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Liu PS, Kuo TY, Chen IC, Lee SW, Chang TG, Chen HL, Chen JP. Optimizing methadone dose adjustment in patients with opioid use disorder. Front Psychiatry 2024; 14:1258029. [PMID: 38260800 PMCID: PMC10800821 DOI: 10.3389/fpsyt.2023.1258029] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Opioid use disorder is a cause for concern globally. This study aimed to optimize methadone dose adjustments using mixed modeling and machine learning. Methods This retrospective study was conducted at Taichung Veterans General Hospital between January 1, 2019, and December 31, 2020. Overall, 40,530 daily dosing records and 1,508 urine opiate test results were collected from 96 patients with opioid use disorder. A two-stage approach was used to create a model of the optimized methadone dose. In Stage 1, mixed modeling was performed to analyze the association between methadone dose, age, sex, treatment duration, HIV positivity, referral source, urine opiate level, last methadone dose taken, treatment adherence, and likelihood of treatment discontinuation. In Stage 2, machine learning was performed to build a model for optimized methadone dose. Results Likelihood of discontinuation was associated with reduced methadone doses (β = 0.002, 95% CI = 0.000-0.081). Correlation analysis between the methadone dose determined by physicians and the optimized methadone dose showed a mean correlation coefficient of 0.995 ± 0.003, indicating that the difference between the methadone dose determined by physicians and that determined by the model was within the allowable range (p < 0.001). Conclusion We developed a model for methadone dose adjustment in patients with opioid use disorders. By integrating urine opiate levels, treatment adherence, and likelihood of treatment discontinuation, the model could suggest automatic adjustment of the methadone dose, particularly when face-to-face encounters are impractical.
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Affiliation(s)
- Po-Shen Liu
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Teng-Yao Kuo
- Fundamental General Education Center, National Chinyi University of Technology, Taiping, Taiwan
| | - I-Chun Chen
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shu-Wua Lee
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ting-Gang Chang
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hou-Liang Chen
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Jun-Peng Chen
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
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Yen TT, Chen IC, Cho S, Chang TG, Shih KH, Hua MW, Li JL, Hsu CY, Hsiao TH, Chen YM. GJB2 p.V37I Mutation Associated With Moderate Nonsyndromic Hearing Loss in an Adult Taiwanese Population. Ear Hear 2023; 44:1423-1429. [PMID: 37271870 DOI: 10.1097/aud.0000000000001384] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Gap junction protein beta 2 ( GJB2 ) p.V37I mutations are the most important hereditary cause of sensorineural hearing loss (SNHL) in Taiwan. Hearing outcomes are associated with hearing levels at baseline and the duration of follow-up. However, the audiological features of GJB2 p.V37I mutations in the adult population are unknown. The objectives of the present study were to investigate the audiological features, progression rate, and allele frequency of GJB2 p.V37I mutations among an adult Taiwanese population. METHODS Subjects of this case-control study were chosen from 13,580 participants of the Taiwan Precision Medicine Initiative. The genetic variations of GJB2 p.V37I were determined by polymerase chain reaction. We analyzed existing pure-tone threshold data from 38 individuals who were homozygous or compound heterozygotes for GJB2 p.V37I, 129 who were heterozygotes, and 602 individuals who were wild-type. Phenome-wide association studies (PheWAS) analysis was also performed to identify phenotypes associated with GJB2 p.V37I. RESULTS The minor allele frequency of GJB2 p.V37I was 0.92% in our study population. The mean hearing level of participants with a p.V37I mutation indicated moderate to severe hearing loss with 38.2% ± 22.3% binaural hearing impairment. GJB2 p.V37I was associated with an increased risk of hearing disability (odds ratio: 21.46, 95% confidence interval: 8.62 to 53.44, p < 0.001) in an autosomal recessive pattern. In addition, PheWAS discovered a significant association between GJB2 p.V37I and fracture of the humerus. GJB2 p.V37I is a pathogenic and prevalent variant of SNHL among the adult population. CONCLUSIONS The present study recommends patients with known GJB2 p.V37I mutations receive regular audiometric evaluation and genetic counseling. Early assistive listening device intervention is suggested to improve the quality of hearing.
