocardial bridge presenting as paroxysmal atrioventricular block. J Postgrad Med 2021; 67:171-173. [PMID: 33835057 PMCID: PMC8445129 DOI: 10.4103/jpgm.jpgm_1027_20] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/09/2020] [Accepted: 12/24/2020] [Indexed: 11/11/2022] Open
Abstract
Chest pain complicated with electrocardiographic changes is not an uncommon scenario in emergency departments, which should be examined cautiously. We describe a 51-years-old man with a myocardial bridge of coronary artery presenting with simultaneous Mobitz type I atrioventricular block on electrocardiography. Echocardiography excluded valvular abnormality and systolic/diastolic dysfunction. Coronary angiography confirmed the diagnosis of a myocardial bridge at the middle segment of the left anterior descending artery, involving the most dominant septal perforator branch with marked systolic compression. The patient underwent coronary artery bypass grafting surgery and was followed up uneventfully at the outpatient department with medical treatment of diltiazem and clopidogrel. The present case is being reported to highlight that clinicians should be alert to such a congenital abnormality as a potential cause of repeated myocardial infarction and conduction abnormality.
Collapse
Affiliation(s)
- CC Lin
- Division of Cardiology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
| | - CH Lai
- Division of Cardiology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
| | - WS Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - CS Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| |
Collapse
|
12
|
Lee YW, Chuang JY, Lin CC, Paul MC, Das S, Dhar A. High-efficiency picosecond mode-locked laser using a thulium-doped nanoengineered yttrium-alumina-silica fiber as the gain medium. Opt Express 2021; 29:14682-14693. [PMID: 33985185 DOI: 10.1364/oe.422947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
We report the theoretical and experimental investigation of a self-starting mode-locked fiber laser with a nanoengineered Tm3+-doped yttrium-alumina-silica (YAS) fiber as the gain medium. The YAS fiber exhibits a higher capability of Tm3+ cluster elimination than commercial silica fibers. The Tm3+ fluorescence properties and YAS dispersion are well characterized. As a result, an efficient picosecond mode-locked fiber laser is demonstrated with a slope efficiency of 14.14% and maximum pulse energy of 1.27 nJ. To the best of our knowledge, this is the first mode-locked fiber laser based on a Tm3+-doped YAS fiber. The experimental observation is also supported by the numerical analysis.
Collapse
|
13
|
Hsu YL, Chang SN, Kuo CC, Lin CC, Lin HC, Lai HC, Hwang KP, Chiang HY. 1372. Urinary Tract Infections Caused by Gram-Positive Bacteria in Patients Younger than 19 Years: Prediction Analysis in a 13-year Hospital-Based Cohort. Open Forum Infect Dis 2020. [PMCID: PMC7777486 DOI: 10.1093/ofid/ofaa439.1554] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Urinary tract infection (UTI) is one of the common pediatric bacterial infections. Gram positive (GP) pathogens, in contrast to gram negative (GN) bacilli such as E. coli, are less accounted for pediatric UTI. The aim of this study was to identify predictors to enable clinicians to detect GP uropathogens from mostly causative GN bacteria in children with UTI.
Methods
This retrospective cohort study identified 26,066 paired urinalysis and urine culture obtained from the pediatric patients during 2003-2016. Of patients with UTI meeting our criterial, we included children with first-time UTI and classified them into GP-UTI and GN-UTI (Figure 1). Demographic, clinical and laboratory data were collected into analysis. We built a multivariable logistic regression model to predict the GP-UTI. The model performance was examined by using calibration and discrimination plots. We demonstrated a nomogram to predict GP-UTI that could be feasible in the clinical practice.
Figure 1. Flowchart of the Selection Process of the Study Population (N = 3,783 patients).
Results
Of 3,783 children with first-time UTIs, 166 (4.4%) were infected by GP and 3,617 (95.6%) by GN bacteria. The top 3 pathogens for GP uropathogens were vancomycin-resistant (VR) E. faecalis, S. saprophyticus, and coagulase-negative Staphylococcus. Significant risk factors associated with GP-UTI in the multivariable analysis were: age >= 24 months [odds ratio (OR) 3.40, 95% confidence interval (CI) 1.40-8.26], serum white blood cell (WBC) (compared to ≥14.4 x 103/μL) [OR 2.18, 95% CI 1.26-3.77], hemoglobin (compared to < 11.3 g/dL) [OR 1.89, 95% CI 1.04-3.45], negative urine leukocyte esterase [OR 3.12, 95% CI 1.83-5.33], negative urine nitrite [OR 4.14, 95% CI 1.88-9.14] and urine WBC (compared to ≥420/μL) [OR 2.16, 95% CI: 1.09, 4.26] (Table 1). This model had good discrimination (C-statistic 0.874; 95% CI 0.839-0.908) and calibration performance (Figure 2). By using our nomogram, physicians can estimate the probability of UTI that is caused by a GP pathogen, with a probability ranges from 0.04% to 55% (Figure 3).
Table 1. Multivariable Prediction Model for Pediatric Urinary Tract Infections Caused by Gram-Positive Bacteria.
Figure 2. Discrimination Plot (A) and Calibration Plot (B) of the Prediction Model for Pediatric Urinary Tract Infections Caused by Gram-Positive Bacteria.
Figure 3. Nomogram of the Prediction Model for Pediatric Urinary Tract Infections Caused by Gram-Positive Bacteria.
Conclusion
VR E. faecalis is the leading GP uropathogen in the children less than two years of age which need notice of infection control. Our proposed prediction model for GP UTI in children could help clinicians detect potential GP uropathogen and enable them to choose adequate antibiotic regimen early.
Disclosures
All Authors: No reported disclosures
Collapse
Affiliation(s)
- Yu-Lung Hsu
- Division of Pediatric Infectious Diseases, China Medical University Children’s Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Chin-Chi Kuo
- China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Hsiao-Chuan Lin
- Division of Pediatric Infectious Diseases, China Medical University Children’s Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Huan-Cheng Lai
- Division of Pediatric Infectious Diseases, China Medical University Children’s Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Kao-Pin Hwang
- Division of Pediatric Infectious Diseases, China Medical University Children’s Hospital, Taichung, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| |
Collapse
|
14
|
Lu YC, Huang DW, Chen PT, Tsai CF, Lin MC, Lin CC, Wang SH, Pan YJ. Association between statin use and second cancer risk in breast cancer patients: a nationwide population-based cohort study. Breast Cancer Res Treat 2020; 185:773-783. [PMID: 33067779 DOI: 10.1007/s10549-020-05969-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/27/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Many studies have revealed that statin therapy reduced mortality in cancer patients, especially in breast cancer, but the effect for second cancer was unclear. We, therefore, performed a comparable cohort study to determine the risk of second cancer in breast cancer patients with statin therapy. METHODS Using claims data from Taiwan's National Health Insurance Program, this study enrolled newly diagnosed breast cancer patients from 2000 to 2007 with and without statin therapy as the statin (n = 1222) and nonstatin (n = 4888) cohorts, respectively. The nonstatin cohort was propensity score matched by cohort entry year, age, and randomly selected comorbidities. These two cohorts were followed up until the diagnosis of second cancer, death, or the end of 2011. Cox proportional hazard models were used to estimate the hazard ratios. RESULTS The statin cohort had a lower incidence rate than the nonstatin cohort for second cancer (7.37 vs. 8.36 per 1000 person-years), although the difference was not significant (adjusted hazard ratio [aHR] 0.90, 95% confidence interval [CI] 0.65-1.26). Compared with the nonstatin cohort, the second cancer risk was significantly higher for patients taking pravastatin (aHR 2.71, 95% CI 1.19-6.19) but lower for those receiving multiple statin treatment (aHR 0.45, 95% CI 0.25-0.81) and combined lipophilic and hydrophilic type of statin (aHR 0.42, 95% CI 0.20-0.89). The risk was lower for patients receiving a cumulative defined daily dose (cDDD) of > 430 (aHR 0.41, 95% CI 0.19-0.86). CONCLUSION This study showed that there is little association between statin use and second cancer risk in breast cancer patients.
Collapse
Affiliation(s)
- Yin-Che Lu
- Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-yi, Taiwan
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Da-Wei Huang
- Section of Neurosurgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-yi, Taiwan
| | - Pin-Tzu Chen
- Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-yi, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-yi, 600, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Shi-Heng Wang
- Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan.
- Department of Public Health, China Medical University, Taichung, Taiwan.
| | - Yi-Jiun Pan
- School of Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
15
|
Wei YT, Lee PY, Lin CY, Chen HJ, Lin CC, Wu JS, Chang YF, Wu CL, Guo HR. Non-alcoholic fatty liver disease among patients with sleep disorders: a Nationwide study of Taiwan. BMC Gastroenterol 2020; 20:32. [PMID: 32041532 PMCID: PMC7011431 DOI: 10.1186/s12876-020-1178-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 01/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases. Studies have shown that sleep apnea is associated with NAFLD. However, studies on the association between sleep disorders in general and NAFLD are limited. We conducted a nationwide population-based longitudinal study to evaluate this potential association. Methods We identified patients diagnosed with sleep disorders in the years 2000 through 2005 in Taiwan using the National Health Insurance Research Database and selected an equal number of patients without sleep disorders from the same database as the comparison cohort. The patients were followed from the index date to the diagnosis of NAFLD or the end of 2013. We used Cox proportional hazards models to estimate the risk of NAFLD associated with sleep disorders. Results A total of 33,045 patients with sleep disorders were identified. The incidence of NAFLD was 14.0 per 10,000 person-year in patients with sleep disorders and 6.2 per 10,000 person-year in the comparison cohort. The adjusted hazard ratio (AHR) of NAFLD associated with sleep disorders was 1.78 (95% confidence interval [95%CI]: 1.46–2.16), and other independent risk factors included male sex (AHR = 1.31, 95%CI: 1.12–1.54), age 40–59 years (AHR = 1.49, 95%CI: 1.21–1.82), and dyslipidemia (AHR = 2.51, 95%CI: 2.08–3.04). In the subgroup analyses, both patients with (AHR = 2.24, 95%CI: 1.05–4.77) and without (AHR = 1.77, 95%CI: 1.46–2.15) sleep apnea had an increased risk of NAFLD. Conclusions Sleep disorders are associated with NAFLD, even in patients without sleep apnea. Further studies are warranted to explore the mechanisms of the association.
Collapse
Affiliation(s)
- Yu-Ting Wei
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China.,Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China.,Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China.,Preventive Medicine Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Road, Taichung, 42743, Taiwan, Republic of China
| | - Peng-Yi Lee
- Department of Radiation Oncology, China Medical University Hospital, No. 2, Yude Road, Taichung, 40447, Taiwan, Republic of China.,Department of Radiation Oncology, China Medical University Beigang Hospital, No.123, Sinde Road, Yunlin, 65152, Taiwan, Republic of China
| | - Cheng-Yu Lin
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China.,Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China.,Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, No.2, Yude Road, North District, Taichung, 40447, Taiwan, Republic of China.,College of Medicine, China Medical University, No.91, Hsueh-Shih Road, Taichung, 40402, Taiwan, Republic of China
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, No.2, Yude Road, North District, Taichung, 40447, Taiwan, Republic of China.,Healthcare Service Research Center, Taichung Veterans General Hospital, No.1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, Republic of China
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China.,Department of Family Medicine, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 70101, Taiwan, Republic of China
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China
| | - Chen-Long Wu
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China. .,Department of Occupational and Environmental Medicine, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China.
