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Tseng YH, Pan SW, Feng JY, Su WJ, Huang CYF, Chen YM. Detecting circulating microbial cell-free DNA by next-generation sequencing in patients with Mycobacterium avium complex-lung disease: A pilot study. Tzu Chi Med J 2024; 36:67-75. [PMID: 38406566 PMCID: PMC10887338 DOI: 10.4103/tcmj.tcmj_191_23] [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: 08/08/2023] [Revised: 08/22/2023] [Accepted: 09/20/2023] [Indexed: 02/27/2024] Open
Abstract
Objectives Determining a diagnosis for non-Tuberculous mycobacterium (NTM)-lung disease (LD) remains difficult. The value of circulating cell-free DNA (cfDNA) secreted from microbes has been established in the detection of pathogens in septic patients. However, it is unknown whether NTM-derived cfDNA is detectable in plasma from patients with NTM-LD and whether this is associated with the disease status of NTM-LD, especially in patients with Mycobacterium avium complex (MAC)-LD. Materials and Methods In this pilot study, from 2018 to 2019, we enrolled adult patients with MAC-LD at Taipei Veterans General Hospital in Taiwan for the detection of circulating cfDNA. We performed cfDNA extraction from plasma, next-generation sequencing (NGS) for nonhuman cfDNA, and sequence matching to a microbial database and then assessed the association between pathogen cfDNA and MAC-LD. Results Two (40%) plasma samples from MAC-LD patients had detectable MAC-specific cfDNA, namely one instance of DNA polymerase III alpha subunit and one instance of ATP-binding cassette transporters permease. The plasma samples from the three other MAC-LD cases and the one tuberculosis control were negative for either NTM-derived cfDNA or tuberculosis-related cfDNA. In addition to MAC-specific cfDNA, Ralstonia solanacearum, Staphylococcus aureus, and Pasteurella multocida were the most observed bacteria in our patients. The two patients with MAC-cfDNA positivity yielded higher radiographic scores (P = 0.076) and presented a higher number of nonhuman reads than those without MAC-cfDNA positivity (P = 0.083). Conclusion Using NGS method, we demonstrated MAC-cfDNA was detectable in patients with MAC-LD. Further large-scale research is warranted to assess the clinical value of detecting MAC-specific cfDNA in MAC-LD patients.
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Affiliation(s)
- Yen-Han Tseng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Juin Su
- Division of Chest Medicine, Department of Internal Medicine, China Medical University Hospital, Taipei Branch, Taipei, Taiwan
| | - Chi-Ying F Huang
- Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Hong K, Su WJ, Wang SJ, Wang ZG, Jiang Y, Shen Y. [Value of genetic screening on guiding the implantation of ICD in the high-risk patients with sudden cardiac death]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:1142-1147. [PMID: 36517434 DOI: 10.3760/cma.j.cn112148-20220328-00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- K Hong
- Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China Department of Genetic Medicine, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China Key Laboratory of Molecular Medicine of Jiangxi Province, Nanchang 330006, China
| | - W J Su
- Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - S J Wang
- Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Z G Wang
- Department of Genetic Medicine, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Y Jiang
- Department of Genetic Medicine, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China Key Laboratory of Molecular Medicine of Jiangxi Province, Nanchang 330006, China
| | - Yang Shen
- Department of Genetic Medicine, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China Key Laboratory of Molecular Medicine of Jiangxi Province, Nanchang 330006, China
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Pan SW, Syed RR, Catanzaro DG, Ho ML, Shu CC, Tsai TY, Tseng YH, Feng JY, Chen YM, Su WJ, Catanzaro A, Rodwell TC. Circulating mitochondrial cell-free DNA dynamics in patients with mycobacterial pulmonary infections: Potential for a novel biomarker of disease. Front Immunol 2022; 13:1040947. [PMID: 36466831 PMCID: PMC9709461 DOI: 10.3389/fimmu.2022.1040947] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
ObjectivesHuman mitochondrial cell-free DNA (Mt-cfDNA) may serve as a useful biomarker for infectious processes. We investigated Mt-cfDNA dynamics in patients with pulmonary mycobacterial infections to determine if this novel biomarker could be used to differentiate disease states and severity.MethodsPatients with pulmonary tuberculosis (PTB), latent tuberculosis infection (LTBI), and nontuberculous mycobacterial-lung disease (NTM-LD) were enrolled at a tertiary care hospital in Taiwan between June 2018 and August 2021. Human Mt-cfDNA and nuclear-cfDNA (Nu-cfDNA) copy numbers were estimated by quantitative polymerase chain reaction. Variables associated with PTB and 2-month sputum culture-positivity, indicating poor treatment response, were assessed using logistic regression.ResultsAmong 97 patients with PTB, 64 with LTBI, and 51 with NTM-LD, Mt-cfDNA levels were higher in patients with PTB than in LTBI (p=0.001) or NTM-LD (p=0.006). In the Mycobacterium tuberculosis-infected population, Mt-cfDNA levels were highest in smear-positive PTB patients, followed by smear-negative PTB (p<0.001), and were lowest in LTBI persons (p=0.009). A Mt-cfDNA, but not Nu-cfDNA, level higher than the median helped differentiate culture-positive PTB from culture-negative PTB and LTBI (adjusted OR 2.430 [95% CI 1.139–5.186], p=0.022) and differentiate PTB from NTM-LD (adjusted OR 4.007 [1.382–12.031], p=0.011). Mt-cfDNA levels decreased after 2 months of treatment in PTB patients (p=0.010). A cutoff Mt-cfDNA level greater than 62.62 x 106 copies/μL-plasma was associated with a 10-fold risk of 2-month culture-positivity (adjusted OR 9.691 [1.046–89.813], p=0.046).ConclusionElevated Mt-cfDNA levels were associated with PTB disease and failed sputum conversion at 2 months in PTB patients, and decreased after treatment.
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Affiliation(s)
- Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Rehan R. Syed
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Donald G. Catanzaro
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR, United States
| | - Mei-Lin Ho
- Department of Chemistry, Soochow University, Taipei, Taiwan
- Department of Chemistry and Biochemistry, University of California San Diego, La Jolla, CA, United States
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsung-Yeh Tsai
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Han Tseng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Jia-Yih Feng,
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Juin Su
- Division of Chest Medicine, China Medical University Hospital, Taipei Branch, Taipei, Taiwan
| | - Antonino Catanzaro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Timothy C. Rodwell
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, United States
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Su WJ, Chang N, He HY. [IgG4-related diseases of retroperitoneum in urinary and male reproductive system: a clinicopathological analysis of eleven cases]. Zhonghua Bing Li Xue Za Zhi 2022; 51:970-975. [PMID: 36207908 DOI: 10.3760/cma.j.cn112151-20220325-00222] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To analyze the clinicopathological features of IgG4-related diseases (RD) of retroperitoneum and the urinary and male reproductive system (IgG4-RUMR). Methods: A total of 11 IgG4-RUMR cases from January 2013 to March 2021 were retrospectively collected at Peking University Third Hospital and Shandong Provincial Hospital affiliated to Shandong First Medical University. The clinicopathologic features, laboratory and imaging findings were analyzed and scored according to the 2019 ACR/EULAR classification criteria for IgG4-RD. Results: The 11 patients (male:female is 9∶2; mean age 59 years, range from 44 to 83 years) were initially admitted to the Deparment of Urology/Kidney Transplantation (10 cases) and the Department of Oncology (1 case). All patients had urogenital disorders or imaging abnormalities. Three of the 11 patients had a history of IgG4-RD such as lacrimal gland engorgement, salivary gland engorgement and IgG4-associated pancreatitis. Abnormal retroperitoneal soft tissue and hydronephrosis were found in eight cases, while epididymal and spermatic cord masses were found in one case, simple renal mass in one case, and"benign prostatic hyperplasia"in one case. In the 10 patients tested for serum IgG4, the serum IgG4 level was 0.8-14.4 g/L. Histologically, all cases showed significant lymphoplasmacytic infiltration and storiform fibrosis, and some were accompanied by obliterative phlebitis. The number of IgG4 positive plasma cells was 12-155 per high-power field, and the IgG4/IgG ratio was 15%-77%. According to the 2019 ACR/EULAR IgG4-RD classification standard 11 cases scored 20-48 points, all of which met the diagnostic criteria of IgG4-RUMR. Therapeutically, the patient with a simple renal mass underwent partial nephrectomy. The patient with prostate lesion underwent transurethral resection of prostate and was initially diagnosed as nonspecific chronic prostatitis. Later, the patient was admitted again because of salivary gland swelling, and the pathologic diagnosis was amended. The patient with epididymal and spermatic cord masses participated in a clinical trial about retroperitoneal fibrosis. The remaining eight patients received symptomatic treatment such as adhesiolysis and stent placement. All the patients were subsequently treated with glucocorticoid/immunosuppressant and symptoms relieved. Conclusions: IgG4-RUMR is uncommon. In clinical practice, information from clinical, serologic, radiologic and pathologic evaluations must be integrated. IgG4-RUMR should be considered in the differential diagnosis of urinary and male reproductive diseases. The 2019 ACR/EULAR classification criteria for IgG4-RD, while relatively complex, are objective and practical in the diagnosis of IgG4-RUMR.