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Affiliation(s)
- Ting-Ting Yen
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - I-Chieh Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sudi Cho
- Department of Neurobiology, Physiology and Behavior, College of Biological Sciences, University of California, Davis, California, USA
| | - Ting-Gang Chang
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Psychology, School of Psychology,Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Kai-Hsiang Shih
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Men-Wei Hua
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jui-Lin Li
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiann-Yi Hsu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzu-Hung Hsiao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Institute of Genomics and Bioinformatics, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Ming Chen
- School of Medicine, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Ph.D. Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, College of Life Sciences, National Chung Hsing University, Taiwan
- Precision Medicine Research Center, College of Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Chang TG, Hung CC, Huang PC, Hsu CY, Yen TT. Demoralization and Its Association with Quality of Life, Sleep Quality, Spiritual Interests, and Suicide Risk in Breast Cancer Inpatients: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph191912815. [PMID: 36232107 PMCID: PMC9566266 DOI: 10.3390/ijerph191912815] [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] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 05/16/2023]
Abstract
With decreasing mortality, the quality of life, spiritual needs, and mental health of breast cancer patients have become increasingly important. Demoralization is a poor prognostic factor for cancer patients. The extent of demoralization in breast cancer patients and its association with these factors remains unclear. This cross-sectional study was conducted at a Taiwanese medical center. We enrolled 121 participants (34 with high demoralization and 87 with low demoralization, as per the Mandarin Version of Demoralization Scale). High demoralization was associated with reduced quality of life, sleep quality, and spiritual interests. Multivariate analyses revealed that the scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire ≥ 62.5 (OR = 0.21, p = 0.002) and Spiritual Interests Related to Illness Tool Chinese Version ≥ 3.66 (OR = 0.11, p < 0.001) were associated with low demoralization. Demoralized patients with depression had a poorer quality of life and sleep quality. Although not statistically significant, depressed and demoralized participants were at a higher risk of suicide. Cancer patients with both depression and demoralization had the worst prognosis. Breast cancer patients exhibited demoralization when they had unmet bio-psycho-social-spiritual needs. An early assessment of demoralization may improve holistic healthcare for breast cancer patients.
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Affiliation(s)
- Ting-Gang Chang
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung 407612, Taiwan
- School of Psychology, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, College of Medicine, National Yung Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Chih-Chiang Hung
- Division of Breast Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 407612, Taiwan
- Department of Applied Cosmetology, College of Human Science and Social Innovation, Hungkuang University, Taichung 433304, Taiwan
| | - Pei-Ching Huang
- Cancer Prevention and Control Center, Taichung Veterans General Hospital, Taichung 407612, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force, Taichung Veterans General Hospital, Taichung 407612, Taiwan
| | - Ting-Ting Yen
- School of Medicine, College of Medicine, National Yung Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung 407612, Taiwan
- Correspondence: ; Tel.: +886-23592525
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Hsu WY, Chiu NY, Chang CC, Chang TG, Lane HY. The association between cigarette smoking and obstructive sleep apnea. Tob Induc Dis 2019; 17:27. [PMID: 31582938 PMCID: PMC6751985 DOI: 10.18332/tid/105893] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a serious sleep disorder characterized by repetitive episodes of paused or shallow breathing during sleep. Patients with OSA often have excessive daytime sleepiness. The role of cigarette smoking in OSA remains controversial. The aim of this study was to examine the relationship between cigarette smoking and OSA. METHODS In this retrospective chart review, we reviewed 18-month sleep laboratory charts in central Taiwan. We collected data regarding sleep, current cigarette smoking status, sex, age, body mass index (BMI), neck circumference, Epworth Sleepiness Scale score, and polysomnographic sleep parameters. In total, 733 subjects were recruited; among these, 151 were smokers and 582 were non-smokers. RESULTS Smokers had significantly higher apnea–hypopnea index (p<0.001) for non-rapid eye movement sleep stage, higher apnea–hypopnea index (p<0.001) for total sleep time, and higher snore frequency (p<0.001) in t-test analysis. They also demonstrated higher Epworth Sleepiness Scale scores, shorter sleep times, lower percentage of slow-wave (deep) sleep, and longer snore times. However, no significant association was found between cigarette smoking and OSA after adjusting for sex, age, and BMI (OR=1.02, 95% CI: 0.66–1.57). CONCLUSIONS We did not find any significant association between cigarette smoking and OSA after adjusting for age, sex, and BMI. Further well-designed prospective controlled cohort studies might clarify the relationship between cigarette smoking and OSA.
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Affiliation(s)
- Wen-Yu Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Nan-Ying Chiu
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Chen Chang
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ting-Gang Chang
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Abstract
Hsu W-Y, Chiu N-Y, Liu J-T, Wang C-H, Chang T-G, Liao Y-C, Kuo P-I. Sleep quality in heroin addicts under methadone maintenance treatment.Background: Sleep disturbance is a common phenomenon among opiate addicts. The side effects of opiate addiction or opiate withdrawal might result in sleep disturbance. However, their problems might be related to sedative medication abuse, alcohol abuse or heroin relapse. Sleep is an important issue in this population.Objective: To evaluate the prevalence of sleep disorders in heroin addicts receiving methadone maintenance treatment (MMT) and analyse the correlation between related factors, such as age at opiate exposure, opiate exposure duration, duration in MMT, methadone current dosage, methadone attendance rate and the severity of sleep disorders.Method: We enrolled 121 heroin addicts who were receiving MMT. We collected data on the duration of insomnia, hypnotic history, Visual Analogue Scale-10 of sleep quality, Pittsburgh Sleep Quality Index (PSQI), methadone dosage, methadone history and opiate history.Results: The mean of the PSQI was 9.1 ± 5.4, and 70.2% of patients had PSQI scores >5, indicating they were poor sleepers. We also found the PSQI scores were correlated significantly with the methadone dosage.Conclusions: The sleep disturbance prevalence rate of opiate addicts under MMT was high in Taiwan, as shown in the previous studies, and the severity of sleep disturbance has been underestimated.