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China. .,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China. .,Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China. .,Department of Occupational and Environmental Medicine, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70403, Taiwan, Republic of China.
| |
Collapse
|
16
|
Hsieh YC, Liao YC, Li CH, Lin JC, Weng CJ, Lin CC, Lo CP, Huang KC, Huang JL, Lin CH, Wang JS, Wu TJ, Sheu WHH. Hypoglycaemic episodes increase the risk of ventricular arrhythmia and sudden cardiac arrest in patients with type 2 diabetes-A nationwide cohort study. Diabetes Metab Res Rev 2020; 36:e3226. [PMID: 31655001 DOI: 10.1002/dmrr.3226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/04/2019] [Revised: 10/06/2019] [Accepted: 10/07/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The impact of hypoglycaemic episode (HE) on the risk of ventricular arrhythmia (VA) and sudden cardiac arrest (SCA) remains unclear. We hypothesized that HE increases the risk of both VA and SCA and that glucose-lowering agents causing HE also increase the risk of VA/SCA in patients with type 2 diabetes (T2D). METHODS Patients aged 20 years or older with newly diagnosed T2D were identified using the Taiwan National Health Insurance Database. HE was defined as the presentation of hypoglycaemic coma or specified/unspecified hypoglycaemia. The control group consisted of T2D patients without HE. The primary outcome was the occurrence of VA (including ventricular tachycardia and fibrillation) and SCA during the defined follow-up periods. A multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for VA or SCA. RESULTS A total of 54 303 patients were screened, with 1037 patients with HE assigned to the HE group and 4148 frequency-matched patients without HE constituting the control group. During a mean follow-up period of 3.3 ± 2.5 years, 29 VA/SCA events occurred. Compared with the control group, HE group had a higher incidence of VA/SCA (adjusted HR: 2.42, P = .04). Patients who had used insulin for glycaemic control showed an increased risk of VA/SCA compared with patients who did not receive insulin (adjusted HR: 3.05, P = .01). CONCLUSIONS The HEs in patients with T2D increased the risk of VA/SCA, compared with those who did not experience HEs. Use of insulin also independently increased the risk of VA/SCA.
Collapse
Affiliation(s)
- Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Ying-Chieh Liao
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Cheng-Hung Li
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Jiunn-Cherng Lin
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan
| | - Chi-Jen Weng
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
- Department of Financial Engineering, Providence University, Taichung, Taiwan
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chu-Pin Lo
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
| | - Kuo-Ching Huang
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Sing Wang
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Rong Hsing Research Center and PhD Program for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wayne H-H Sheu
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| |
Collapse
|
17
|
Hsieh YC, Liao YC, Li CH, Lin JC, Weng CJ, Lin CC, Lo CP, Huang KC, Huang JL, Lin CH, Wu TJ, Sheu WH. P5644Hypoglycemic episodes increase the risk of ventricular arrhythmias and sudden cardiac arrest in patients with type 2 diabetes - a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0587] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypoglycemic episode (HE) increases the risk of cardiovascular mortality. The impact of HE on the risk of sudden death remains unclear. We hypothesized that HE increases the risks of ventricular arrhythmia (VA) and sudden cardiac arrest (SCA), and that anti-diabetic agents (ADAs) causing hypoglycemia also increase the risks of VA and SCA.
Methods
Patients aged ≥20 years with newly diagnosed diabetes were identified from the Taiwan National Insurance Database. HE was defined as the presentation of hypoglycemic coma or specified/unspecified hypoglycemia. For control group, we included diabetic patients without HE, and they were frequency-matched to the HE group at a 4:1 ratio. The primary outcome was the occurrence of any event of VA (including ventricular tachycardia and fibrillation) and SCA during the defined follow-up periods. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for VA or SCA.
Results
A total of 54,303 diabetic patients were screened with 1,037 of them in the HE group, and 4,148 in the control group. During a mean follow-up period of 3.3±2.5 years, 29 VA/SCA events had occurred. Compared to the control group, the HE group had a higher incidence of VA/SCA (adjusted HR: 2.42, p=0.04). Diabetic patients medicated with insulin for glycemic control increased the risk of VA/SCA compared to those without insulin (adjusted HR: 3.05, p=0.01).
Kaplan-Meier survival curves
Conclusions
HEs in patients with diabetes increased the risks of VA and SCA compared to those without. Their use of insulin also independently increased the risk of VA/SCA.
Collapse
Affiliation(s)
- Y C Hsieh
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - Y C Liao
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - C H Li
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - J C Lin
- Chiayi Branch, Taichung Veterans General Hospital, Department of Internal Medicine, Chiayi, Taiwan
| | - C J Weng
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - C C Lin
- Taichung Veterans General Hospital, Department of Medical Research, Taichung, Taiwan
| | - C P Lo
- Providence University, Department of Financial Engineering, Taichung, Taiwan
| | - K C Huang
- Providence University, Department of Financial Engineering, Taichung, Taiwan
| | - J L Huang
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - C H Lin
- Taichung Veterans General Hospital, Department of Medical Research, Taichung, Taiwan
| | - T J Wu
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - W H Sheu
- Taichung Veterans General Hospital, Division of Endocrinology and Metabolism, Department of Medicine, Taichung, Taiwan
| |
Collapse
|
18
|
Chuang SC, Lin CC, Peng CY, Huang WH, Su WP, Lai SW, Lai HC. Proton pump inhibitors increase the risk of cholecystitis: a population-based case-control study. Gut 2019; 68:1337-1339. [PMID: 30018164 DOI: 10.1136/gutjnl-2018-316899] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/02/2018] [Accepted: 06/19/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Shih-Chieh Chuang
- School of Medicine, China Medical University, Taichung, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - Cheng-Yuan Peng
- School of Medicine, China Medical University, Taichung, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Hsin Huang
- School of Medicine, China Medical University, Taichung, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Pang Su
- School of Medicine, China Medical University, Taichung, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- School of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsueh-Chou Lai
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
19
|
Chen MN, Ho KY, Hung YN, Su CC, Kuan CH, Tai HC, Cheng NC, Lin CC. Pre-treatment quality of life as a predictor of distant metastasis-free survival and overall survival in patients with head and neck cancer who underwent free flap reconstruction. Eur J Oncol Nurs 2019; 41:1-6. [PMID: 31358241 DOI: 10.1016/j.ejon.2019.05.003] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE This study examined the prognostic associations of pre-treatment quality of life (QoL) with overall survival (OS) and distant metastasis-free survival (DFMS) among patients with head and neck cancer (HNC) who underwent free flap reconstruction. METHODS A cohort of 127 HNC patients who received free flap reconstruction between November 2010 and June 2014 at a hospital were recruited. Pre-treatment QoL was measured by the University of Washington Quality of Life Questionnaire, which contains six physical domains, including speech, swallowing, appearance, saliva, taste and chewing, as well as the six social-emotional domains of pain, activity, recreation, shoulder, mood, and anxiety. Cox regression analyses were performed. RESULTS Results showed that pre-treatment QoL was predictive of OS and DMFS. Of the domains, swallowing, chewing, speech, taste, saliva, pain and shoulder were demonstrated to be significant predictors of OS. Additionally, swallowing, chewing, speech, pain and activity were demonstrated making significant contributions to DMFS. CONCLUSION Our data supported that physical domains of pre-treatment QoL were predictors for OS and DFMS in HNC patients with free-flap reconstruction. Longitudinal studies are warranted to clarify the prognostic abilities of social-emotional domains. Information on pre-treatment QoL should be taken into account to individualize care plan for these patients, and hence prolong their survival.
Collapse
Affiliation(s)
- M N Chen
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - K Y Ho
- School of Nursing, The University of Hong Kong, HKSAR, China.
| | - Y N Hung
- School of Gerontology and Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - C C Su
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - C H Kuan
- Graduate Institute of Clinical Research, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - H C Tai
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - N C Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - C C Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, The University of Hong Kong, HKSAR, China; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
| |
Collapse
|
20
|
Fu LS, Lin CC, Wei CY, Lin CH, Huang YC. Risk of acute exacerbation between acetaminophen and ibuprofen in children with asthma. PeerJ 2019; 7:e6760. [PMID: 31024768 PMCID: PMC6474393 DOI: 10.7717/peerj.6760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/09/2019] [Indexed: 11/20/2022] Open
Abstract
Background Antipyretics are widely prescribed in pediatric practice. Some reports have mentioned that acetaminophen and non-steroid anti-inflammatory drugs may negatively affect asthma control by causing asthma exacerbation (AE). However, many confounding factors can also influence the risks. We assessed the impact of using acetaminophen or ibuprofen on AE in asthmatic children, especially those with strong risk factors. Methods We used the 2010 Taiwan National Health Insurance Research Database and identified 983 children with persistent asthma aged 1-5 years old; among them, 591 used acetaminophen alone and 392 used ibuprofen alone in 2010. Then, we analyzed the risk of AE over 52 weeks in the patients with and without severe AE in the previous year. Results The ibuprofen group had a higher risk of an emergency room (ER) visit or hospitalization for AE (odds ratio (OR) = 2.10, 95% confidence interval (CI) [1.17-3.76], P = 0.01). Among asthmatic children who had severe AE in the previous year, the risk of AE was higher in the ibuprofen group than in the acetaminophen group (OR = 3.28, 95% CI [1.30-8.29], P = 0.01), where as among those who did not, the risks of AE were similar between the acetaminophen and ibuprofen groups (OR = 1.52, 95% CI [0.71-3.25], P = 0.28). Conclusions Among young asthmatic children, use of ibuprofen was associated with a higher risk of AE than acetaminophen, if they had severe AE with ER visit or hospitalization in the previous year. Pediatricians should use antipyretics among children with asthma after a full evaluation of the risk.