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Affiliation(s)
- W J Su
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - N Chang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital and Institute for Cancer Research, Beijing 100142, China
| | - H Y He
- Department of Pathology, School of Basic Medical Sciences, Peking University Third Hospital, Peking University Health Science Center, Beijing 100191, China
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Wang TY, Feng JY, Shu CC, Lee SSJ, Chen CY, Wei YF, Lin CB, Huang WC, Su WJ, Lin SM. Plasma Concentrations of sTREM-1 as Markers for Systemic Adverse Reactions in Subjects Treated With Weekly Rifapentine and Isoniazid for Latent Tuberculosis Infection. Front Microbiol 2022; 13:821066. [PMID: 35308376 PMCID: PMC8927064 DOI: 10.3389/fmicb.2022.821066] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background A regimen of once-weekly rifapentine plus isoniazid for 3 months (3HP) is an effective treatment for subjects with latent tuberculosis infection; however, no reliable biomarker exists for predicting systemic adverse reactions (SARs) to 3HP treatment. Methods This prospective, multi-center study evaluated the plasma concentrations of soluble triggering receptors expressed on myeloid cells (sTREM)-1 and sTREM-2 in subjects undergoing 3HP treatment and examined the associations between these biomarkers and SARs. Results This study enrolled 80 consecutive subjects receiving 3HP treatment, 25 of whom had SARs and 55 of whom did not. Subjects with SARs presented higher concentrations of sTREM-1 at baseline than those without SARs (240.1 ± 19.1 vs. 176.7 ± 9.4 pg/mL, P = 0.001). The area under the receiver operating characteristic curves revealed that day 1 plasma levels of sTREM-1 (0.708, 95% CI, 0.584–0.833, P = 0.003) and sTREM-2 (0.343, 95% CI, 0.227–0.459, P = 0.025) as well as the sTREM-1/sTREM-2 ratio (0.748, 95% CI, 0.638–0.858, P = 0.001) had modest discriminative power pertaining to the development of SARs. An sTREM-1 level exceeding the cut-off value (>187.4 pg/mL) (hazard ratio [HR], 6.15; 95% CI 1.67–22.70, P = 0.006) and a sTREM-2 below the cut-off value (<237.2 pg/mL) (HR, 4.46; 95% CI 1.41–14.1, P = 0.011) were independent predictors of SARs after controlling for other variables. Conclusions Plasma sTREM-1 and sTREM-2 levels are useful biomarkers for predicting SARs during 3HP treatment. Clinical trial government NCT04655794
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Affiliation(s)
- Tsai-Yu Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Susan Shin-Jung Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,Division of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Yu-Feng Wei
- Division of Chest Medicine, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Bin Lin
- Division of Chest Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Wei-Chang Huang
- Division of Chest Medicine, 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, National Chung Hsing University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Su WJ, He HY. [Clinicopathological features of testis teratoma and ovary teratoma]. Zhonghua Bing Li Xue Za Zhi 2022; 51:7-11. [PMID: 34979746 DOI: 10.3760/cma.j.cn112151-20210825-00601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- W J Su
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - H Y He
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing 100191, China
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Pan SW, Su WJ, Chan YJ, Ho ML, Feng JY, Shu CC, Wang JY, Wang HC, Yu CJ, Chen YM. Disease progression in patients with nontuberculous mycobacterial lung disease of nodular bronchiectatic (NB) pattern: the role of cavitary NB and soluble programmed death protein-1. Clin Infect Dis 2021; 75:239-247. [PMID: 34726741 DOI: 10.1093/cid/ciab929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In patients with nodular bronchiectatic (NB) nontuberculous mycobacterial-lung disease (NTM-LD), risk factors for disease progression have not been clearly investigated. The roles of cavitary NB and soluble programmed death protein-1 (sPD-1), an immune-related biomarker, in the disease course of NB NTM-LD remain unknown. METHODS Patients with NB NTM-LD were enrolled from two medical centers in 2014-2020. We identified cavitary NB, measured sPD-1 levels, and analyzed factors associated with cavitary NB and predictors for disease progression of NB NTM-LD. RESULTS Of 120 cases of NB NTM-LD, 87 (72.5%) were caused by Mycobacterium avium complex. sPD-1 levels were lower in 13 (10.8%) patients with cavitary NB than in non-cavitary patients (P = 0.020). Over 1.41 ± 1.43 years of follow-up, 12 (92.3%) patients in the cavitary and 66 (61.7%) in the non-cavitary group developed disease progression (P = 0.032). In multivariate analysis, body mass index (BMI) (Kg/m 2, adjusted hazard ratio [aHR], 0.895 [95% CI, 0.811-0.988]), sputum smear grade (aHR, 1.247 [1.014-1.534), cavitary NB (aHR, 2.008 [1.052-3.834]) and sPD-1 (per 10-pg/mL increase, aHR, 0.889 [0.816-0.967]) were predictive for disease progression. Notably, sPD-1 showed a dose-dependent association with disease progression (sPD-1 ≤ 23.5 pg/ml; aHR, 3.306 [1.664-6.567], and sPD-1: 23.6-53.7 pg/ml; aHR, 2.496 [1.390-4.483]) compared with the reference (sPD-1 > 53.7 pg/ml). CONCLUSIONS Patients with NB NTM-LD and low sPD-1, low BMI, high smear grade and cavitary NB were at high risk for disease progression. sPD-1 was low in patients with cavitary NB phenotype and dose-responsively associated with disease progression.
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Affiliation(s)
- Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Juin Su
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Chest Medicine, China Medical University Hospital, Taipei Branch, Taipei, Taiwan
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Lin Ho
- Department of Chemistry, Soochow University, Taipei, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Departmnet of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Xi WJ, Zhang Z, Li J, Su WJ, Li H, Pu ZM, Zhang Y, Feng SQ, Zhang YX. [Clinical effect of fractional carbon dioxide laser in the treatment of contracture scars]. Zhonghua Shao Shang Za Zhi 2021; 37:711-717. [PMID: 34404161 DOI: 10.3760/cma.j.cn501120-20210624-00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical effect of the fractional carbon dioxide laser in the treatment of contracture scars. Methods: A retrospective before-after self-control study was conducted. From December 2016 to April 2021, 16 patients (7 males and 9 females, aged 3-49 years) with contracture scars causing impaired function of the adjacent joint were admitted to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Eighteen joint scars of 16 patients were treated with fractional carbon dioxide laser every 2-3 months until the joint retained its normal range of motion or the effect plateaued. The treatment times of each patient were recorded. Before the first treatment and 6 months after the last treatment, the ranges of motion of the affected joint were measured in each patient, and the difference was calculated, meanwhile, the Vancouver Scar Scale (VSS) was used to evaluate the scar of each patient. In the treatment of 1 joint scar in each of 6 patients (totally 6 times of treatments), the ranges of motion of the affected joint before the current treatment, immediately after the treatment, and at the first follow-up after the treatment were documented, and the differences between the ranges before and immediately after the treatment as well as between the ranges before and at the first follow-up after the treatment were calculated. Adverse effects after the treatment in the treatment area were documented. At the last follow-up, a self-made questionnaire was used to collect the implementation status of the physical therapy and other scar management modalities during the treatment interval and follow-up period. Data were statistically analyzed with Wilcoxon rank sum test. Results: Eighteen joint scars in 16 patients received 2 (1, 3) times of fractional carbon dioxide laser treatment. The range of motion of the affected joint of 16 patients 6 months after the last treatment was 56.5 (39.0, 128.8)°, notably higher than 38.4 (22.9, 116.3)° before the first treatment (Z=-3.724, P<0.01), showing a remarkable improvement by 17.4 (8.0, 24.1)°. The vascular distribution, softness, and thickness scores, and total score in VSS scoring of scars of 16 patients 6 months after the last treatment were significantly lower than those before the first treatment (Z=-2.989, -3.762, -2.814, -3.739, P<0.01), with the most obvious improvement in softness. In 6 times of treatments, the range of motion of the affected joint immediately after treatment and at the first follow-up of (2.5±0.6) months after treatment were 156.2 (148.0, 164.2)° and 160.2 (156.7, 166.4)°, both notably higher than 151.4 (145.7, 155.3)° before treatment (Z=-2.201, -2.201, P<0.05), showing a remarkable improvement by 9.1 (4.4, 13.0)° and 13.1 (8.0, 15.7)°, respectively. No adverse effects such as blisters, infection, or hypertrophic scar formation were observed in the treatment area of 16 patients after treatment. Most patients adopted physical therapy, compression, silicone gel or sheets, and braces during the treatment interval and follow-up period. Conclusions: The fractional carbon dioxide laser can soften the scar and increase the range of motion of the affected joint, which is suitable for the clinical treatment of mild contracture scars.
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Affiliation(s)
- W J Xi
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Z Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - J Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - W J Su
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - H Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Z M Pu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Y Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - S Q Feng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Y X Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Pan SW, Su WJ, Chan YJ, Chuang FY, Feng JY, Chen YM. Mycobacterium tuberculosis-derived circulating cell-free DNA in patients with pulmonary tuberculosis and persons with latent tuberculosis infection. PLoS One 2021; 16:e0253879. [PMID: 34166477 PMCID: PMC8224927 DOI: 10.1371/journal.pone.0253879] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/04/2021] [Accepted: 06/14/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives The timely diagnosis of pulmonary tuberculosis (PTB) is challenging. Although pathogen-derived circulating cell-free DNA (cfDNA) has been detected in humans, the significance of Mycobacterium tuberculosis (MTB)-cfDNA detection in patients with PTB remains unclear. Methods This study enrolled patients with PTB and persons with latent tuberculosis infection (LTBI) as the study and control groups, respectively, from 2018 to 2020. We measured interferon-γ levels and calculated blood monocyte-to-lymphocyte ratio (MLR). We conducted plasma cfDNA extraction, quantitative polymerase chain reaction (qPCR), and droplet digital PCR targeting the IS6110 gene of MTB. We calculated the sensitivity and specificity of using MTB-cfDNA to identify PTB and analyzed the factors associated with PTB diagnosis and MTB-cfDNA positivity. Results We enrolled 24 patients with PTB and 57 LTBI controls. The sensitivity of using MTB-cfDNA to identify PTB was 54.2%(13/24) in total and 46.2%(6/13) in smear-negative cases. Two LTBI controls (3.5%) tested positive for MTB-cfDNA, indicating a specificity of 96.5%(55/57). By using MTB-cfDNA positivity and an MLR ≥0.42 to identify PTB, sensitivity increased to 79.2%(19/24). Among patients with PTB, MTB-specific interferon-γ levels were higher in MTB-cfDNA positive participants than in those who tested negative (7.0 ±2.7 vs 2.7±3.0 IU/mL, p<0.001). MTB-cfDNA levels declined after 2 months of anti-tuberculosis therapy (p<0.001). Conclusion The sensitivity of using MTB-cfDNA to identify PTB in participants was 54.2%, which increased to 79.2% after incorporating an MLR ≥0.42 into the analysis. MTB-cfDNA positivity was associated with MTB-specific immune response, and MTB-cfDNA levels declined after treatment. The clinical value of MTB-cfDNA in PTB management necessitates further investigation.