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Affiliation(s)
- Wen-Yu Hsu
- Department of Psychiatry, Lu-Tung Branch of Changhua Christian Hospital, LuKang, Taiwan
| | - Nan-Ying Chiu
- Department of Psychiatry, Lu-Tung Branch of Changhua Christian Hospital, LuKang, Taiwan
| | - Jui-Ting Liu
- Department of Psychiatry, Lu-Tung Branch of Changhua Christian Hospital, LuKang, Taiwan
| | - Chieh-Hui Wang
- Department of Psychiatry, Lu-Tung Branch of Changhua Christian Hospital, LuKang, Taiwan
| | - Ting-Gang Chang
- Department of Psychiatry, Lu-Tung Branch of Changhua Christian Hospital, LuKang, Taiwan
| | - Yi-Cheng Liao
- Department of Psychiatry, Lu-Tung Branch of Changhua Christian Hospital, LuKang, Taiwan
| | - Pei-I Kuo
- Changhua County Public Health Bureau, Changhua, Taiwan
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Hsu WY, Kuo SY, Huang SS, Chang TG, Chiu NY. Valproate and high dosage of zotepine induced acute delirium: a case report. Br J Clin Pharmacol 2012; 73:486-8. [DOI: 10.1111/j.1365-2125.2011.04119.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Chang TG, Wang J, Chen LW, Hsu CY, Chang HW, Chen JS, Cho CL. Loss of expression of the p16 gene is frequent in malignant skin tumors. Biochem Biophys Res Commun 1997; 230:85-8. [PMID: 9020067 DOI: 10.1006/bbrc.1996.5891] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Expression of the p16 gene from 30 malignant skin tumors has been surveyed by immunohistochemical assay. Gene point mutations were detected by DNA direct sequencing and the mRNA level of gene expression was measured by RT-PCR. A silent point mutation of the p16 gene was found in only one patient. However, loss of expression of the p16 gene was noticed in 23 of 29 samples (79.3%). Correlation between loss of expression of the p16 gene and metastasis is significant (p = 0.0036). These findings suggest that loss of expression of the p16 gene may play a critical role in tumor progression of malignant skin tumors.
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Affiliation(s)
- T G Chang
- Institute of Life Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
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Kang KI, Chang TG, Glesk I, Prucnal PR. Nonlinear-index-of-refraction measurement in a resonant region by the use of a fiber Mach-Zehnder interferometer. Appl Opt 1996; 35:1485-1488. [PMID: 21085262 DOI: 10.1364/ao.35.001485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The nonlinear index of refraction in a resonant region has been determined by the use of a fiber-based Mach--Zehnder interferometer to measure the temporal fringe shift between two signals. The measurement technique is direct and does not require additional amplitude information for the extraction of the nonlinear index of refraction. This technique has been used to measure the temporal response of an InGaAsP semiconductor optical amplifier at 1.313 µm.
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Kang KI, Chang TG, Glesk I, Prucnal PR. Comparison of Sagnac and Mach-Zehnder ultrafast all-optical interferometric switches based on a semiconductor resonant optical nonlinearity. Appl Opt 1996; 35:417-426. [PMID: 21069026 DOI: 10.1364/ao.35.000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We present a theoretical analysis of recently demonstrated ultrafast all-optical interferometric switching devices (based on Sagnac and Mach-Zehnder interferometers) that use a large optical nonlinearity in a resonant regime. These devices achieve ~10-ps switching windows and do not require high-energy optical control pulses. We theoretically analyze and compare one Sagnac and two Mach-Zehnder switching configurations.
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Abstract
This paper addresses sleep staging as a medical decision problem. It develops a model for automated sleep staging by combining signal information, human heuristic knowledge in the form of rules, and a mathematical framework. The EEG/EOG/EMG events relevant for sleep staging are detected in real time by an existing front-end system and are summarized per minute. These token data are translated, normalized, and constitute the input alphabet to a finite state machine (automaton). The processed token events are used as partial belief in a set of anthropomimetic rules, which encode human knowledge about the occurrence of a particular sleep stage. The Dempster-Shafer theory of evidence weighs the partial beliefs and attributes the minutes sleep stage to the machine state transition that displays the highest final belief. Results are briefly presented.
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