Collapse
Affiliation(s)
- Lin-Shien Fu
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Pediatrics, National Yang-Ming University, Taipei, Taiwan
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Yi Wei
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yung-Chieh Huang
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Pediatrics, Puli Branch, Taichung Veterans General Hospital, Nantou, Taiwan
| |
Collapse
|
21
|
Hao S, Lu CH, Lin CC, Chen HY, Li L, Wang YB, Feng MX, He Y. [The role and mechanism of 2-deoxyglucose in reversing osimertinib-acquired resistance of non-small cell lung cancer cell line]. Zhonghua Jie He He Hu Xi Za Zhi 2019; 42:198-205. [PMID: 30845397 DOI: 10.3760/cma.j.issn.1001-0939.2019.03.010] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the role and mechanism of 2-deoxyglucose (2-dg) in reversing osimertinib- acquired resistance of non-small cell lung cancer(NSCLC)cell line. Methods: The NSCLC line H1975 (purchased from the American Type Culture Collection) was conducted by induction method in vitro to construct the osimertinib-resistance NSCLC cell line H1975-OR. The osimertinib-resistance of H1975-OR cell line was examined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, colony-formation assay, Ki67 incorporation assay and the expression of apoptosis-related protein. The glycolysis level was assayed by the lactic acid production measured in the culture medium supernatant of H1975 and H1975-OR. The expression of glycolysis key enzymes (HK2, GLUT1, P-PKM2) and apoptosis-related protein (BIM, Bcl-2) were detected by Western blot. The cells were divided into control group, 2-deoxyglucose (4 mmol/L) monotherapy group, osimertinib (3 μmol/L) monotherapy group and 2-deoxyglucose (4 mmol/L)+ osimertinib (3 μmol/L) combination therapy group, then the apoptosis rate of cells was measured by flow cytometry to evaluate the pro-apoptotic ability of drugs. Date were analyzed by Independent-Samples t-test using SPSS 16.0 statistical software. Results: The glycolysis level of osimertinib-sensitive cell line H1975 was lower than that of osimertinib-resistance cell line H1975-OR [the yield of lactic acid, respectively, was (21.0±0.9) and (26.5±2.8) mmol·L(-1)·10(4)cells(-1), P<0.05]. The osimertinib- acquired resistance of H1975-OR could be reversed by 4 mmol/L 2-deoxyglucose(the IC(50) value of osimertinib in H1975-OR cell line decreased from (7.0±1.9) μmol/L to (1.4±0.1) μmol/L, which was close to the IC(50) value of osimertinib in H1975 cell line (1.0±0.2) μmol/L. The apoptosis rate of H1975-OR was significantly higher in 2-deoxyglucose + osimertinib combination therapy group (26.7±2.4)%, compared to control group (5.1±0.7)%, 2-deoxyglucose monotherapy group (6.1±2.5)% and osimertinib monotherapy group (11.4±2.7)%(all P<0.05). The expression of pro-apoptotic protein BIM in H1975-OR was significantly higher in 2-deoxyglucose+ osimertinib combination therapy group (177.8±28.1)% and the expression of anti-apoptotic protein Bcl-2 in H1975-OR was significantly lower in 2-deoxyglucose+ osimertinib combination therapy group (24.6±5.2)%, compared to control group (100±0)%, all P<0.05. Conclusion: 2-deoxyglucose can reverse the acquired resistance of NSCLC cell line to osimertinib, which may be related to the inhibition of cell glycolysis and the induction of apoptosis.
Collapse
Affiliation(s)
- S Hao
- Department of Respiratory Disease, Daping Hospital, Army Military Medical University, Chongqing 400042, China
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Chen YM, Lin CH, Chen HH, Chao WC, Chen DY, Lin CC, Liao TL. Risk of mycobacterial disease among cancer patients: A population-based cohort study in a TB endemic area. Cancer Epidemiol 2019; 59:64-70. [PMID: 30703617 DOI: 10.1016/j.canep.2019.01.010] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Tuberculosis (TB) and nontuberculous mycobacteria (NTM) disease have similar symptoms, which makes them difficult to distinguish clinically and leads to the danger of NTM disease being neglected. The aim of this study was to assess the risk of developing mycobacterial disease among cancer patients. METHODS We conducted a retrospective cohort study using a population-based database. The multivariable Cox proportional hazards model was adjusted to identify independent factors contributing to the development of mycobacterial disease in the cancer cohort. RESULTS The results showed that the increased risk of developing TB and NTM disease was 1.84-fold and 4.43-fold, respectively, in cancer patients compared with the general population. Advanced age (≥65years) and being male were risk factors for developing TB disease. There was a 4.09-fold significantly increased risk of TB disease within six months of a cancer diagnosis. Hematological cancer patients were most likely to develop mycobacterial disease. Younger hematological cancer patients (< 45years) had a higher risk of NTM disease development. CONCLUSION There is an increasing risk of mycobacterial disease in cancer patients. We suggest that the possibility of mycobacterial disease in cancer patients should be assessed during the period of cancer therapy, particularly in those who have risk factors.
Collapse
Affiliation(s)
- Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407, Taiwan; Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan; Ph. D Program in Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan; Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407, Taiwan; National Taipei University of Nursing and Health Science, Taipei, 112, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407, Taiwan; Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan; Ph. D Program in Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan; Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Wen-Cheng Chao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Der-Yuan Chen
- Center of Rheumatology and Immunology, China Medical University Hospital, Taichung, 404, Taiwan; College of Medicine, China Medical University, Taichung, 404, Taiwan
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Tsai-Ling Liao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407, Taiwan; Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan; Ph. D Program in Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan.
| |
Collapse
|
23
|
Weng CJ, Li CH, Liao YC, Lin CC, Lin JC, Chang SL, Lo CP, Huang KC, Huang JL, Lin CH, Hsieh YC, Wu TJ. Rhythm control better prevents stroke and mortality than rate control strategies in patients with atrial fibrillation - A nationwide cohort study. Int J Cardiol 2018; 270:154-159. [DOI: 10.1016/j.ijcard.2018.06.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022]
|
24
|
Lin HJ, Lin CC, Lin HM, Chen HJ, Lin CC, Chang CT, Chou CY, Huang CC. Hypothyroidism is associated with all-cause mortality in a national cohort of chronic haemodialysis patients. Nephrology (Carlton) 2018; 23:559-564. [PMID: 28346975 DOI: 10.1111/nep.13049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/27/2022]
Abstract
AIM The prevalence of hypothyroidism is high in haemodialysis (HD) patients and hypothyroidism increases all-cause mortality in HD patients. Comorbidities are common in HD patients and are associated with both mortality and hypothyroidism. The aim of the study is to explore the effect of the interactions of comorbidities and hypothyroidism on all-cause mortality in HD patients. METHOD Patients with hypothyroidism (ICD-9-CM 244.0, 244.1, and 244.9) and matched patients without hypothyroidism in the Registry for Catastrophic Illness Patient Database of Taiwan Health Insurance from 2000 to 2010 were analyzed. The association of hypothyroidism and risk of all-cause mortality was analyzed using Cox proportional hazard regression. RESULT Nine hundred and eight HD patients with hypothyroidism and 3632 sex-, age-, gender- matched HD patients without hypothyroidism were analyzed. Hypothyroidism was associated with increased all-cause mortality with an adjusted hazard ratio of 1.22 [95% confidence interval (CI): 1.10-1.36, P < 0.001]. TRT may decrease mortality associated with hypothyroidism (P < 0.001). There was a significant interaction (P = 0.04) between diabetes and hypothyroidism. There was no significant interaction found in hypothyroidism and the following comorbidities: hyperlipidaemia, hypertension, chronic obstructive pulmonary disease, coronary artery disease, stroke, peripheral arterial disease, asthma, congestive heart failure and cancer. CONCLUSION Hypothyroidism is associated with increased all-cause mortality in chronic HD patients. The interaction of hypothyroidism and diabetes, but not other common comorbidities in HD patients, has an effect on mortality risks.
Collapse
Affiliation(s)
- Hsuan-Jen Lin
- Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan.,Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan
| | - Chung-Chih Lin
- Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan
| | - Hsuan Ming Lin
- Division of Nephrology, Department of Internal Medicine, Tainan Municipal Annan Hospital- China Medical University, Wufeng, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan.,Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Wufeng, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan.,Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan.,Department of Biotechnology, Asia University, Wufeng, Taichung, Taiwan
| | - Chiu-Ching Huang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan
| |
Collapse
|
25
|
Chen CM, Chen HJ, Chen WS, Lin CC, Hsu CC, Hsu YH. Clinical effectiveness of influenza vaccination in patients with rheumatoid arthritis. Int J Rheum Dis 2018; 21:1246-1253. [PMID: 29879317 DOI: 10.1111/1756-185x.13322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the clinical effectiveness of influenza vaccination in patients with rheumatoid arthritis (RA). METHODS The present study was conducted by using the Taiwan National Health Insurance Research Database. In this retrospective nationwide study, we included 3748 RA patients who received influenza vaccinations in 2008, 2009 and 2010, and 3748 matched RA patients who did not receive influenza vaccinations. We followed the patients from 4 weeks after influenza vaccination to the end of the influenza season in each year. After adjustment for potential confounding factors, including disease-modifying anti-rheumatic drugs, we used the Cox proportional hazards regression model to analyze the clinical effectiveness of influenza vaccination. RESULTS The influenza vaccination rate in RA patients was 14.8% in 2008, 19.8% in 2009 and 9.50% in 2010. Receiving influenza vaccine was associated with reduced risk of hospitalization for septicemia, bacteremia or viremia (hazards ratio [HR] = 0.65, 95% CI = 0.45-0.94), and lower risk of mortality (HR = 0.62, 95% CI = 0.39-0.97). The effectiveness was particularly significant in elderly patients. CONCLUSIONS RA patients receiving influenza vaccine have significantly lower morbidity and mortality, particularly in elderly patients. Further studies are needed to explore effective policies to increase the vaccination rate in elderly RA patients.
Collapse
Affiliation(s)
- Chun-Ming Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Shan Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Healthcare Service Research Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.,Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Yueh-Han Hsu
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan
| |
Collapse
|
26
|
Weng CJ, Li CH, Liao YC, Lin CC, Lin JC, Chang SL, Lo CP, Huang KC, Huang JL, Lin CH, Hsieh YC, Wu TJ. Data for rate versus rhythm control strategy on stroke and mortality in patients with atrial fibrillation. Data Brief 2018; 20:1279-1285. [PMID: 30238040 PMCID: PMC6143751 DOI: 10.1016/j.dib.2018.08.199] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/25/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022] Open
Abstract
The data relates to the cohort of patients with atrial fibrillation (AF) from the National Health Insurance Research Database of Taiwan, "Rhythm Control Better Prevents Stroke and Mortality than Rate Control Strategies in Patients with Atrial Fibrillation - A Nationwide Cohort Study" (Weng et al., in press). The AF patients might receive either rate or rhythm control strategy according to the medication used. The baseline medication in rate and rhythm control groups was included in this dataset. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for major adverse cardiovascular events (MACE), including ischemic/hemorrhagic stroke and mortality in AF patients receiving rate or rhythm control. The occurrence of MACE was identified from the ICD-9 CM codes. The data also contains the HR for MACE stratified by the CHA2DS2-VASc score, baseline characteristics, and the duration of strategy employed of the AF patients.