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Affiliation(s)
- Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- * E-mail: (JYF); (SWP)
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fan-Yi Chuang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- * E-mail: (JYF); (SWP)
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Su VYF, Pan SW, Yen YF, Feng JY, Su WJ, Chen YM. Statin use and impact on tuberculosis risk. Expert Rev Anti Infect Ther 2021; 19:1093-1098. [PMID: 33641582 DOI: 10.1080/14787210.2021.1892488] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Tuberculosis, a chronic infection caused by Mycobacterium tuberculosis (MTB), is one of the 10 leading causes of death in the world. The current treatment is a combination antimicrobial therapy administered for 6-9 months. It is important to find therapeutic strategy to shorten the treatment during and strengthen the host immune response against MTB.Areas covered: There is evidence that MTB uses cholesterol in the host macrophage to infect and survive inside the host macrophage. Statins inhibit the synthesis of cholesterol and aid in reducing the levels of cholesterol in human, which have been associated with better outcome in infectious diseases. In this narrative review, we discuss recent studies that investigated the effects of statins on the prevention or treatment of TB infection.Expert opinion: The evaluation of the published evidence suggests that statins may be beneficial in the treatment of patients with TB infections. Future studies may focus not only on the beneficial effects of statins, but also on distinguishing the effects of different statins.
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Affiliation(s)
- Vincent Yi-Fong Su
- Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Wei Pan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Jia-Yih Feng
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Juin Su
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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11
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Pan SW, Shu CC, Lee CC, Feng JY, Chan YJ, Chen YM, Su WJ. Role of Soluble T-Cell Immunoglobulin Mucin Domain-3 in Differentiating Nontuberculous Mycobacterial Lung Disease from Pulmonary Colonization. Arch Bronconeumol 2021; 58:S0300-2896(21)00063-6. [PMID: 33745754 DOI: 10.1016/j.arbres.2021.01.035] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/13/2021] [Accepted: 01/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Differentiating between nontuberculous mycobacterial lung disease (NTM-LD) and pulmonary NTM colonization (NTM-Col) is difficult. Compared with healthy controls, patients with NTM-LD generally present immune tolerance along with increased expressions of T-cell immunoglobulin mucin domain-3 (TIM-3) and programmed cell death-1 (PD-1) on T lymphocytes. However, the role of soluble TIM-3 (sTIM-3) and soluble PD-1 (sPD-1) in differentiating NTM-LD from NTM colonization (NTM-Col) remains unclear. METHODS Patients with NTM-positive respiratory samples and controls were enrolled from 2016 to 2019. Patients were classified into NTM-Col and NTM-LD groups. Levels of sTIM-3, sPD-1, soluble PD-ligand-1 (sPD-L1), and TIM-3 expression were measured. Factors associated with NTM-LD were analyzed by logistical regression. RESULTS TIM-3 expression on CD4+ and CD8+ T lymphocytes were highest in NTM-LD group, followed by NTM-Col, and control (P=.017 and P=.011 for trend). sTIM-3 elevated in the NTM-Col group compared with the NTM-LD and control groups (856.3±518.7 vs. 595.3±352.6pg/mL, P=.009; vs. 437.0±267.4pg/mL, P<.001). Levels of sPD-1 and sPD-L1 were similar among groups. Among the 79 NTM-positive patients, sTIM-3 was associated with NTM-LD (100-pg/mL increase, adjusted odds ratio (aOR) 0.658 [95% CI, 0.502-0.864], P=.003). Patients with ≥2 risk factors (sTIM-3≤530pg/mL, BMI≤22.5, and radiographic score ≥5) were 13 times more likely to exhibit NTM-LD than those without (aOR 13.234 [2.983-58.709], P=.001). CONCLUSIONS sTIM-3 was an independent factor for differentiating NTM-LD from NTM-Col, suggesting the immunologic role of sTIM-3 in NTM-LD pathogenesis. By assessing sTIM-3 levels and other risk factors, physicians may be able to identify NTM-LD cases in a simplified manner.
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Affiliation(s)
- Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Ching Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Chest Medicine, China Medical University Hospital, Taipei Branch, Taipei, Taiwan.
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12
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Su WJ, Zong YY, Cui FY. [Mixed atypical type A thymoma and micronodular thymoma with lymphoid stroma: report of a case]. Zhonghua Bing Li Xue Za Zhi 2020; 49:1333-1335. [PMID: 33287528 DOI: 10.3760/cma.j.cn112151-20200408-00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- W J Su
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Y Y Zong
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - F Y Cui
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
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13
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Feng JY, Su WJ, Chuang FY, Pan SW, Yeh YC, Lin YY, Chen NJ. TREM-1 enhances Mycobacterium tuberculosis-induced inflammatory responses in macrophages. Microbes Infect 2020; 23:104765. [PMID: 33049389 DOI: 10.1016/j.micinf.2020.10.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/09/2020] [Accepted: 10/05/2020] [Indexed: 01/06/2023]
Abstract
Triggering receptor expressed on myeloid cells 1 (TREM-1) extensively interacts with toll-like receptors and amplifies pro-inflammatory responses. The effect of TREM-1 on Mycobacterium tuberculosis (MTB)-related immune responses remains to be elucidated. We isolated bone marrow-derived macrophages (BMDMs) from wild-type mice and Trem-1 KO mice and treated them with MTB whole cell lysate and EsxA (ESAT-6). Cytokine production and mRNA expression, including Trem-1, following stimulation were evaluated. Intratracheal instillation of heat-killed MTB (HKMTB) in mice was performed and the presence of TREM-1-positive macrophages was investigated by immunohistochemistry analysis. In our study, BMDMs isolated from wild-type mice produced more pro-inflammatory cytokines and demonstrated higher inflammatory gene expression levels compared with those isolated from Trem-1 KO mice when stimulated with MTB whole cell lysate. EsxA had a synergistic effect with MTB whole cell lysate on the induction of pro-inflammatory responses. The gene expression of Trem-1 was upregulated when treated with MTB-related proteins. TREM-1-positive macrophages were identified in the lung tissues from patients with active TB and from wild-type mice treated with intratracheal instillation of HKMTB. In conclusion, in mouse macrophages, TREM-1 could enhance pro-inflammatory immune responses when stimulated with MTB-related proteins. The gene expression of Trem-1 could also be induced by MTB-related stimulation.
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Affiliation(s)
- Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fan-Yi Chuang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Yang Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Nien-Jung Chen
- Institute of Microbiology and Immunology, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan.
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14
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Pan SW, Feng JY, Yen YF, Chuang FY, Shen HS, Su VYF, Chuang PH, Chan YJ, Su WJ. Metformin use and post-exposure incident tuberculosis: a nationwide tuberculosis-contact cohort study in Taiwan. ERJ Open Res 2020; 6:00050-2020. [PMID: 32743005 PMCID: PMC7383051 DOI: 10.1183/23120541.00050-2020] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022] Open
Abstract
Patients with diabetes mellitus are susceptible to active tuberculosis (TB) and latent TB infection (LTBI) [1–3]. Close contact with patients with infectious TB is associated with an increased risk of having coprevalent TB or developing incident TB [4, 5]. However, information on the burden of incident TB in contacts with underlying diabetes is limited. Considering post-exposure TB in patients with diabetes, metformin has demonstrated anti-TB effects in preclinical studies and association with a low LTBI prevalence in a cross-sectional survey [6, 7]. Despite metformin's wide use and correlation with a lower TB risk in patients with type 2 diabetes (T2D) [8], the impact of metformin use during TB exposure on subsequent TB risk has not been thoroughly investigated. We aimed to obtain the rate of post-exposure incident TB, but not coprevalent TB, in T2D patients and evaluate whether TB risk can be modified by metformin use during the TB-exposure period. This TB contact cohort study showed that the risk of incident TB, not coprevalent TB, was highest in the diabetes group without metformin use during TB exposure, followed by the nondiabetes population, and was lowest in the diabetes group with metformin usehttps://bit.ly/3fpJyF0
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Affiliation(s)
- Sheng-Wei Pan
- Dept of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Jia-Yih Feng
- Dept of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Feng Yen
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan
| | - Fan-Yi Chuang
- Dept of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiang-Shi Shen
- Dept of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Vincent Yi-Fong Su
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Dept of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Dept of Internal Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taiwan
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Division of Infectious Diseases, Dept of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Microbiology, Dept of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Juin Su
- Dept of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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Yi-Fong Su V, Yen YF, Yang KY, Su WJ, Chou KT, Chen YM, Perng DW. Masks and medical care: Two keys to Taiwan's success in preventing COVID-19 spread. Travel Med Infect Dis 2020; 38:101780. [PMID: 32505623 PMCID: PMC7270822 DOI: 10.1016/j.tmaid.2020.101780] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Vincent Yi-Fong Su
- Department of Internal Medicine, Taipei City Hospital, Taipei City Government, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Ta Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Pan SW, Shu CC, Feng JY, Su WJ. Treatment for Mycobacterium avium complex lung disease. J Formos Med Assoc 2020; 119 Suppl 1:S67-S75. [DOI: 10.1016/j.jfma.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022] Open
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Feng JY, Chen WC, Chen YY, Su WJ. Clinical relevance and diagnosis of nontuberculous mycobacterial pulmonary disease in populations at risk. J Formos Med Assoc 2020; 119 Suppl 1:S23-S31. [PMID: 32482607 DOI: 10.1016/j.jfma.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/26/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
The lungs are the most common disease site of nontuberculous mycobacteria (NTM). However, the isolation of NTM in a respiratory specimen does not indicate lung disease (LD). Differentiation between NTM colonization and NTM-LD remains challenging. In this brief review, we summarize the clinical impact of NTM-LD on morbidity and mortality in high-risk populations. The diagnosis criteria for NTM-LD-including clinical features, radiological presentations, and microbiological evidence-are also reviewed, according to the latest American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) guideline and the British Thoracic Society (BTS) guideline. However, the diagnosis of NTM-LD does not necessitate the initiation of anti-NTM treatment. Both environmental, host, and bacterial factors should be considered to identify patients that require NTM-LD treatment.
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Affiliation(s)
- Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Ying Chen
- Department of Internal Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Feng JY, Huang WC, Lin SM, Wang TY, Lee SSJ, Shu CC, Pan SW, Chen CY, Lin CB, Wei YF, Tung CL, Li CP, Su WJ. Safety and treatment completion of latent tuberculosis infection treatment in the elderly population-A prospective observational study in Taiwan. Int J Infect Dis 2020; 96:550-557. [PMID: 32434083 DOI: 10.1016/j.ijid.2020.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/17/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The detection and treatment of latent tuberculosis infection (LTBI) is a key step in eliminating tuberculosis (TB), but information on safety and on treatment interruption in elderly LTBI patients remains limited. METHODS This multicenter prospective observational study included individuals with LTBI who underwent preventive therapy. Incidents of systemic adverse reactions (SARs) and treatment interruption rates in an elderly group (≥60 years old) and a young group (<60 years old) were analyzed. RESULTS A total of 406 LTBI patients, comprising 167 elderly and 239 young patients, were included in the analyses. The incidence of SARs was similar in the elderly group (18%) and the young group (15.1%). Being middle-aged (35-59 years), body mass index <23 kg/m2, a regimen of 3 months of once-weekly rifapentine plus isoniazid, and end-stage renal disease were independent factors associated with SARs. The treatment interruption rate was similar between the elderly group (21.6%) and the young group (15.9%). LTBI patients aged ≥80 years with SARs had the highest risk of treatment interruption. CONCLUSIONS The occurrence of SARs was similar in the elderly (≥60 years old) and young (<60 years old) LTBI patients receiving preventive therapy. Extremely old (≥80 years old) LTBI patients had a higher treatment interruption rate, especially when they had SARs.
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Affiliation(s)
- Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chang Huang
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Shu-Min Lin
- Department of Chest Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tsai-Yu Wang
- Department of Chest Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Bin Lin
- Division of Chest Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Feng Wei
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Chest Medicine, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chin-Lien Tung
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiao-Ping Li
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Huang SF, Su WJ. Role of invariant nature killer T cell in dysbiosis of gut microbiota among Mycobacterium tuberculosis infected patients. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.148.34] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Background
In Mycobacterium tuberculosis (MTB)-infected patients, the dysbiosis in gut microbiota was associated with systemic proinflammation. The invariant nature killer T (iNKT) cell was suggested the T-cell involved in immune modulation activated by metabolites or structural molecules of microbial in gut lumen. Herein we investigated how the gut microbiota influence on the systemic immunity by study the iNKT cells in peripheral blood in human.
Method
Patients with active TB, latent TB infection (LTBI), and healthy controls (HC) were enrolled. Interleukin (IL)-10, IL-4, IL-6, and IL-1B levels, the CD3+, CD4+, CD8+ cells, iNKT (CD3+6B11+) cells counts in blood, proliferation index (PI) of iNKT cells by α-galactosylceramide (α-GalCer) stimulation in vitro, and the interferon-gamma (IFN-γ) concentration by IFN-r-releasing-assay (IGRA) were measured.
Results
In active TB, both the cell counts and PI of iNKT were decreased. In LTBI, the PI of iNKT cells and the stimulated IFN-γ by MTB-Antigen divided to the iNKT cell counts (IFN-TBAg/iNKT) were positively associated with the relative abundance of Firmicutes. In active TB, a higher iNKT cell counts were also associated with higher relative abundance of Firmicutes. After adjusted by iNTK cell counts, the proinflammatory cytokines IL-10, IL-1B, and IL-6 were positively associated with the relative abundance of Bacteroidaceae in the gut microbiota.
Conclusion
In LTBI, Firmicutes in the gut microbiota determined the activities of iNKT cell and the IFN-TBAg level in peripheral blood. In active TB, the iNKT cell was related to the pro-inflammation and the relative abundances of Bacteroidaceae in gut microbiota.
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Affiliation(s)
- Shiang-Fen Huang
- 1Taipei Veterans General Hospital, Taiwan
- 2National Yang-Ming University, Taiwan
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Pan SW, Yen YF, Feng JY, Chuang PH, Su VYF, Kou YR, Su WJ, Chan YJ. Opposite effects of statins on the risk of tuberculosis and herpes zoster in patients with diabetes: A population-based cohort study. Br J Clin Pharmacol 2020; 86:569-579. [PMID: 31633826 DOI: 10.1111/bcp.14142] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/29/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Abstract
It remains uncertain whether statin use is associated with the risks of tuberculosis (TB) and herpes zoster in patients with type 2 diabetes. This study aims to assess the effects of statins vs nonstatin lipid-lowering agents on the risk of these infectious diseases in patients with diabetes. METHODS Participants in the Taiwan National Health Insurance Research Database diagnosed with type 2 diabetes in 2001-2013 were classified as statin users, nonstatin users and lipid-lowering drug-free groups. Participants were observed for incident TB and herpes zoster from diabetes diagnosis until treatment crossover or December 2013. Statin user and nonstatin user were the time-dependent variables in Cox regression analysis. RESULTS Over 240 782 person-years of observation, statin users (n = 17 696) were associated with a lower TB risk than nonstatin users (n = 5327) and the drug-free group (n = 22 316) (adjusted hazard ratio [aHR]: 0.66; 95% confidence interval [CI]: 0.44-0.99 and aHR: 0.57; 95% CI: 0.44-0.73). Compared with nonstatin users, statin users showed a dose-dependent association with TB risk (low-potency statin users, aHR: 0.692; 95% CI: 0.455-1.053; high-potency users, aHR: 0.491; 95% CI: 0.241-0.999). Statin users presented with a higher risk of herpes zoster than nonstatin users and the drug-free group (aHR: 1.23; 95% CI: 1.01-1.50 and aHR: 1.20; 95% CI: 1.09-1.33). The risks of TB and herpes zoster were not statistically different between nonstatin users and the drug-free group. CONCLUSION Compared with nonstatin drugs, statin use was specifically associated with a decreased risk of TB but a moderately increased risk of herpes zoster in this cohort study.
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Affiliation(s)
- Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Feng Yen
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan.,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taiwan
| | - Vincent Yi-Fong Su
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Yu Ru Kou
- Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
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21
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Hsieh MJ, Huang YW, Tsai YH, Feng JY, Su WJ. Improved appropriateness of anti-tuberculosis prescription by the expert prescription review program in Taiwan. J Formos Med Assoc 2020; 119:1658-1665. [PMID: 31932200 DOI: 10.1016/j.jfma.2019.12.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/03/2019] [Accepted: 12/16/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A nationwide program initiated by Taiwan CDC was conducted by the Taiwan Society of Tuberculosis and Lung Disease to improve the appropriateness of anti-TB prescriptions in Taiwan. METHODS All anti-TB prescriptions from 12 hospitals across Taiwan were reviewed by experienced pulmonologists, according to the 2011 Taiwan TB treatment guidelines, between May and October 2013. The investigation period was divided into three stages: May to June, July to August, and September to October. The concordance rates between anti-TB prescriptions and the guidelines were compared among the three stages and between medical centers and regional hospitals. RESULTS A total of 2574 new anti-TB prescriptions were reviewed. The appropriateness of anti-TB prescriptions was 82.0%. The most dominant error was inappropriate dosage of anti-TB medications. The appropriateness improved significantly with prescription review, and the concordance rates were 78.7%, 80.6%, and 87.6% in stages 1, 2, and 3, respectively (P < 0.001). The inappropriateness of medication dosage also improved significantly, with the rates of inappropriate dosage dropping from 10.2% in stage 1-5.4% in stage 3 (Odds ratio 0.491, P < 0.001). The appropriateness rates showed no significant difference between regional hospitals and medical centers (82.5% vs. 81.3%, Odds ratio 0.915, P = 0.393), but the improvement of prescription appropriateness was significant in regional hospitals but not in medical centers. CONCLUSION Prescription review by TB experts is an effective approach to improve the appropriateness of anti-TB prescriptions.
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Affiliation(s)
- Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan; Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Yi-Wen Huang
- Respiratory and Critical Care Center, Changhua Hospital, Ministry of Health & Welfare, Changhua, Taiwan
| | - Ying-Huang Tsai
- Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan; Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan
| | - Jia-Yih Feng
- Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Juin Su
- Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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22
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Su VYF, Yang YH, Perng DW, Tsai YH, Chou KT, Su KC, Su WJ, Chen PC, Yang KY. Correction for: Real-world effectiveness of medications on survival in patients with COPD-heart failure overlap. Aging (Albany NY) 2019; 11:8728-8729. [PMID: 31596732 PMCID: PMC6814592 DOI: 10.18632/aging.102363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Vincent Yi-Fong Su
- Department of Internal Medicine, Taipei City Hospital, Taipei City Government, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Huang Tsai
- Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Ta Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pau-Chung Chen
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan.,Cancer Progression Research Center, National Yang-Ming University, Taipei, Taiwan
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Abstract
BACKGROUND Antituberculosis (TB) drug-induced liver injury (ATLI) is a common adverse effect of anti-TB drugs. Whether regular monitoring of liver function can ameliorate ATLI has been widely debated. The current study aimed to investigate the liver test monitoring status of patients receiving anti-TB treatment in Taiwan, as well as the impact of scheduled liver function monitoring on the risk of ATLI. METHODS Patients who received anti-TB treatment at our hospital between 2009 and 2017 were enrolled for retrospective analysis. RESULTS A total of 1062 patients were included, and of them 469 (44.2%) received regular liver function monitoring (good monitoring group). ATLI was recognized in 100 (9.4%) patients. The good monitoring group detected more ATLI cases early compared with the poor monitoring group (14.7% vs 5.2%, and 21.4 vs 61.6 days, p < 0.01), with a lower peak serum alanine aminotransferase (276.1 vs 507.1 IU/L, p = 0.05). CONCLUSION In the current study, less than half of all patients who received anti-TB drugs had their liver function monitored regularly. Scheduled monitoring of liver function could facilitate the early identification of more ATLI cases, thus leading to less liver injury. The implementation of periodic liver function monitoring tests in patients receiving anti-TB treatment should be re-emphasized and encouraged.