Collapse
Affiliation(s)
- Chi-Jen Weng
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Hung Li
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan.,Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Ying-Chieh Liao
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan.,Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiunn-Cherng Lin
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan.,Department of Financial Engineering, Providence University, Taichung, Taiwan.,Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan
| | - Shih-Lin Chang
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chu-Pin Lo
- Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan
| | - Kuo-Ching Huang
- Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Data Science and Big Data Analytics, Providence University, Taichung, Taiwan.,Department of Financial Engineering, Providence University, Taichung, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| |
Collapse
|
27
|
Sun MH, Liao YJ, Lin CC, Chiang RPY, Wei JCC. Association between obstructive sleep apnea and optic neuropathy: a Taiwanese population-based cohort study. Eye (Lond) 2018; 32:1353-1358. [PMID: 29695760 DOI: 10.1038/s41433-018-0088-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 12/16/2017] [Accepted: 03/16/2018] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with many systemic diseases including diabetes, hypertension, stroke, and cardiovascular disease. The aim of our study was to investigate the association between OSA and optic neuropathy (ON), and to evaluate the efficacy of treatment for OSA on the risk of ON. METHODS We used the data from the Longitudinal Health Insurance Database, which involved one million insurants from Taiwan National Health Insurance program (Taiwan NHI). RESULTS OSA patients had a 1.95-fold higher risk of ON compared with non-OSA patients in all age group. The risk was significantly higher (adjusted hazard ratio: 4.21) in the group aged <45 years and male individuals (adjusted hazard ratio: 1.93). Meanwhile, sleep apnea was associated with ON regardless of the existence of comorbidity or not. OSA patients treated with continuous positive airway pressure (CPAP) had an adjusted 2.31-fold higher hazard of developing ON compared to controls, and those without any treatment had an adjusted 1.82-fold higher hazard of developing ON compared to controls. Moreover, ON patients had a 1.45-fold higher risk of OSA, and those aged between 45 and 64 years (hazard ratio: 1.76) and male individuals (hazard ratio: 1.55) had highest risk. CONCLUSIONS Our study showed that OSA increased the risk of developing ON after controlling the comorbidities; however, treatment with CPAP did not reduce the risk of ON. Further large population study accessing to medical records about the severity of OSA and treatment for OSA is needed to clarify the efficacy of treatment for OSA in reducing the risk of ON.
Collapse
Affiliation(s)
- Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | | | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Taichung, Taiwan
| | - Rayleigh Ping-Ying Chiang
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, University of Kang Ning, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
28
|
Chou CC, Hsu MY, Lin CH, Lin CC, Wang CY, Shen YC, Wang IJ. Risk of developing open-angle glaucoma in patients with carotid artery stenosis: A nationwide cohort study. PLoS One 2018; 13:e0194533. [PMID: 29684030 PMCID: PMC5912741 DOI: 10.1371/journal.pone.0194533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/30/2017] [Accepted: 03/05/2018] [Indexed: 11/19/2022] Open
Abstract
Whether carotid artery stenosis (CAS) is an independent risk factor for open-angle glaucoma remains unclear. In this study, we investigated the association between CAS and the development of open-angle glaucoma in the Taiwanese population-based cohort derived from a longitudinal database containing claims data from the Taiwan National Health Insurance (NHI) program; this study enrolled 2093 patients with CAS and 8372 patients without CAS matched by age and sex from 1999 to 2010. Diagnoses of open-angle glaucoma (OAG) were identified during a follow-up period lasting through December 31, 2013. A Cox proportional hazards model was applied to evaluate the hazard ratio (HR) for OAG in the CAS cohort compared with the matched cohort. We found that the HR for open-angle glaucoma in the CAS cohort compared with the matched cohort. The adjusted HR for OAG in the CAS cohort was 1.50 (95% confidence interval, 1.11-2.02, P = .008). The Kaplan-Meier analysis revealed that the CAS cohort had a higher cumulative incidence of OAG than did the matched cohort during the follow-up period (log-rank test, P < .001). We concluded that CAS is a significantly independent risk factor for the development of OAG. Our finding is clinically important for the aging population, which has an increasing prevalence of CAS.
Collapse
Affiliation(s)
- Chien-Chih Chou
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Yen Hsu
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Che-Chen Lin
- Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Yuan Wang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ying-Cheng Shen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
29
|
Huang YT, Lin HY, Wang CH, Su BH, Lin CC. Association of preterm birth and small for gestational age with metabolic outcomes in children and adolescents: A population-based cohort study from Taiwan. Pediatr Neonatol 2018; 59:147-153. [PMID: 28789832 DOI: 10.1016/j.pedneo.2017.07.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 06/21/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Previous studies have identified preterm birth and/or small for gestational age (SGA) as risk factors for features of the metabolic syndrome, including high blood pressure, insulin sensitivity and atherosclerosis, occurring later in life, with controversial results. We conducted this population-based cohort study to investigate metabolic outcomes in those with former preterm birth and/or SGA status in Taiwan. METHODS Data were obtained from Taiwan's universal National Health Insurance Research Database. From 1996 to 2004, 37,119 preterm infants, 3386 SGA infants, and 162,020 matched controls were included. We investigated the risk of the metabolic disease, including hypertension, diabetes, and hyperlipidemia, which had been recorded by the end of 2008. RESULTS The preterm and SGA cohort, combined into one, had a significantly increased risk of developing metabolic disorders when compared with the comparison cohort (HR = 2.46, 95% CI = 2.02-3.01). We observed that children with former preterm and SGA status in Taiwan had a higher risk of developing hypertension (HR = 3.24, 95% CI = 1.58-6.67), Type 1 diabetes mellitus (HR = 1.80, 95% CI = 1.05-3.07), Type 2 diabetes mellitus (HR = 2.49, 95% CI = 1.98-3.14), and hyperlipidemia (HR = 2.14, 95% CI = 1.29-3.52). CONCLUSION Our study revealed the risk of metabolic disease in those with preterm birth and/or SGA. Further studies with a longer duration of follow-up are required to confirm if there is a tendency for the metabolic syndrome to develop in this study cohort.
Collapse
Affiliation(s)
- Yu-Ting Huang
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiang-Yu Lin
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Chung-Hsing Wang
- Department of Genetics and Metabolism, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Bai-Horng Su
- Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
30
|
Chan CW, Yu CL, Lin JC, Hsieh YC, Lin CC, Hung CY, Li CH, Liao YC, Lo CP, Huang JL, Lin CH, Wu TJ. Glitazones and alpha-glucosidase inhibitors as the second-line oral anti-diabetic agents added to metformin reduce cardiovascular risk in Type 2 diabetes patients: a nationwide cohort observational study. Cardiovasc Diabetol 2018; 17:20. [PMID: 29368615 PMCID: PMC5781294 DOI: 10.1186/s12933-018-0663-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/15/2018] [Indexed: 12/23/2022] Open
Abstract
Objective Metformin is the standard first-line drug for patients with Type 2 diabetes (T2DM). However, the optimal second-line oral anti-diabetic agent (ADA) remains unclear. We investigated the cardiovascular risk of various ADAs used as add-on medication to metformin in T2DM patients from a nationwide cohort. Methods T2DM patients using different add-on oral ADAs after an initial metformin therapy of > 90 days were identified from the Taiwan National Health Insurance Database. Five classes of ADAs, including sulphonylureas (SU), glinides, thiazolidinediones (TZD), alpha-glucosidase inhibitors (AGI), and dipeptidyl peptidase-4 inhibitors (DPP-4I) were selected for analysis. The reference group was the SU added to metformin. Patients were excluded if aged < 20 years, had a history of stroke or acute coronary syndrome (ACS), or were receiving insulin treatment. The primary outcomes included any major adverse cardiovascular event (MACE) including ACS, ischemic/hemorrhagic stroke, and death. A Cox regression model was used to estimate the hazard ratio (HR) for MACE. Results A total of 26,742 patients receiving their add-on drug to metformin of either SU (n = 24,277), glinides (n = 962), TZD (n = 581), AGI (n = 808), or DPP-4I (n = 114) were analyzed. After a mean follow-up duration of 6.6 ± 3.4 years, a total of 4775 MACEs occurred. Compared with the SU+metformin group (reference), the TZD+metformin (adjusted HR: 0.66; 95% CI 0.50–0.88, p = 0.004) and AGI+metformin (adjusted HR: 0.74; 95% CI 0.59–0.94, p = 0.01) groups showed a significantly lower risk of MACE. Conclusion Both TZD and AGI, when used as an add-on drug to metformin were associated with lower MACE risk when compared with SU added to metformin in this retrospective cohort study. Trial registration CE13152B-3. Registered 7 Mar, 2013, retrospectively registered Electronic supplementary material The online version of this article (10.1186/s12933-018-0663-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Cheng-Wei Chan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chu-Leng Yu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jiunn-Cherng Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Internal Medicine, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.,Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan. .,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Department of Internal Medicine, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan. .,Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan.
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Ying Hung
- Department of Internal Medicine, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu, Taiwan.,Department of Nutrition, Hung-Kuang University, Taichung, Taiwan
| | - Cheng-Hung Li
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ying-Chieh Liao
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chu-Pin Lo
- Department of Financial and Computational Mathematics, Providence University, Taichung, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| |
Collapse
|
31
|
Suen KM, Lin CC, Seiler C, George R, Poncet-Montange G, Biter AB, Ahmed Z, Arold ST, Ladbury JE. Phosphorylation of threonine residues on Shc promotes ligand binding and mediates crosstalk between MAPK and Akt pathways in breast cancer cells. Int J Biochem Cell Biol 2018; 94:89-97. [PMID: 29208567 DOI: 10.1016/j.biocel.2017.11.014] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/16/2017] [Accepted: 11/30/2017] [Indexed: 01/14/2023]
Abstract
Scaffold proteins play important roles in regulating signalling network fidelity, the absence of which is often the basis for diseases such as cancer. In the present work, we show that the prototypical scaffold protein Shc is phosphorylated by the extracellular signal-regulated kinase, Erk. In addition, Shc threonine phosphorylation is specifically up-regulated in two selected triple-negative breast cancer (TNBC) cell lines. To explore how Erk-mediated threonine phosphorylation on Shc might play a role in the dysregulation of signalling events, we investigated how Shc affects pathways downstream of EGF receptor. Using an in vitro model and biophysical analysis, we show that Shc threonine phosphorylation is responsible for elevated Akt and Erk signalling, potentially through the recruitment of the 14-3-3 ζ and Pin-1 proteins.