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Affiliation(s)
- Tien-En Chang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yi-Shin Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Wei-Juin Su
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chin-Lin Perng
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Chen YY, Pan SW, Shen HS, Chuang FY, Feng JY, Su WJ. Declining trend in incidence of tuberculosis in adolescents and young adults in Taiwan. Eur Respir J 2019; 53:53/5/1801305. [DOI: 10.1183/13993003.01305-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/01/2019] [Indexed: 11/05/2022]
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25
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Huang SF, Yang YY, Chou KT, Fung CP, Wang FD, Su WJ. Systemic proinflammation after Mycobacterium tuberculosis infection was correlated to the gut microbiome in HIV-uninfected humans. Eur J Clin Invest 2019; 49:e13068. [PMID: 30620398 DOI: 10.1111/eci.13068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/18/2018] [Revised: 01/01/2019] [Accepted: 01/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The dysbiosis of gut microbiome and interaction with host immunity after Mycobacterium tuberculosis (MTB) infection are under investigation. We had found fatigue symptom concurrent with dysbiosis by decreasing the ratio of Firmicutes to Bacteroidetes (F/B ratio) in active tuberculosis (TB). The study aims to assess the inflammatory biomarkers and their interaction with gut microbiome in active TB and latent TB infection before starting anti-TB regimens. MATERIALS AND METHOD Interleukin-1 beta (IL-1B), IL-4, IL-6, IL-10, CD3+, CD4+, CD8+ T cells and interferon-gamma (IFN-γ) releasing assay (IGRA) were measured in 25 active TB patients, 32 LTBI subjects and 23 healthy controls (HC). Gut microbiome profiles were obtained using 16S rRNA MiSeq sequencing method. RESULTS The leucocytosis (7032 ± 387 cell/cum, P < 0.05), increase in IL-6 (229.7 ± 104 µg/dL, P < 0.05), and decrease in IL-4 (0.27 µg/dL ± 0.1, P < 0.05) were presented in active TB. The proportion of polymorphic neutrophil (PMN) in peripheral blood was positively related to the relative abundance of Bacteroidetes in LTBI and active TB (R2 = 0.23, P < 0.05). The F/B ratio was positively related to the detectable IL-1B in TB (R2 = 0.97, P < 0.01) and to the IL-4 in LTBI (R2 = 0.27, P < 0.05). In LTBI, the relative abundances of Coriobacteriaceae were positively related to the secretion of IFN-gamma against MTB-antigens more likely associated with of CD4+ T cell (R2 = 0.42, P < 0.05). CONCLUSION In active TB, dysbiosis with higher relative abundances of Bacteroidetes in stool and low F/B ratio was related to systemic proinflammation. In LTBI, dose-response relationship between peripheral PMN and relative abundances of Bacteroidetes was remained but not leads to systemic inflammation.
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Affiliation(s)
- Shiang-Fen Huang
- Institution of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Ying-Ying Yang
- Institution of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.,Institute of Public Health, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C
| | - Kun-Ta Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chang-Phone Fung
- Institution of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Fu-Der Wang
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wei-Juin Su
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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26
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Hsieh CJ, Su WJ, Wu SC, Chiu JH, Lin LC. Efficacy of acupressure to prevent adverse reactions to anti-tuberculosis drugs: Randomized controlled trials. J Adv Nurs 2019; 75:640-651. [PMID: 30375013 DOI: 10.1111/jan.13881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/21/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine whether acupressure can prevent or relieve the adverse drug reactions (ADRs) of anti-tuberculosis drugs. BACKGROUND People receiving drug treatment for TB often experience ADRs that may cause them to stop taking their medication. Acupressure is a form of traditional Chinese medicine that can be applied to alleviate or prevent disease symptoms. DESIGN A double-blinded, repeated-measures clinical trial in hospitals in Taiwan was carried out from April 2015 - May 2017. METHODS Convenience sampling was used to select 32 people (15 for the experimental group and 17 for the control group) aged >20 years who were taking anti-tuberculosis drugs. The people were randomized to receive 4-week of true acupressure and 4-weeks of sham acupressure. Acupressure therapy was given by a researcher in all cases. Both groups received treatment once per day on weekdays, with 15 min for each acupressure session. Outcomes (gastrointestinal irritation and adverse skin reactions) were assessed according to the people feedback and the physicians' recordings during the treatment course, and during monthly follow-up visits for 6 months thereafter. RESULTS Both groups typically experienced gastrointestinal irritation and adverse skin reactions within 2 months of beginning anti-tuberculosis drug treatment. The 4-weeks intervention involving relevant acupressure points successfully relieved both types of side effects in both immediate and delayed manner. CONCLUSIONS When correctly implemented, acupressure can prevent and relieve the ADRs of anti-tuberculosis drugs, and motivate people to complete their treatment course.
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Affiliation(s)
- Chia-Ju Hsieh
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.,Department of Nursing, Cardinal Tien College of Healthcare and Management, New Taipei City, Taiwan
| | - Wei-Juin Su
- Division of Pulmonary Immunology and Infectious Diseases, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Hwey Chiu
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Chan Lin
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan
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Yuan J, Mo B, Ma Z, Lv Y, Cheng SL, Yang Y, Tong Z, Wu R, Sun S, Cao Z, Wu J, Zhu D, Chang L, Zhang Y, Zhao L, Wang X, Wang X, Wang D, Li X, Peng Y, Liang Y, Liu H, Xiao Z, Lv X, Wu S, Dai Y, Huang Y, Hu Z, Qiu C, Li X, Zhang S, Li W, Liu S, Shi Y, Xiong C, Kuang J, Xiu Q, Cui S, Li J, Lin Q, Huang W, Wan Y, Qimanguli, Shen C, Xiao Y, Wu X, Chuang YC, Perng WC, Tsao SM, Hsu JY, Wang CC, Wang JH, Yeh PF, Lin HH, Kuo P, Lin MS, Su WJ. Safety and efficacy of oral nemonoxacin versus levofloxacin in treatment of community-acquired pneumonia: A phase 3, multicenter, randomized, double-blind, double-dummy, active-controlled, non-inferiority trial. Journal of Microbiology, Immunology and Infection 2019; 52:35-44. [DOI: 10.1016/j.jmii.2017.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/08/2017] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
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Abstract
Experimental studies have demonstrated that influenza vaccination may protect against tuberculosis (TB) through a Th17 response. This nationwide cohort study aimed to evaluate the association of influenza vaccination with incident TB among elderly persons in Taiwan. This 2005–2012 study included 99,982 elderly persons (64,290 vaccinated and 35,692 unvaccinated) from the Taiwan National Health Insurance Research Database. During the 738,367 person-years of follow-up, 1,141 (1.14%) persons had incident TB. The cumulative incidences of TB were 145.2 cases/100,000 person-years among vaccinated elderly persons and 175.5 cases/100,000 person-years among unvaccinated elderly persons (p = 0.002). The time-dependent Cox proportional hazards model revealed that influenza vaccination was an independent protective factor for incident TB. Our results suggest that influenza vaccination is associated with a lower risk of incident TB among elderly persons in Taiwan. Further investigation of biologic mechanisms is warranted.
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Su VYF, Su WJ. Response. Chest 2018; 153:1509-1510. [DOI: 10.1016/j.chest.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 10/14/2022] Open
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Feng JY, Su WJ, Pan SW, Yeh YC, Lin YY, Chen NJ. Role of TREM-1 in pulmonary tuberculosis patients- analysis of serum soluble TREM-1 levels. Sci Rep 2018; 8:8223. [PMID: 29844416 PMCID: PMC5974358 DOI: 10.1038/s41598-018-26478-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 09/21/2017] [Accepted: 04/25/2018] [Indexed: 01/26/2023] Open
Abstract
Triggering receptor expressed on myeloid cells 1 (TREM-1) amplifies inflammatory responses and is upregulated during sepsis and pulmonary infection. The association between serum soluble TREM-1 (sTREM-1) level and pulmonary tuberculosis (PTB) disease deserves investigation. In the present study, patients with PTB, latent TB infection (LTBI), and non-TB, non-LTBI subjects were prospectively enrolled and serum levels of sTREM-1, sTREM-2, and C-reactive protein (CRP) were measured. We correlated serum biomarkers and clinical presentations and treatment outcomes of PTB cases. We also utilized immunohistochemistry (IHC) to visualize TREM-1-expressing cells in lung tissues from PTB patients. A total of 86 PTB, 41 LTBI, and 20 non-TB, non-LTBI subjects were enrolled. Serum levels of sTREM-1 and CRP significantly increased in PTB patients; these higher serum levels were correlated with more advanced involvement in chest films and higher bacteria burden in sputum. In multivariate analysis, serum levels of sTREM-1 >260 pg/mL and CRP >2.6 mg/L were independent predictors for on-treatment mortality. Abundant TREM-1-expressing macrophages were identified in lung tissues from PTB samples. In conclusion, serum levels of sTREM-1 correlated with disease severity and treatment outcomes in PTB patients.
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Affiliation(s)
- Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chen Yeh
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Yang Lin
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Nien-Jung Chen
- Institute of Microbiology and Immunology, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan.
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Pan SW, Shu CC, Feng JY, Wang JY, Chan YJ, Yu CJ, Su WJ. Microbiological Persistence in Patients With Mycobacterium avium Complex Lung Disease: The Predictors and the Impact on Radiographic Progression. Clin Infect Dis 2018; 65:927-934. [PMID: 28541556 DOI: 10.1093/cid/cix479] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 02/19/2017] [Accepted: 05/23/2017] [Indexed: 01/05/2023] Open
Abstract
Background Persistent growth of Mycobacterium avium complex (MAC) in the lungs indicates continuous infection in MAC lung disease (MAC-LD), but its clinical significance has not been investigated. We aimed to evaluate the predictors of persistent culture-positivity for MAC (MAC-PP) and its impact on radiographic deterioration in MAC-LD. Methods Patients with MAC-LD at multiple medical centers from 2011 to 2016 were enrolled retrospectively. Microbiological persistence of MAC-LD was defined as MAC-PP exceeding 1 year, in contrast with the negative-conversion group. The outcome was radiographic progression, namely, increased number of involved lung areas or cavitary formation. Results Among 126 patients with MAC-LD, 75 (60%) were in the MAC-PP group; these patients had a higher proportion of radiographic progression (54%) than patients in the negative-conversion group (odds ratio [OR], 3.318; 95% confidence interval, 1.146-9.612). Independent predictors of MAC-PP were low body mass index (BMI), radiographic nodular-bronchiectatic (NB) pattern, and increase in the highest grade of acid-fast bacilli smear (AFS). Patients with BMI <21 kg/m2, NB pattern, and positive AFS had an OR of 17.7 for MAC-PP, and those with ≥2 of the factors had a 4.5-fold increased OR for MAC-PP relative to the comparison group. Other than MAC-PP, the highest AFS grade and no anti-MAC treatment were correlated with radiographic progression. Conclusion Microbiological persistence in patients with MAC-LD is not uncommon and leads to an increased risk of radiographic progression. The predictors of MAC-PP are low BMI, NB pattern, and high AFS grade; if these risk factors are present, anti-MAC treatment should be seriously considered.
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Affiliation(s)
- Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital.,School of Medicine.,Institute of Public Health, National Yang-Ming University
| | - Chin-Chung Shu
- Department of Internal Medicine.,Department of Traumatology, National Taiwan University Hospital.,Graduate Institute of Clinical Medicine, National Taiwan University
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital.,School of Medicine
| | | | - Yu-Jiun Chan
- Institute of Public Health, National Yang-Ming University.,Division of Infectious Diseases, Department of Internal Medicine.,Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital.,School of Medicine
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Pan SW, Yen YF, Kou YR, Chuang PH, Su VYF, Feng JY, Chan YJ, Su WJ. The Risk of TB in Patients With Type 2 Diabetes Initiating Metformin vs Sulfonylurea Treatment. Chest 2017; 153:1347-1357. [PMID: 29253553 DOI: 10.1016/j.chest.2017.11.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/28/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Metformin and the sulfonylureas are common initial antidiabetic agents; the former has demonstrated anti-TB action in in vitro and animal studies. The comparative effect of metformin vs the sulfonylureas on TB risk in patients with type 2 diabetes mellitus (T2DM) remains unclear. METHODS In this retrospective cohort study, patients without chronic kidney disease who received a T2DM diagnosis during 2003 to 2013 were identified from the Taiwan National Health Insurance Research Database. Participants with ≥ 2 years of follow-up were reviewed and observed for TB until December 2013. Patients receiving metformin ≥ 60 cumulative defined daily dose (cDDD) and sulfonylureas < 15 cDDD in the initial 2 years were defined as metformin majors; it was the inverse for sulfonylurea majors. The two groups were matched 1:1 by propensity score and compared for TB risk by multivariate Cox regression analysis. RESULTS Among 40,179 patients with T2DM, 263 acquired TB (0.65%) over a mean follow-up of 6.1 years. In multivariate analysis, the initial 2-year dosage of metformin, but not that of the sulfonylureas, was an independent predictor of TB (60-cDDD increase (adjusted hazard ratio [HR], 0.931; 95% CI, 0.877-0.990) after adjustment by cofactors, including adapted diabetes complication severity index. Metformin majors had a significantly lower TB risk than that of sulfonylurea majors before and after matching (HR, 0.477; 95% CI, 0.268-0.850 and HR, 0.337; 95% CI, 0.169-0.673; matched pairs, n = 3,161). Compared with the reference group (initial 2-year metformin < 60 cDDD), metformin treatment showed a dose-dependent association with TB risk (60-219 cDDD; HR, 0.860; 95% CI, 0.637-1.161; 220-479 cDDD, HR, 0.706; 95% CI, 0.485-1.028; ≥ 480 cDDD, HR, 0.319; 95% CI, 0.118-0.863). CONCLUSIONS Metformin use in the initial 2 years was associated with a decreased risk of TB, and metformin users had a reduced risk compared with their sulfonylurea comparators.
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Affiliation(s)
- Sheng-Wei Pan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Feng Yen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan
| | - Yu Ru Kou
- Institute of Physiology, National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Vincent Yi-Fong Su
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Jia-Yih Feng
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Juin Su
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Huang HC, Su WJ, Chiang CL, Feng JY, Huang HY, Lin CH, Lin SH, Cheng CY, Chiu CH. The predictive value of the interferon-γ release assay for chemotherapy responses in patients with advanced non-small-cell lung cancer. Lung Cancer 2017; 115:64-70. [PMID: 29290264 DOI: 10.1016/j.lungcan.2017.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/12/2017] [Accepted: 11/18/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES IFN-γ takes part in immunologic responses to cancer and its interactions with chemotherapy have also been described. Our previous study had showed an association between phytohemagglutinin (PHA)-stimulated IFN-γ (PSIG) response and overall survival in patients with advanced non-small-cell lung cancer (NSCLC). Here, we aimed to evaluate the correlation between PSIG and chemotherapy responses. MATERIALS AND METHODS From January 2011 to August 2012, 340 newly diagnosed patients with lung cancer were enrolled in a prospective latent tuberculosis observational study. Patients with advanced NSCLC who were treated with chemotherapy were included in this analysis. An IFN-γ release assay (IGRA) was used to evaluate pre-treatment PSIG levels. Patients were grouped into low and high PHA response groups according to their PSIG levels. Their demographic characteristics, tumor responses, and survival rates were investigated. RESULTS Eighty-four patients were enrolled. The chemotherapy response rates in the high and low PHA response groups were 45.2% and 35.7% (p=0.190), respectively. The disease control rate in the high PHA response group was 76.2%, versus 52.4% in the low PHA response group (p=0. 023). In multivariate analysis, PHA response was an independent predictor of disease control (odds ratio=3.017, 95% confidence interval=1.115-8.165). The Kaplan-Meier method demonstrated both longer progression-free survival (p=0.008) and overall survival (p=0.003) in the high PHA response group. CONCLUSIONS A higher pre-treatment PSIG response, obtained using the IGRA, was associated with better disease control rate and survival among patients with advanced NSCLC treated with chemotherapy.
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Affiliation(s)
- Hsu-Ching Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Lu Chiang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Yi Huang
- Biostatics Task Force, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Sheng-Hao Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Yuan Cheng
- Pulmonary Division, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Su WJ, Huang SF, Chen MH. Efficacy of isoniazid preventive therapy for latent tuberculosis infection in patients with immune-mediated inflammatory disorders-a retrospective cohort study in Taiwan. Tuberculosis (Edinb) 2017. [DOI: 10.1183/1393003.congress-2017.pa2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Feng JY, Lee MC, Pan SW, Su WJ. What is the optimal follow-up period for TB contacts- experience from a a population-based study in a TB-endemic area. Tuberculosis (Edinb) 2017. [DOI: 10.1183/1393003.congress-2017.oa1948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Huang SF, Chen MH, Wang FD, Tsai CY, Fung CP, Su WJ. Efficacy of isoniazid salvage therapy for latent tuberculosis infection in patients with immune-mediated inflammatory disorders - A retrospective cohort study in Taiwan. J Microbiol Immunol Infect 2017; 51:784-793. [PMID: 28739436 DOI: 10.1016/j.jmii.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/28/2017] [Accepted: 04/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Active tuberculosis (TB) in patients with latent tuberculosis infection (LTBI) was associated with use of biological agents for immune-mediated inflammatory disorders (IMIDs). For decreasing active TB, isoniazid prophylaxis therapy was administered before biologic therapy among IMID patients with LTBI. However, for patients who had been received biologics for a long time with unknown status of LTBI or exposure history of active TB, the prevalence of LTBI and efficacy of isoniazid therapy were unclear. METHOD A retrospective cohort study was conducted during 2012-2014 in a tertiary medical center in Taiwan, and the incidence case of active TB was identified by the national TB registration system on October 1, 2015. RESULTS All 382 patients with 1532 person-years were followed up, the initial prevalence of LTBI by positive interferon-gamma releasing assay (IGRA+) was 17.5%. The prevalence of LTBI was increased in elder age (>20%, p < 0.05), chronic kidney disease (33%, p < 0.05), metabolic syndrome (26.3%, p < 0.05), but not related to the type of IMIDs or biologics. The crude incidences of TB were increased in elders (53.3/1000 person-year), abnormal chest film (49.6/1000 person-year), administration of tocilizumab (13.6/1000 person-year), and metabolic syndrome (56.1/1000 person-year), respectively. Among patents with LTBI, the incidence of active TB was lower in patients with isoniazid therapy (9.2/1000 person-year, p = 0.02) than without isoniazid therapy (92.2/1000 person-years), regardless the timing of initiating isoniazid therapy (p > 0.05). CONCLUSION Isoniazid therapy can prevent active TB from LTBI despite of the timing of biologics administration.
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Affiliation(s)
- Shiang-Fen Huang
- Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taiwan, ROC.
| | - Ming-Han Chen
- Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
| | - Fu-Der Wang
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taiwan, ROC.
| | - Chang-Youh Tsai
- Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
| | - Chang-Phone Fung
- Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
| | - Wei-Juin Su
- School of Medicine, National Yang-Ming University, Taiwan, ROC; Department of Chest Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
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Wang FD, Chang CH, Su WJ, Shih JF, Hsiao KM, Chern MS, Chen TL, Lin MY, Chen YY, Lee CH. Screening of Hospital Workers for Pulmonary Tuberculosis in a Medical Center in Taiwan. Infect Control Hosp Epidemiol 2016; 27:510-1. [PMID: 16671034 DOI: 10.1086/503639] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Accepted: 08/29/2005] [Indexed: 11/03/2022]
Abstract
At a medical center in Taiwan, all workers were examined by chest radiography, to determine the prevalence of pulmonary tuberculosis. The prevalence of tuberculosis among all hospital workers was 0.12%, that among nurses was 0.35%, and that among externally contracted cleaners was 0.57%. All of the Mycobacterium tuberculosis isolates recovered from 2 nurses and from a patient with pulmonary tuberculosis were the Beijing strain, but the strains had different serotypes.
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Affiliation(s)
- Fu-Der Wang
- Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201 Section 2 Shih-Pai Road, Taipei, Taiwan
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Abstract
The association of latent tuberculosis infection (LTBI) with subsequent cancer remains unclear. We investigated the risk of future cancer among tuberculosis (TB) contacts with or without subsequent TB activation. Using the Taiwan National Health Insurance Research Database, we conducted a nationwide population-based study. TB contacts during 1997 to 2012 were included as the study cohort. Patients with antecedent cancer and TB were excluded. Data from 11,522 TB contacts and 46,088 age-, sex-, and enrollment date-matched subjects during 1997 to 2012 were analyzed. The 2 cohorts were monitored until December 31, 2012 for incidence of cancer and TB infection. LTBI was defined as a TB contact with subsequent TB activation. The primary endpoint was occurrence of newly diagnosed cancer. There was no difference in cancer development between the TB contact cohort and comparison cohort (log-rank test, P = 0.714). After multivariate adjustment, the hazard ratio (HR) for cancer among the LTBI patients was 2.29 [95% confidence interval (CI), 1.26-4.17; P = 0.007]. There was increase in cancer incidences for several specific cancer types, including multiple myeloma (HR 340.28), lung (HR 2.69), kidney and bladder (HR 6.16), hepatobiliary (HR 2.36), and gastrointestinal (HR 2.99) cancers. None of the 136 TB contacts who received isoniazid prophylaxis developed cancer. LTBI patients had a higher risk of future cancer.