Collapse
Affiliation(s)
- K M Suen
- Department of Biochemistry and Molecular Biology, The University of Texas MD Anderson Cancer Center, Unit 1954, 1515 Holcombe Blvd, Houston, TX 77030, USA; Graduate School of Biological Sciences, The University of Texas MD Anderson Cancer Center, Unit 1954, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - C C Lin
- School of Molecular and Cellular Biology, University of Leeds, LC Miall Building, Leeds, LS2 9JT, UK
| | - C Seiler
- School of Molecular and Cellular Biology, University of Leeds, LC Miall Building, Leeds, LS2 9JT, UK
| | - R George
- Structural Biology STP, The Francis Crick Institute, Lincolns Inn Fields Laboratory, 44 Lincolns Inn Fields, Holborn, London, WC2A 3LY, UK
| | - G Poncet-Montange
- Orthogon Therapeutics, 960 Turnpike Street, Unit 10, Canton, MA 02021, USA
| | - A B Biter
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, 1102 Bates Avenue, Houston, TX 77030, USA
| | - Z Ahmed
- Department of Biochemistry and Molecular Biology, The University of Texas MD Anderson Cancer Center, Unit 1954, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - S T Arold
- Division of Biological and Environmental Sciences and Engineering, CBRC, King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
| | - J E Ladbury
- School of Molecular and Cellular Biology, University of Leeds, LC Miall Building, Leeds, LS2 9JT, UK.
| |
Collapse
|
32
|
Chan CW, Yu CW, Lin CC, Lee CH. Hepatic Portal Venous Gas in a Patient with Penetrating Injuries. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000608] [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: 11/15/2022] Open
Abstract
Hepatic portal venous gas (HPVG) refers to the branching area of low attenuation extending to within 2 cm of the liver capsule in computed tomography scan. The most common causes of HPVG are mesenteric ischaemia in adults and necrotising enterocolitis in infants. HPVG in trauma patients is mostly reported in cases of blunt abdominal trauma. We present a deceased patient who had chest and abdominal wall penetrating injuries with concomitant hypovolemic shock. A computed tomography scan revealed HPVG and pulmonary artery air emboli. The mechanism of the presentation of HPVG in this patient and the possible cause of death would be discussed. (Hong Kong j.emerg.med. 2013;20:382-384)
Collapse
Affiliation(s)
- CW Chan
- Chang Gung Memorial Hospital, Department of Emergency Medicine, Taoyuan, Taiwan
| | - CW Yu
- Chang Gung Memorial Hospital, Department of Emergency Medicine, Keelung, Taiwan
| | - CC Lin
- Chang Gung Memorial Hospital, Department of Emergency Medicine, Taoyuan, Taiwan
| | - CH Lee
- Chang Gung Memorial Hospital, Department of Emergency Medicine, Keelung, Taiwan
| |
Collapse
|
33
|
Lin CC, Lu CH, Pan YH, Jiao L, Chen HY, Li L, He Y. [Effect and mechanism of silibinin on the inhibition of ALK positive NSCLC cells by sensitizing crizotinib]. Zhonghua Zhong Liu Za Zhi 2017; 39:650-656. [PMID: 28926892 DOI: 10.3760/cma.j.issn.0253-3766.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the synergistic effect of silibinin combined with crizotinib on anaplastic lymphoma kinase positive (ALK+ ) non-small cell lung cancer (NSCLC) cells and its mechanism. Methods: H2228 and H3122 cells were treated with silibinin, crizotinib alone or in combination. Cell proliferation was measured by 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and colony formation assay. Migration or invasion ability was tested by wound healing assay or transwell assay, respectively. Expressions of E-Cadherin and vimentin protein were examined by immunofluorescence staining. The protein expressions of ALK, p-ALK, E-Cadherin and Vimentin were detected by western blotting.The anti-cancer effect of silibinin combined with crizotinib in vivo was determined by subcutaneously injecting 2×10(6) H2228 cells into immunodeficient nude mice. Results: The result of MTT assay showed that the cell viability of H2228 or H3122 treated with 100 μmol/L silibinin was (88.38±4.10)% or (72.27±3.62)%, respectively, marginally decreased compared with that of the control. The 50% inhibitory concentration (IC(50)) of H2228 cells treated with crizotinib alone or combined with 100 μmol/L silibinin was (917.10±7.75) nmol/L or (238.73±7.67) nmol/L, respectively. The IC(50) of H3122 cells treated with crizotinib alone or combined with 100 μmol/L silibinin was (472.50±15.70) nmol/L or (206.10±12.01) nmol/L, respectively. The IC(50s) of H2228 and H3122 cells were significantly decreased by combined treatment of crizotinib and silibinin compared to crizotinib treatment alone (P<0.01). When compared with the control group, colony forming ratios of H2228 cells were (83.34±2.72)% in 100 μmol/L silibinin treatment group, (69.42±3.06)% in 400 nmol/L crizotinib treatment group and (27.32±1.42)% in combined treatment group. When compared with the control group, colony forming ratios of H3122 cells were (84.45±5.67)% in 100 μmol/L silibinin treatment group, (45.02±5.83)% in 400 nmol/L crizotinib treatment group and (17.43±3.83)% in combined treatment group. Silibinin combined with crizotinib treatment significantly inhibited the colony formation ability of H2228 and H3122 cells (P<0.01). Migration and invasion results showed that combined treatment of crizotinib and silibinin markedly inhibited the migration and invasion ability of H2228 cells (P<0.01). Western blot results indicated that treated with silibinin alone or in combination of crozitinib for 48 hours, the protein level of E-cadherin in H2228 cells was upregulated, while the expressions of p-ALK and vimentin were downregulated, without obvious alteration of ALK protein expression. In the xenograft model, the mean tumor weight was (9.40±2.58)g in crizotinib treatment group and (4.58±1.07)g in the combined treatment group. The inhibitory effect of tumor growth in vivo of combined treatment was significantly superior to that of crizotinib treatment alone (P<0.05). Conclusion: Silibinin enhances the inhibitory effect of crizotinib on ALK positive NSCLC cells, which may be associated with suppression of ALK activity and mesenchymal-epithelial transition.
Collapse
Affiliation(s)
- C C Lin
- Department of Respiratory, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - C H Lu
- Department of Respiratory, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - Y H Pan
- Department of Respiratory, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - L Jiao
- Department of Respiratory, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - H Y Chen
- Department of Respiratory, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - L Li
- Department of Respiratory, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - Y He
- Department of Respiratory, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| |
Collapse
|
34
|
Abstract
Worker compensation insurance in Taiwan ensures that a woman under the age of 45 years who has her uterus removed can receive disability compensation benefits. The present study investigated whether such a compensation policy was related to a woman's inclination to have a hysterectomy. We extracted the records of 16,030 women diagnosed with uterine fibroids (UF) between 2000 and 2010 from the Longitudinal Taiwan Health Insurance Database. Each younger and older age group had a significantly lower hysterectomy rate compared to that of the 44-year-old age group. Moreover, significantly more patients with lower monthly wages had had hysterectomies than those with higher monthly wages. Policy makers should be aware that worker compensation regulations in Taiwan might encourage women with economic need to undergo hysterectomy surgery when approaching the age of 45 years.
Collapse
Affiliation(s)
- Ya-Lee Ho
- a Department of Business Administration and Department of Business Administration , Feng Chia University , Taichung , Taiwan
| | - Chu-Shiu Li
- b Department of Risk Management and Insurance , National Kaohsiung First University of Science and Technology, Kaohsiung, and College of Management, Asia University , Taichung , Taiwan
| | - Chwen-Chi Liu
- c Department of Risk Management and Insurance , Feng Chia University , Taichung , Taiwan
| | - Che-Chen Lin
- d Management Office for Health Data , China Medical University Hospital , Taichung , Taiwan
| | - Chih-Jen Hung
- e Department of Anesthesiology, Taichung Veterans General Hospital, and Department of Nursing , Hung Kuang University , Taichung , Taiwan
| | - Chia-Hung Kao
- f Departments of Nuclear Medicine and PET Center, China-Medical University Hospital and Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine , China-Medical University , Taichung , Taiwan
| |
Collapse
|
35
|
Abstract
Sleep-disordered breathing (SDB) and Eustachian tube disorders (ETDs) share the same risk factors. The specific aim of this study was to determine the correlation between these 2 conditions and to determine whether treatments for SDB reduce the risk of ETD.This is a retrospective and large population-based cohort study. According to Taiwan's National Health Insurance Research Database, out of 1,000,000 insured patients, 24,251 patients were newly diagnosed with SDB from year 2000 through 2009. The control group for this study comprised 96,827 patients without SDB who were randomly selected from the same database at a ratio of 1:4, frequency matched for sex, age, and index year of SDB. The incidence of developing ETD was compared between these 2 groups; the main covariates were demographic data, interventions, and medical comorbidities.There was an increased risk of developing ETD among the SDB cohort compared with the control group (hazard ratio = 1.51, 95% confidence interval = 1.41-1.63). Compared with SDB patients who did not receive treatment, those who received the treatment, that is, pharyngeal or nasal surgery, CPAP, or multiple modalities (both surgery and CPAP), had a significantly reduced risk of developing ETD.This study showed that patients with SDB are at an increased risk of developing ETD and other comorbidities. The risk of developing ETD can be reduced by implementing prompt treatment for SDB. Multidisciplinary evaluation including ETD should be conducted in the management of patients presenting with SDB.
Collapse
Affiliation(s)
| | | | - Che-Chen Lin
- Management Office for Health Data
- Department of Public Health
| | | | - Yung-An Tsou
- Department of Otolaryngology-Head and Neck Surgery
- Graduate Institute of Clinical Medical Science
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| |
Collapse
|
36
|
Chu CS, Lin CC, Peng CY, Chuang PH, Su WP, Lai SW, Chen HJ, Chung CJ, Lai HC. Does pyogenic liver abscess increase the risk of delayed-onset primary liver cancer?: Evidence from a nationwide cohort study. Medicine (Baltimore) 2017; 96:e7785. [PMID: 28834881 PMCID: PMC5572003 DOI: 10.1097/md.0000000000007785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 02/06/2023] Open
Abstract
Delayed-onset primary liver cancer (PLC) including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) in patients with pyogenic liver abscess (PLA) is not common. The relationship between PLA and delayed-onset PLC is unclear. We investigated the association in a nationwide cohort study.From Taiwan National Health Insurance claims data, a cohort of 17,531 patients with PLA was generated after excluding patients with a history of cancer (n = 2034) and those diagnosed with PLC (n = 572) and other cancers (n = 627) within 1 year of a diagnosis of PLA. An age-, sex-, index year-, and diabetes mellitus (DM)-matched control cohort of 70,124 persons without PLA was selected from the same dataset. Both cohorts were followed up until the end of 2011. The risk of PLC was estimated for both cohorts.The incidence of PLC was nearly 2-fold greater in the PLA group than in the control cohort (29.3 per 10,000 person-years vs. 16.2 per 10,000 person-years). The incidences of HCC and ICC were 1.5- (22.1 per 10,000 person-years vs. 15.0 per 10,000 person-years) and 11-fold greater (6.73 per 10,000 person-years vs. 0.62 per 10,000 person-years), respectively, in the PLA group than in the control cohort. The PLA cohort also had high risks of PLC (adjusted hazard ratio [aHR] = 1.56; 95% confidence interval [CI] = 1.35-1.81), HCC (aHR = 1.34; 95% CI = 1.15-1.57), and ICC (aHR = 6.94; 95% CI = 4.23-11.57).In conclusion, in this nationwide cohort study, PLA increased the risk of delayed-onset PLC.