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Affiliation(s)
- Vincent Yi-Fong Su
- From the Department of Chest Medicine (VY-FS, S-WP, J-YF, K-TC, Y-MC, W-JS); Center for Prevention and Treatment of Occupational Injury and Disease (P-HC); Department of Family Medicine, Taipei Veterans General Hospital (T-JC); Section of Infectious Diseases, Taipei City Hospital, Taipei City Government (Y-FY); Institute of Clinical Medicine (VY-FS, K-TC); and School of Medicine, National Yang-Ming University, Taipei, Taiwan (VY-FS, Y-FY, S-WP, J-YF, K-TC, Y-MC, T-JC)
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Yeh CF, Tu TY, Wang MC, Chu CH, Huang CY, Su WJ, Shiao AS. Emergence of Refractory Otomastoiditis Due to Nontuberculous Mycobacteria: Institutional Experience and Review of the Literature. Clin Infect Dis 2015; 62:739-745. [PMID: 26689957 DOI: 10.1093/cid/civ1033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/10/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) infection has attracted increasing attention in recent years; however, NTM otomastoiditis is extremely rare. Surgery combined with antibiotic therapy is the current mainstay of treatment; however, the reported duration of medication still varies. In this study, we aimed to analyze patients with NTM otomastoiditis and establish a more efficient treatment strategy. METHODS Medical records and temporal bone images of patients with NTM otomastoiditis were retrospectively analyzed. In addition, a comprehensive review of cases with NTM otomastoiditis in the literature was also performed. RESULTS Twenty-two patients were identified in our institution, and all patients had refractory otorrhea. The rates of granulation tissue, otalgia, and facial palsy were 90.9%, 31.8%, and 9.1%, respectively. Soft tissue attenuation via imaging studies was demonstrated in all of the middle ear cavities. All patients received medical treatment, 20 (90.9%) underwent surgery, and 4 (18.2%) underwent revision surgery. The median time to cure was similar between the "prolonged-course" and "standard-course" antibiotic groups (3.0 vs 3.3 months; P = .807). However, the former had a longer median duration of antibiotic therapy (6.0 vs 3.0 months; P = .01). In the literature review, 54 (96.4%) patients received medical treatment, 51 (91.1%) underwent surgery, and 27 (48.2%) underwent revision surgery. CONCLUSIONS NTM otomastoiditis should be suspected if a patient has chronic refractory otorrhea and ear granulation tissue. Surgery, which is the mainstay of treatment, should be complemented with antibiotics. In those without temporal bone osteomyelitis, antibiotic treatment can be stopped after a dry ear is achieved.
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Affiliation(s)
- Chien-Fu Yeh
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine.,Department of Otolaryngology-Head & Neck Surgery, National Defense Medical Center
| | - Tzong-Yang Tu
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine
| | - Mao-Che Wang
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine
| | - Chia-Huei Chu
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine
| | - Chii-Yuan Huang
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine
| | - Wei-Juin Su
- Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, Taipei Veterans General Hospital.,Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - An-Suey Shiao
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine.,Department of Otolaryngology-Head & Neck Surgery, National Defense Medical Center
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Pan SW, Yen YF, Feng JY, Su VYF, Kou YR, Su WJ. The Risk of Depressive Disorder Among Contacts of Tuberculosis Patients in a TB-endemic Area: A Population-based Cohort Study. Medicine (Baltimore) 2015; 94:e1870. [PMID: 26512600 PMCID: PMC4985414 DOI: 10.1097/md.0000000000001870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Tuberculosis (TB) disease may be transmitted to close contacts of index cases, causing physical illness. No studies have investigated the risk of developing depressive disorder among TB contacts in a TB-endemic area.Adult participants with a new diagnosis of TB contact (ICD-9-CM codes V01.1 plus chest radiographic order) since January 1, 2008, were identified from the National Health Insurance Research Database in Taiwan. A control cohort matched for age (±5 y), sex, enrolled years, and income level was selected. These 2 cohorts were followed until December 31, 2012, and observed for the development of depressive disorder. The Kaplan-Meier method and the log-rank test were used to examine the difference in cumulative incidences of depressive disorder between groups. Cox proportional-hazard models were used to calculate adjusted hazard ratios (aHRs) for depressive disorder.The TB contact cohort consisted of 9046 patients and matched controls of 36,184 ones. The mean age of TB contacts was 44.7 years, and 56.0% of them were women. During a mean follow-up period of 2.5 years, 127 (1.40%) TB contacts and 521 (1.44%) matched controls developed depressive disorder. TB exposure was found to be an independent risk factor of depressive disorder in women (aHR 1.34, 95% confidence interval [CI] 1.07-1.68), but not in men (aHR 0.71, 95% CI 0.48-1.06) after adjusting for age, comorbidities, and income levels. The risk of depression was significantly higher for female TB contacts than for matched controls in the first and second years (aHR 1.49, 95% CI 1.03-2.14; and aHR 1.53, 95% CI 1.05-2.23, respectively), but not thereafter. Of note, 67 (0.74%) TB contacts and 88 (0.24%) matched controls developed active TB, but none of them had subsequent depressive disorder during follow-up periods.Female TB contacts had an increased risk of depression within the first 2 years after exposure. Clinicians should consider conducting depression evaluations in addition to routine TB contact investigations in this subgroup population.
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Affiliation(s)
- Sheng-Wei Pan
- From the Department of Chest Medicine, Taipei Veterans General Hospital (SWP, J-YF, VY-FS, W-JS); School of Medicine (S-WP, Y-FY, J-YF, VY-FS, W-JS); Institute of Physiology, National Yang-Ming University, Taipei, Taiwan (S-WP, YRK); Section of Infectious Diseases, Taipei City Hospital, Taipei City Government (YFY); and Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan (YRK)
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Su VYF, Chen YT, Lin WC, Wu LA, Chang SC, Perng DW, Su WJ, Chen YM, Chen TJ, Lee YC, Chou KT. Sleep Apnea and Risk of Panic Disorder. Ann Fam Med 2015; 13. [PMID: 26195676 PMCID: PMC4508172 DOI: 10.1370/afm.1815] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Epidemiological studies have identified a trend in the development of depressive and anxiety disorders following a diagnosis of sleep apnea. The relationship between sleep apnea and subsequent panic disorder, however, remains unclear. METHODS Using a nationwide database, the Taiwan National Health Insurance Research Database, patients with sleep apnea and age-, sex-, income-, and urbanization-matched control patients who did not have sleep apnea were enrolled between 2000 and 2010. Patients with a prior diagnosis of panic disorder before enrollment were excluded. The 2 cohorts were observed until December 31, 2010. The primary endpoint was occurrence of newly diagnosed panic disorder. RESULTS A total of 8,704 sleep apnea patients and 34,792 control patients were enrolled. Of the 43,496 patients, 263 (0.60%) suffered from panic disorder during a mean follow-up period of 3.92 years, including 117 (1.34%) from the sleep apnea cohort and 146 (0.42%) from the control group. The Kaplan-Meier analysis revealed a predisposition of patients with sleep apnea to develop panic disorder (log-rank test, P <.001). After multivariate adjustment, the hazard ratio for subsequent panic disorder among the sleep apnea patients was 2.17 (95% confidence interval, 1.68-2.81; P <.001). CONCLUSIONS Sleep apnea appears to confer a higher risk for future development of panic disorder.
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Affiliation(s)
- Vincent Yi-Fong Su
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Tai Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medicine, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Chen Lin
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-An Wu
- Department of Radiology, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Shi-Chuan Chang
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Diahn-Warng Perng
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chin Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Ta Chou
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Su VYF, Liu CJ, Hu YW, Su WJ, Chen YM, Lai SL, Chen TJ, Perng DW, Lee YC, Tzeng CH, Chou KT. Amyloidosis and the risk of cancer: a nationwide population-based study. Int J Clin Oncol 2015; 20:1244-51. [PMID: 26041464 DOI: 10.1007/s10147-015-0849-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/13/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The association between amyloidosis and cancer remains unclear. PARTICIPANTS AND METHODS Using the Taiwan National Health Insurance Research Database we conducted a population-based cohort study. Patients newly diagnosed with amyloidosis between 1997 and 2009 were enrolled. Patients with antecedent cancer were excluded. Standardized incidence ratios (SIR) of cancers were calculated for the study cohort and compared with cancer incidence among the general population. We used a multivariate Cox regression model to evaluate the predictors of cancer development for patients with amyloidosis. RESULTS The study included 1,693 subjects with median follow-up of 5.63 years. A total of 68 patients developed cancer. The incidence of kidney cancer (SIR 3.42; 95 % CI 1.11-7.97; p = 0.034) and hematologic malignancies (SIR 3.88; 95 % CI 1.86-7.14; p < 0.001) were significantly higher for patients with amyloidosis. CONCLUSION This is currently the largest study to evaluate cancer risk among patients with amyloidosis. The results indicate that amyloidosis may be associated with an increased risk of kidney cancer and hematologic malignancies.