Collapse
Affiliation(s)
- Chia-Sheng Chu
- School of Chinese Medicine, China Medical University
- Division of Hepatogastroenterology, Department of Internal Medicine
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital
- School of Medicine, China Medical University
| | - Cheng-Yuan Peng
- Division of Hepatogastroenterology, Department of Internal Medicine
- School of Medicine, China Medical University
| | - Po-Heng Chuang
- Division of Hepatogastroenterology, Department of Internal Medicine
- School of Medicine, China Medical University
| | - Wen-Pang Su
- Division of Hepatogastroenterology, Department of Internal Medicine
- School of Medicine, China Medical University
| | - Shih-Wei Lai
- School of Medicine, China Medical University
- Department of Family Medicine
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital
- School of Medicine, China Medical University
| | - Chi-Jung Chung
- Department of Medical Research, China Medical University Hospital
- Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - Hsueh-Chou Lai
- School of Chinese Medicine, China Medical University
- Division of Hepatogastroenterology, Department of Internal Medicine
| |
Collapse
|
37
|
Liao TL, Lin CH, Chen HH, Chen YM, Lin CC, Chen DY. Significant Associations of Neurological Complications of Herpes Zoster With Stroke in Rheumatoid Arthritis Patients. J Am Heart Assoc 2017; 6:JAHA.117.006304. [PMID: 28724649 PMCID: PMC5586320 DOI: 10.1161/jaha.117.006304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accumulating evidence suggests an increased risk of stroke after herpes zoster (HZ). This risk is elevated in immunocompromised patients. The incidence of HZ in Asia is higher than in Western countries. However, the epidemiology of HZ and HZ-related stroke among rheumatoid arthritis (RA) patients in Asia remains unclear. METHODS AND RESULTS We conducted a retrospective cohort study using a population-based database to investigate the epidemiology of HZ in RA patients in Taiwan during the period of 2000-2011. A total of 27 609 newly diagnosed and eligible RA cases were identified, and 110 436 non-RA cases were matched for age and sex at a ratio of 4:1. HZ risk increased by 2.53-fold (P<0.0001) in RA patients compared with the general population. Exposure to corticosteroids (adjusted odds ratio=1.73, P<0.0001), adalimumab (adjusted odds ratio=1.61, P=0.002), and rituximab (adjusted odds ratio=2.06, P=0.008) was associated with an increased risk of HZ in RA patients. A significant association between the use of methotrexate or corticosteroids and HZ risk was dose-dependent (Ptrend<0.0001). Elevated risk of stroke was observed in RA patients with HZ (adjusted hazard ratio=1.27, P=0.047), particularly in those with neurological complications (adjusted hazard ratio=1.54, P=0.015). A 2.30-fold significantly increased risk of stroke within 90 days after HZ occurrence was observed in RA patients compared with those without HZ (P=0.02). Furthermore, death risk increased in RA patients with HZ (adjusted hazard ratio=1.18, P=0.026). CONCLUSIONS The risk of HZ and HZ-related stroke has increased in RA patients. Monitoring the occurrence of HZ in RA patients and preventing HZ-related stroke or mortality during a specific immunosuppressive therapy are important.
Collapse
Affiliation(s)
- Tsai-Ling Liao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Che-Chen Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Der-Yuan Chen
- Department of Internal Medicine and Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan .,Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
| |
Collapse
|
38
|
Hung YC, Lin CC, Chen HJ, Chang MP, Huang KC, Chen YH, Chen CC. Severe hypoglycemia and hip fracture in patients with type 2 diabetes: a nationwide population-based cohort study. Osteoporos Int 2017; 28:2053-2060. [PMID: 28374044 DOI: 10.1007/s00198-017-4021-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 08/26/2016] [Accepted: 03/27/2017] [Indexed: 02/01/2023]
Abstract
UNLABELLED Hypoglycemia is a major concern in glycemic control. Using the Taiwan National Health Insurance Research Database, we found that the risk of hip fracture was associated with emergency or hospitalization visits of severe hypoglycemia in patients with type 2 diabetes; greater visits were associated with higher incidence of hip fracture. INTRODUCTION The objective of the study was to assess the risk of hip fracture among patients with type 2 diabetes mellitus (T2DM) and severe hypoglycemia. METHODS Using the National Health Insurance Research database in Taiwan, we identified 2588 patients with T2DM who had developed severe hypoglycemia from 2001 to 2009. A comparison cohort who had never developed severe hypoglycemia was frequency matched at a ratio of approximately 1:2. Multivariate Cox proportional hazard regression analysis was used to evaluate the risk of hip fracture. RESULTS During a median follow-up period of 3.9 years, there were 219 hip fracture events in 5173 comparison cohorts and 148 hip fracture events in 2588 hypoglycemia cohorts. The incidence of hip fracture was higher in patients with severe hypoglycemia than without severe hypoglycemia (17.19 vs. 8.83 per 1000 person-years; adjusted HR 1.71, 95% CI = 1.35-2.16). Approximately half of the individuals developed hip fracture within 2 years from the first occurrence of severe hypoglycemia. There was a significant associated trend towards increased hip fracture risk with increasing average visit of severe hypoglycemia per year (p for trend <0.001). Medication analysis showed that patients taking sulfonylurea alone, insulin alone, and insulin secretagogues combined with insulin had a higher associated risk to develop hip fracture. CONCLUSIONS Severe hypoglycemia was associated with a higher risk to develop hip fracture. The more the visits of severe hypoglycemia per year indicated the higher associated risk in patients with T2DM. Fall is likely an important reason for severe hypoglycemia in relation to increased risk of hip fracture.
Collapse
Affiliation(s)
- Y C Hung
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan
- Department of Medicine, China Medical University, Taichung, 40402, Taiwan
| | - C C Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan
- Veterans General Hospital, Taichung, Taiwan
| | - H J Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan
| | - M P Chang
- Department of Nursing, School of Health, National Taichung University of Science and Technology, Taichung, 40343, Taiwan
| | - K C Huang
- Department of Integration of Traditional Chinese and Western Medicine, China Medical University Hospital, Taichung, 40447, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan
| | - Y H Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan
- Department of Medicine, China Medical University, Taichung, 40402, Taiwan
| | - C C Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan.
- School of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan.
| |
Collapse
|
39
|
Macerollo A, Lu MK, Huang HC, Chen HJ, Lin CC, Kao CH, Tsai CH, Chen JC. Colonic diverticular disease: A new risk factor for Parkinson's disease? Parkinsonism Relat Disord 2017; 42:61-65. [PMID: 28651752 DOI: 10.1016/j.parkreldis.2017.06.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 05/15/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Colonic diverticular disease is a chronic gastrointestinal disorder. Previous studies have suggested that chronic gastrointestinal tract is involved in the pathophysiology of Parkinson's disease. OBJECT This study investigated the potential link between colonic diverticular disease and risk of Parkinson's disease. METHODS Data in this nationwide population-based cohort study were obtained from the National Health Insurance Research Database. Patients with colonic diverticular disease were identified from among 23.22 million insured Taiwanese residents who had been diagnosed between 2000 and 2005 and were aged ≥20 years (n = 23367). The comparison cohort included patients without colonic diverticular disease, matched by sex, age, and all comorbidities with the colonic diverticular disease patients cohort (n = 23367). Using univariable and multivariable Cox proportional hazard regression models, we estimated the adjusted hazard ratio (aHR) for PD with a 95% confidence interval (CI) after adjusting for age, sex, and all of comorbidities. RESULTS The risk of Parkinson's disease was higher in the CDD cohort than in the comparison cohort (HR = 1.27, 95%CI = 1.10-1.47). Compared with patients aged ≥65 years without CDD, the CDD patients in the equal age group had a 1.25-fold increased risk of PD (95% CI = 1.07-1.46). CONCLUSION Colonic diverticular disease may be associated with an increased risk of Parkinson's disease. Thus, the risk of this neurodegenerative disease should be considered in patients with colonic diverticular disease.
Collapse
Affiliation(s)
| | - Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Hui-Chun Huang
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Cheng Chen
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Brain Disease Research Centre, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
40
|
Lu YY, Wang MY, Wei IH, Lin CC, Huang CC. Tourette syndrome increases risk of bone fractures: a population-based cohort study. Eur Child Adolesc Psychiatry 2017; 26:531-539. [PMID: 27807804 DOI: 10.1007/s00787-016-0916-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022]
Abstract
This study assesses the risk of fractures among children with Tourette syndrome (TS), and identifies the effects of comorbidities and antipsychotics. We randomly sampled the claims data of 1 million enrollees in the National Health Insurance program of Taiwan, and identified 1258 children with TS diagnosed between 2000 and 2010. Additionally, 12,580 children without TS who were frequency matched for sex, age, residential area, parental occupation, and index year were identified for comparison. The children's cases were followed until December 31, 2010, or censored to ascertain incident fractures cases and associations with comorbidities of attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD) and treatments with antipsychotics, antidepressants, or clonidine. The TS cohort had a 1.27-fold higher incidence of fractures than did the comparison cohort (190.37 vs. 149.94 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.28 [95% confidence interval (CI) 1.06-1.55] based on multivariable Cox regression analysis. This increased risk of fractures was apparent for fractures of the skull, neck, and spine. Comorbid ADHD and OCD did not result in an additional risk of fractures. The children without both ADHD and OCD were also at a higher risk of fractures, indicating that TS alone increases the risk of fractures. The children taking antipsychotics had a reduced risk of fractures, and the adjusted HR decreased to 1.17 (95% CI 0.90-1.52). Children with TS have an increased risk of fractures. ADHD and OCD do not increase the risk further.
Collapse
Affiliation(s)
- Yuan-Yuan Lu
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science and Graduate Institute of BioMedical Sciences, China Medical University, Taichung, Taiwan
| | - Ming-Yu Wang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science and Graduate Institute of BioMedical Sciences, China Medical University, Taichung, Taiwan
| | - I-Hua Wei
- Department of Anatomy, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Chia Huang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan. .,Graduate Institute of Clinical Medical Science and Graduate Institute of BioMedical Sciences, China Medical University, Taichung, Taiwan. .,Department of Psychiatry, China Medical University, No. 2, Yuh-Der Road, Taichung, Taiwan.
| |
Collapse
|
41
|
Emmakah AM, Arman HE, Bragg JC, Greene T, Alvarez MB, Childress PJ, Goebel WS, Kacena MA, Lin CC, Chu TM. A fast-degrading thiol–acrylate based hydrogel for cranial regeneration. Biomed Mater 2017; 12:025011. [DOI: 10.1088/1748-605x/aa5f3e] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
42
|
Lau CI, Lin CC, Chen HJ, Wang HC, Chen WH, Liang JA. Increased risk of essential tremor in migraine: A population-based retrospective cohort study. PLoS One 2017; 12:e0173586. [PMID: 28288163 PMCID: PMC5348003 DOI: 10.1371/journal.pone.0173586] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine the long-term risk of essential tremor (ET) in migraine. Methods Using population-based administrative data from a subset of the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 22,696 newly diagnosed migraineurs (mean age 44.5 years) and a matched migraine-free cohort of 90,784 individuals in the period 2000–2008. Multivariable Cox proportional hazards regression analysis was conducted for assessing the ET risk for the migraine cohort compared to the migraine-free cohort. Results After adjusting for covariates, the migraine cohort had a 1.83-fold increased risk (95% CI 1.50–2.23) of subsequent ET in comparison to the migraine-free cohort (8.97 vs. 4.81 per 10,000 person-years). In the subgroup analysis, patients with migraine were associated with higher risks of ET, regardless of gender, age or the existence of comorbidities. Conclusion Our findings demonstrated an association between migraine and ET, suggesting a possible shared pathophysiology underpinning both disorders.
Collapse
Affiliation(s)
- Chi-Ieong Lau
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Institute of Cognitive Neuroscience, University College London, Queen Square, London, United Kingdom.,College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Han-Cheng Wang
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,College of Medicine, Taipei Medical University, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Hung Chen
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ji-An Liang
- Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
43
|
Hsu FG, Hsieh YW, Sheu MJ, Lin CC, Lin CL, Hsu CY, Lee CY, Chang MY, Chang KH. Tamoxifen use and acute pancreatitis: A population-based cohort study. PLoS One 2017; 12:e0173089. [PMID: 28291833 PMCID: PMC5349648 DOI: 10.1371/journal.pone.0173089] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/22/2016] [Accepted: 02/15/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several case reports have indicated that tamoxifen induced acute pancreatitis (AP); but no pharmacoepidemiological data support the claim. Therefore, we investigated whether tamoxifen use is correlated with the risk of AP in patients with breast cancer. METHODS This population-based cohort study used the Taiwan National Health Insurance Research Database. A cohort of 22 005 patients aged ≥20 years with breast cancer from January 1, 2000 to December 31, 2009 was identified and the date of cancer diagnosis was set as the index date. The end point was developing AP during the follow-up. Hazard ratios (HRs) and 95% confidence intervals (CIs) were evaluated to determine the correlation between the risk of AP and tamoxifen use. Because the drug use varied over time, it was measured as a time-dependent covariate in the Cox proportional hazard model. The same approaches were applied in PS-matched cohorts. RESULTS After adjustment for covariates and medication use including fluorouracil and doxorubicin, the risk of AP was not significant between tamoxifen users and tamoxifen nonusers (adjusted HR = 0.94, 95% CI = 0.74-1.19) in the non-matching cohorts. The results revealed no dose-response trend between tamoxifen use and the risk of AP (adjusted HR = 0.98, 95% CI = 0.96-1.00). The comorbidities DM and gallstones were associated with a significantly increased risk of AP. Similar trends were observed in PS-matched cohorts. CONCLUSIONS No significant correlation was observed between tamoxifen use and the risk of AP in patients with breast cancer.
Collapse
Affiliation(s)
- Fan-Gen Hsu
- School of Pharmacy, China Medical University, Taichung, Taiwan
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Yow-Wen Hsieh
- School of Pharmacy, China Medical University, Taichung, Taiwan
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Jyh Sheu
- School of Pharmacy, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Chang-Yin Lee
- College of Medicine, The School of Chinese Medicine for Post Baccalaureate, I-Shou University (Yancho Campus), Kaohsiung, Taiwan
- Department of Chinese Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Mei-Yin Chang
- Department of Medical Laboratory Science and Biotechnology, School of Medical and Health Sciences, Fooyin University, Kaohsiung, Taiwan
| | - Kuang-Hsi Chang
- Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| |
Collapse
|
44
|
Huang PH, Shih BF, Tsai YF, Chung PCH, Liu FC, Yu HP, Lee WC, Chang CJ, Lin CC. Accuracy and Trending of Continuous Noninvasive Hemoglobin Monitoring in Patients Undergoing Liver Transplantation. Transplant Proc 2017; 48:1067-70. [PMID: 27320558 DOI: 10.1016/j.transproceed.2015.12.121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/30/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Shift in large fluid volumes and massive blood loss during liver transplantation frequently leads to rapid changes in hemoglobin (Hb) concentration; thus, to ensure adequate tissue oxygenation, accurate and rapid determination of Hb concentration is essential in transplant recipients. The Radical-7 Pulse CO-Oximeter provides a noninvasive and continuous way to monitor Hb concentration (SpHb) in real time and is an ideal candidate for use during liver transplantation. In this study, we assessed the relationship between SpHb and total Hb (tHb) obtained from arterial blood samples during surgery. METHODS Forty patients undergoing liver transplantation were enrolled in this study. tHb and time-matched SpHb were measured at 5 different phases throughout surgery. Paired SpHb and tHb levels were assessed using linear regression, Bland-Altman analysis, and the Critchley polar plot method. RESULTS A total of 161 paired measurements with sufficient signal quality were analyzed. The correlation between SpHb and tHb was 0.59 (P < .001). Bland-Altman analysis revealed that a bias between SpHb and tHb was 2.28 g/dL, and limits of agreement (LoA) were from -0.78 to 5.34 g/dL. Trending analysis showed that 87% of data were located within the acceptable trending area, indicating that the trending ability was not satisfied. CONCLUSIONS The Radical-7 Pulse CO-Oximeter was not sufficient to monitor Hb levels and trends during liver transplantation surgery in our cohort. In particular, in critical patients and in those with low Hb levels, invasive Hb measurement should be used for assessment.
Collapse
Affiliation(s)
- P H Huang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - B F Shih
- Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Y-F Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - P C H Chung
- Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - F C Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - H P Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - W C Lee
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - C J Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Guishan, Taoyuan, Taiwan; Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - C C Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.
| |
Collapse
|
45
|
Yeh JJ, Wang YC, Lin CC, Lin CL, Hsu WH. Association of Respiratory Tuberculosis with Incident Bone Fracture: Bridging the Tuberculosis Airway Infection and the Osteoporotic Bone. PLoS One 2016; 11:e0168673. [PMID: 28005963 PMCID: PMC5178997 DOI: 10.1371/journal.pone.0168673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 11/23/2016] [Indexed: 01/31/2023] Open
Abstract
Objective The relationship between respiratory tuberculosis (RT) and incident fragility fracture and osteoporosis/fragility fracture in the general population is not well determined; therefore, we conducted a nationwide cohort study to investigate this relationship. Methods We used the National Health Insurance Research Database of Taiwan to identify 6612 newly diagnosed patients with RT (RT cohort) and 13220 patients without RT (non-RT cohort) from 1999 to 2005. The mean durations of follow-up were (6.73 ± 4.00 years, 8.11 ± 3.24 years) in the (RT cohort, non- RT cohort); respectively. The occurrence of incident fragility fracture and osteoporosis/fragility fracture were followed up until the end of 2011. The adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) and 98% CIs of incident fragility fracture and osteoporosis/fragility fracture were estimated using the multivariable Cox proportional hazard model after adjusting for age, sex, occupation, drug use, and comorbidities. Results A Cox proportional hazards regression analysis was performed and showed the aHRs of [incident fragility fracture; osteoporosis/fragility fracture] were [1.69 (95% CI = 1.26–2.28, 98% CI = 1.18–2.44); 1.42 (95% CI = 1.25–1.61, 98% CI = 1.21–1.65)] between the RT and non-RT cohorts. Regarding the sex, the aHRs of the [incident fragility fracture; osteoporosis / fragility fracture] were [1.57 (98% CI = 1.10–2.23, 98% CI = 1.02–2.41); 1.15 (95% CI = 0.97–1.36, 98% CI = 0.94–1.41)] in the men. The aHRs of the RT cohort without oral steroid use in the [incident fragility fracture; osteoporosis / fragility fracture] were [1.87 (95% CI = 1.20–2.90, 98% CI = 1.09–3.19); 1.41 (95% CI = 1.19–1.67, 98% CI = 1.14–1.74)]. Conclusion The RT associated with the incident fragility fracture, either in men or absence of oral steroid use.
Collapse
Affiliation(s)
- Jun-Jun Yeh
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Meiho University, Pingtung, Taiwan
| | - Yu-Chiao Wang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
46
|
Tsai MY, Hu WL, Lin CC, Lee YC, Chen SY, Hung YC, Chen YH. Prescription pattern of Chinese herbal products for heart failure in Taiwan: A population-based study. Int J Cardiol 2016; 228:90-96. [PMID: 27863367 DOI: 10.1016/j.ijcard.2016.11.172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/06/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Certain Chinese herbal products (CHPs) may protect against the progression of heart failure (HF). However, there is a lack of research regarding the use of CHPs in patients with HF. The aims of this study were to analyze CHPs usage patterns in patients with HF and to identify the frequency and combination of CHPs most commonly used for HF. METHODS This retrospective, nationwide, population-based cohort study was conducted using a randomly sampled cohort of one million patients selected from the National Health Insurance Research Database (NHIRD) for the years 2000-2010 in Taiwan. CHP use and the top ten most frequently prescribed formulae and single herbs for treating HF were assessed, including total formulae number and average and frequency of prescriptions. Demographic characteristics, including sex and age at diagnosis of HF, were examined, together with existing comorbidities. RESULTS The cohort included 19,988 newly diagnosed AD patients, who were given CHP treatment for HF between 2000 and 2010. Among them, female patients (53.3%) and those over 65years old (63.9%) were more likely to use CM. After adjusting for demographic factors, HF patients suffering from coronary artery disease (CAD) were more likely to seek traditional Chinese medicine (TCM) treatment than those with non-TCM users (57.6% vs. 52.6%). Zhi-Gan-Cao-Tang (4.07%) and Danshen (5.13%) were the most frequent formula CHP and single CHP prescribed by TCM practitioners for treating HF, respectively. CONCLUSION Most people with HF who consumed CHPs used CHPs to supplement Yang-Qi, nourish the Ying-blood, and strengthen the heart spirit as complementary medicines to relieve HF-related symptoms, in addition to using standard anti-HF treatments. Further large-scale, randomized clinical trials are warranted in order to determine the effectiveness and safety of these herbal medicines.
Collapse
Affiliation(s)
- Ming-Yen Tsai
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Chiao Lee
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Yu Chen
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan.
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| |
Collapse
|
47
|
Abstract
There is still debate on whether high uric acid increases bone mineral density (BMD) against osteoporotic fracture or bone resorption caused by gout inflammation. This study aimed to evaluate whether gout offers a protective effect on bone health or not. We conducted a nationwide population-based retrospective cohort study to evaluate the association between gout history and risk factors of fracture.A retrospective cohort study was designed using the claim data from Longitudinal Health Insurance Database (LHID). A total of 43,647 subjects with gout and a cohort of 87,294 comparison subjects without gout were matched in terms of age and sex between 2001 and 2009, and the data were followed until December 31, 2011. The primary outcome of the study was the fracture incidence, and the impacts of gout on fracture risks were analyzed using the Cox proportional hazards model.After an 11-year follow-up period, 6992 and 11,412 incidents of fracture were reported in gout and comparison cohorts, respectively. The overall incidence rate of fracture in individuals with gout was nearly 23%, which was higher than that in individuals without gout (252 vs 205 per 10,000 person-years) at an adjusted hazard ratio of 1.17 (95% confidence interval = 1.14-1.21). Age, sex, and fracture-associated comorbidities were adjusted accordingly. As for fracture locations, patients with gout were found at significant higher fracture risks for upper/lower limbs and spine fractures. In gout patient, the user of allopurinol or benzbromarone has significantly lower risk of facture than nonusers.Gout history is considered as a risk factor for fractures, particularly in female individuals and fracture sites located at the spine or upper/lower limbs.
Collapse
Affiliation(s)
- Huey-En Tzeng
- Graduate Institute of Clinical Medicine
- School of Medicine, China Medical University
- Division of Hematology/Oncology
| | - Che-Chen Lin
- Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital
| | - I-Kuan Wang
- Graduate Institute of Clinical Medicine
- School of Medicine, China Medical University
- Division of Nephrology
| | - Po-Hao Huang
- School of Medicine, China Medical University
- Division of Rheumatology
| | - Chun-Hao Tsai
- Graduate Institute of Clinical Medicine
- School of Medicine, China Medical University
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
- Correspondence: Chun-Hao Tsai, Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, #91 Hsueh-Shih Road, Taichung 404, Taiwan (e-mail: )
| |
Collapse
|
48
|
Tsai TY, Lin CC, Peng CY, Huang WH, Su WP, Lai SW, Chen HJ, Lai HC. The association between biliary tract inflammation and risk of digestive system cancers: A population-based cohort study. Medicine (Baltimore) 2016; 95:e4427. [PMID: 27495065 PMCID: PMC4979819 DOI: 10.1097/md.0000000000004427] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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
The relationship between biliary tract inflammation (BTI) and digestive system cancers is unclear. This study aimed to evaluate the association between BTI and the risks of digestive system cancers.Using the Taiwan National Health Insurance claims data, information on a cohort of patients diagnosed with BTI (n = 4398) between 2000 and 2009 was collected. A comparison cohort of sex-, age-, and index year-matched persons without BTI (n = 17,592) was selected from the same database. The disease was defined by the ICD-9-CM. Both cohorts were followed until the end of 2010 and incidences of digestive system cancers were calculated.The results revealed an increase in adjusted hazard ratio (aHR) of biliary tract cancer (24.45; 95% confidence interval [CI]: 9.20-65.02), primary liver cancer (1.53; 95% CI: 1.07-2.18), and pancreatic cancer (3.10; 95% CI: 1.20-8.03) in patients with both gallbladder and BTI. The aHR of stomach cancer was also found to be increased (2.73; 95% CI: 1.28-5.81) in patients with gallbladder inflammation only. There were no differences in esophageal cancer (aHR: 0.82; 95% CI: 0.23-2.87) and colorectal cancer (aHR: 0.92; 95% CI: 0.59-1.45). The aHR for digestive system cancers increased by 3.66 times (95% CI: 2.50-5.35) and 12.20 times (95% CI: 8.66-17.17) in BTI visits frequency averaged 2 to 4 visits per year and frequency averaged ≥5 visits per year, respectively.Patients with BTI have significantly higher risk of digestive system cancers, particularly biliary tract, pancreatic, and primary liver cancers, compared with those who are without it.
Collapse
Affiliation(s)
- Tsung-Yu Tsai
- Graduate Institute of Clinical Medical Science
- School of Medicine
- Division of Hepato-gastroenterology, Department of Internal Medicine
| | - Che-Chen Lin
- Management Office for Health Data
- Department of Public Health
| | - Cheng-Yuan Peng
- School of Medicine
- Division of Hepato-gastroenterology, Department of Internal Medicine
| | - Wen-Hsin Huang
- School of Medicine
- Division of Hepato-gastroenterology, Department of Internal Medicine
| | - Wen-Pang Su
- School of Medicine
- Division of Hepato-gastroenterology, Department of Internal Medicine
| | | | - Hsuan-Ju Chen
- Management Office for Health Data
- Department of Public Health
| | - Hsueh-Chou Lai
- Graduate Institute of Clinical Medical Science
- Division of Hepato-gastroenterology, Department of Internal Medicine
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Correspondence: Hsueh-Chou Lai, Division of Hepato-gastroenterology, Department of Internal Medicine, Graduate Institute of Clinical Medical Science and, School of Chinese Medicine, China Medical University, China Medical University Hospital, 2 Yuh-Der Road, Taichung, Taiwan (e-mail: )
| |
Collapse
|
49
|
Wang HC, Lau CI, Lin CC, Chang A, Kao CH. Group A Streptococcal Infections Are Associated With Increased Risk of Pediatric Neuropsychiatric Disorders: A Taiwanese Population-Based Cohort Study. J Clin Psychiatry 2016; 77:e848-54. [PMID: 27464318 DOI: 10.4088/jcp.14m09728] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 07/28/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study evaluated the association between group A streptococcal (GAS) infections and the risks of developing tic disorders, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD). METHODS We conducted a follow-up cohort study in 2014 using Taiwan's National Health Insurance Research Database. The study cohort consisted of patients younger than 18 years with newly diagnosed GAS infection (ICD-9-CM codes 034 [streptococcal sore throat and scarlet fever] and 482.31 [pneumonia due to Streptococcus, group A]) from 2001 to 2010. All patients having GAS infection codes between 1996 and 2000 were excluded. We assessed the patients' risks of developing tic disorders, OCD, and ADHD (ICD-9-CM codes 300.3 [obsessive-compulsive disorders], 301.4 [obsessive-compulsive personality disorder], 307.2 [tic disorder, unspecified], and 314 [attention deficit disorder]) and compared these risks with those of a control cohort. The primary outcomes of this study were the overall neuropsychiatric disorder occurrence and the occurrence of separate subtypes. RESULTS We examined 2,596 patients and 25,960 controls. The incidence of neuropsychiatric disorders in the GAS infection cohort (60.42 per 10,000 person-years) was significantly higher than that in the comparison cohort (49.32 per 10,000 person-years) (hazard ratio [HR] = 1.22; 95% CI, 1.00-1.49). The largest increased risk was for tic disorders (HR = 1.63; 95% CI, 1.02-2.62). Patients hospitalized for GAS infection had a 1.96-fold higher risk of neuropsychiatric disorders than did people without GAS infection (HR = 1.96; 95% CI, 1.23-3.12), and there was no difference in risk between outpatients with GAS infection and people without GAS infection (HR = 1.14; 95% CI, 0.92-1.41). Patients with moderate or high frequencies of GAS infection-related clinic visits had much higher risks of developing a neuropsychiatric disorder and, specifically, tic disorders and ADHD (all P values for trend < .05). These risks were not increased in patients with a low frequency of clinic visits. CONCLUSIONS Our results confirmed an association between previous group A streptococcal infection and neuropsychiatric disorders.
Collapse
Affiliation(s)
- Han-Cheng Wang
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan.,College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Ieong Lau
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, eDepartment of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, gGraduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Taichung, Taiwan
| | - Anna Chang
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chia-Hung Kao
- Professor, Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, No. 2, Yuh-Der Rd, Taichung 40447, Taiwan.
| |
Collapse
|
50
|
Chang CC, Lee YC, Lin CC, Chang CH, Chiu CD, Chou LW, Sun MF, Yen HR. Characteristics of traditional Chinese medicine usage in patients with stroke in Taiwan: A nationwide population-based study. J Ethnopharmacol 2016; 186:311-321. [PMID: 27090345 DOI: 10.1016/j.jep.2016.04.018] [Citation(s) in RCA: 48] [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] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Stroke has been the leading causes of death worldwide. Traditional Chinese medicine (TCM) has been used for stoke patients for thousands of years. This study aimed to investigate TCM usage and prescription patterns in stroke patients in Taiwan. MATERIALS AND METHODS We analyzed a random sample of one million individuals representing the 23 million enrollees selected from the National Health Insurance Research Database in Taiwan. Demographic characteristics, TCM usage, prescription patterns and mortality rate among stroke patients were analyzed. RESULTS We identified 23,816 patients who were newly diagnosed with stroke between 2001 and 2009 by their diagnostic codes (ICD-9-CM 430-438). Among them, 4302 patients had hemorrhagic stroke while 19,514 patients had ischemic stroke. Overall, 12% of the stroke patients (n=2862) were TCM users. The median interval between stroke onset to the first TCM consultation is 12.2 months. Among the TCM users, more than half (52.7%) of the patients received both Chinese herbal remedies and acupuncture/traumatology treatment. Bu-yang-huan-wu-tang and Dan-shen (Radix Salviae Miltiorrhizae; Salvia miltiorrhiza Bunge) was the most commonly prescribed Chinese herbal formula and single herb, respectively. TCM users had a higher incidence rate ratio in myalgia, myositis, fasciitis and insomnia than non-TCM users. Mental disorders such as anxiety and depression are common in both TCM and non-TCM users. Comparing with the non-TCM users, the TCM users had a lower mortality rate (adjusted hazard ratios were 0.44 in overall stroke, 0.50 in ischemic stroke and 0.25 in hemorrhagic stroke). CONCLUSION Adjunctive TCM use may reduce the risk of mortality rate among stroke patients. Bu-yang-huan-wu-tang and Dan-shen are the most common prescribed Chinese herbal formula and single herb for stroke patients, respectively. Future study investigating the anti-inflammatory and neuroprotective efficacy of Bu-yang-huan-wu-tang and Dan-shen in stroke is warranted.
Collapse
Affiliation(s)
- Chia-Chi Chang
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan.
| | - Yu-Chen Lee
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; Graduate Institute of Acupuncture Science, China Medical University, Taichung 404, Taiwan.
| | - Che-Chen Lin
- Health Data Management Office, China Medical University Hospital, Taichung 404, Taiwan.
| | - Chin-Hsien Chang
- Department of Traditional Chinese Medicine, En Chu Kong Hospital, New Taipei City 237, Taiwan; Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan.
| | - Cheng-Di Chiu
- Department of Neurosurgery, China Medical University Hospital, Taichung 404, Taiwan; School of Medicine, China Medical University, Taichung 404, Taiwan.
| | - Li-Wei Chou
- Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; Graduate Institute of Acupuncture Science, China Medical University, Taichung 404, Taiwan; School of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404, Taiwan.
| | - Mao-Feng Sun
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; School of Chinese Medicine, China Medical University, Taichung 404, Taiwan.
| | - Hung-Rong Yen
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; School of Chinese Medicine, China Medical University, Taichung 404, Taiwan.
| |
Collapse
|