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Affiliation(s)
- Vincent Yi-Fong Su
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Wen Hu
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shinn-Liang Lai
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chin Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Ta Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Yen YF, Hu HY, Lin IF, Lai YJ, Su VYF, Pan SW, Ting WY, Su WJ. Associations of Metabolic Syndrome and its Components With Mortality in the Elderly: A Cohort Study of 73,547 Taiwanese Adults. Medicine (Baltimore) 2015; 94:e956. [PMID: 26061328 PMCID: PMC4616481 DOI: 10.1097/md.0000000000000956] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Available evidence shows that metabolic syndrome (Mets) has clear adverse effects for middle-aged and pre-elderly adults; however, the effect of Mets on mortality among elderly adults remains unclear. In addition, the comparative utility of Mets and its component for predicting mortality among the elderly has not been clearly established. Using data from a large Taiwanese cohort, we evaluated the effect of Mets and its components on subsequent all-cause and cause-specific mortality overtime among the elderly. A total of 73,547 elders (age ≥65 years) participated in the Taipei Elderly Health Examination Program from 2007 to 2010. Mets was diagnosed using the adult treatment panel III criteria, and mortality was ascertained by using national death records. Time-dependent analysis was used to evaluate associations of Mets and its components with all-cause mortality, cardiovascular disease (CVD) mortality, and expanded CVD mortality. This retrospective cohort study found that 42.6% of elders had Mets. During 194,057 person-years of follow-up, 2944 deaths were observed. After adjusting for sociodemographic characteristics and comorbidities, Mets was associated with increased risk of expanded CVD mortality (hazard ratio [HR], 1.27; 95% CI, 1.10-1.46) but not all-cause or CVD mortality. Among Mets components, decreased high-density lipoprotein cholesterol (HDL-C, HR 1.25, 95% CI 1.13-1.37) and hyperglycemia (HR 1.21, 95% CI 1.12-1.31) were associated with a significant increase in all-cause mortality. Hypertension and low HDL-C were predictors of CVD mortality and expanded CVD mortality, and, as compared with Mets, were associated with a higher risk of expanded CVD mortality. The present findings indicate that, in elderly adults, individual components of Mets are better predictors of all-cause and cause-specific mortality than is Mets as a whole. Our results suggest that future efforts should focus on preventing and managing individual risk factors (particularly hypertension, low HDL-C, and hyperglycemia) rather than on "diagnosing" Mets in elders.
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Affiliation(s)
- Yung-Feng Yen
- From the Section of Infectious Diseases, Taipei City Hospital, Taipei City Government (YY); School of Medicine, National Yang-Ming University (YY, YL, VYS, SP, WS); Department of Education and Research, Taipei City Hospital (HH); Institute of Public Health, National Yang-Ming University, Taipei (HH, IL); Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou (YL); Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC (VYS, SP, WT, WS)
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Feng JY, Chen SC, Lee MC, Fan WC, Su WJ, Hu YW, Yeh CM, Chen TJ, Liu CJ. Is 1-year follow-up adequate for adult tuberculosis contacts? Eur Respir J 2015; 45:1501-4. [PMID: 25700384 DOI: 10.1183/09031936.00142114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 01/03/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Jia-Yih Feng
- Dept of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C Both authors contributed equally
| | - San-Chi Chen
- Division of Hematology and Oncology, Dept of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C Both authors contributed equally
| | - Ming-Che Lee
- Dept of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Wen-Chien Fan
- Division of Infectious Disease, Dept of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wei-Juin Su
- Dept of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Yu-Wen Hu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chiu-Mei Yeh
- Dept of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C Dept of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Dept of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C School of Medicine, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, R.O.C
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Ting WY, Huang SF, Lee MC, Lin YY, Lee YC, Feng JY, Su WJ. Gender disparities in latent tuberculosis infection in high-risk individuals: a cross-sectional study. PLoS One 2014; 9:e110104. [PMID: 25369472 PMCID: PMC4219689 DOI: 10.1371/journal.pone.0110104] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 01/26/2014] [Accepted: 09/16/2014] [Indexed: 11/18/2022] Open
Abstract
Male predominance in active tuberculosis (TB) is widely-reported globally. Gender inequalities in socio-cultural status are frequently regarded as contributing factors for disparities in sex in active TB. The disparities of sex in the prevalence of latent TB infection (LTBI) are less frequently investigated and deserve clarification. In this cross-sectional study conducted in a TB endemic area, we enrolled patients at high-risk for LTBI and progression from LTBI to active TB from 2011 to 2012. Diagnosis of LTBI was made by QuantiFERON-TB Gold In-Tube (QFT-GIT). Differences in sex in terms of prevalence of LTBI and clinical predictors for LTBI were investigated. Associations among age, smoking status, and sex disparities in LTBI were also analyzed. A total of 1018 high-risk individuals with definite QFT-GIT results were included for analysis, including 534 males and 484 females. The proportion of LTBI was significantly higher in males than in females (32.6% vs. 25.2%, p = 0.010). Differences in the proportion of LTBI between sexes were most prominent in older patients (age ≥ 55 years). In multivariate analysis, independent clinical factors associated with LTBI were age (p = 0.014), smoking (p = 0.048), and fibro-calcified lesions on chest radiogram (p = 0.009). Male sex was not an independent factor for LTBI (p = 0.88). When stratifying patients according to the smoking status, the proportion of LTBI remained comparable between sexes among smokers and non-smokers. In conclusion, although the proportion of LTBI is higher in men, there is no significant disparity in terms of sex in LTBI among high-risk individuals after adjusting for age, smoking status, and other clinical factors.
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Affiliation(s)
- Wen-Ying Ting
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
| | - Shiang-Fen Huang
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
| | - Ming-Che Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
| | - Yung-Yang Lin
- Institute of Clinical Medicine and Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, R.O.C.
- Laboratory of Neurophysiology and Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
| | - Yu-Chin Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
- * E-mail: (JYF); (WJS)
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
- * E-mail: (JYF); (WJS)
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Fan WC, Ting WY, Lee MC, Huang SF, Chiu CH, Lai SL, Chen YM, Shih JF, Lin CH, Kao SJ, Wu MF, Tsao TCY, Wu CH, Yang KY, Lee YC, Feng JY, Su WJ. Latent TB infection in newly diagnosed lung cancer patients - A multicenter prospective observational study. Lung Cancer 2014; 85:472-8. [PMID: 25063540 DOI: 10.1016/j.lungcan.2014.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 04/11/2014] [Revised: 06/20/2014] [Accepted: 07/01/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Lung cancer and tuberculosis (TB) share common risk factors and are associated with high morbidity and mortality. Coexistence of lung cancer and TB were reported in previous studies, with uncertain pathogenesis. The association between lung cancer and latent TB infection (LTBI) remains to be explored. METHODS Newly diagnosed, treatment-naïve lung cancer patients were prospectively enrolled from four referral medical centers in Taiwan. The presence of LTBI was determined by QuantiFERON-TB Gold In-Tube (QFT-GIT). Demographic characteristics and cancer-related factors associated with LTBI were investigated. The survival status was also analyzed according to the status of LTBI. RESULTS A total of 340 lung cancer patients were enrolled, including 96 (28.2%) LTBI, 214 (62.9%) non-LTBI, and 30 (8.8%) QFT-GIT results-indeterminate cases. Non-adenocarcinoma cases had higher proportion of LTBI than those of adenocarcinoma, especially in patients with younger age. In multivariate analysis, COPD (OR 2.41, 95% CI 1.25-4.64), fibrocalcified lesions on chest radiogram (OR 2.73, 95% CI 1.45-5.11), and main tumor located in typical TB areas (OR 2.02, 95% CI 1.15-3.55) were independent clinical predictors for LTBI. Kaplan-Meier survival analysis demonstrated patients with indeterminate QFT-GIT results had significantly higher 1-year all-cause mortality than those with LTBI (p<0.001) and non-LTBI (p=0.003). In multivariate analysis, independent predictors for 1-year all-cause mortality included BMI<18.5 (HR 2.09, 95% CI 1.06-4.14, p=0.033), advanced stage of lung cancer (RR 7.76, 95% CI 1.90-31.78, p=0.004), and indeterminate QFT-GIT results (RR 2.40, 95% CI 1.27-4.54, p=0.007). CONCLUSIONS More than one-quarter of newly diagnosed lung cancer patients in Taiwan have LTBI. The independent predictors for LTBI include COPD, fibrocalcified lesions on chest radiogram, and main tumor located in typical TB areas. The survival rate is comparable between LTBI and non-LTBI cases. However, indeterminate QFT-GIT result was an independent predictor for all-cause mortality in lung cancer patients.
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Affiliation(s)
- Wen-Chien Fan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Ying Ting
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Che Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shiang-Fen Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shinn-Liang Lai
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, ROC
| | - Jen-Fu Shih
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC; Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan, ROC; School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Shang-Jyh Kao
- Pulmonary Division, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC; Taipei Medical University, Taipei, Taiwan, ROC
| | - Ming-Fang Wu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC; Divisions of Chest Medicine and Medical Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Thomas Chang Yao Tsao
- Department of Chest Medicine, Chung Shan Medical University and Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Chieh-Hung Wu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Infection and Immunity Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Chin Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Wei-Juin Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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Su VYF, Liu CJ, Wang HK, Wu LA, Chang SC, Perng DW, Su WJ, Chen YM, Lin EYH, Chen TJ, Chou KT. Sleep apnea and risk of pneumonia: a nationwide population-based study. CMAJ 2014; 186:415-21. [PMID: 24591276 DOI: 10.1503/cmaj.131547] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Evidence evaluating the risk of pneumonia in patients with obstructive sleep apnea is limited and mostly focuses on patients who receive continuous positive airway pressure (CPAP) therapy or on pediatric patients. We aimed to explore the risk of incident pneumonia among adults with sleep apnea, either with or without the need of CPAP therapy. METHODS From Jan. 1, 2000, we identified adult patients with sleep apnea from the Taiwan National Health Insurance Research Database. A control cohort without sleep apnea, matched for age, sex and comorbidities, was selected for comparison. The 2 cohorts were followed until Dec. 31, 2010, and observed for occurrence of pneumonia. RESULTS Of the 34,100 patients (6816 study patients and 27,284 matched controls), 2757 (8.09%) had pneumonia during a mean follow-up period of 4.50 years, including 638 (9.36%) study patients and 2119 (7.77%) controls. Kaplan-Meier analysis showed a higher incidence of pneumonia among patients with sleep apnea (log rank test, p < 0.001). After multivariate adjustment, patients with sleep apnea experienced a 1.20-fold (95% confidence interval 1.10-1.31) increase in incident pneumonia. The risk was even higher among patients who received CPAP therapy. INTERPRETATION Sleep apnea appeared to confer a higher risk for future pneumonia, possibly in a severity-dependent manner.
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Feng JY, Huang SF, Ting WY, Lee MC, Chen YC, Lin YY, Lee YC, Su WJ. Impact of cigarette smoking on latent tuberculosis infection: does age matter? Eur Respir J 2013; 43:630-2. [PMID: 24072215 DOI: 10.1183/09031936.00118313] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Feng JY, Huang SF, Lee MC, Ting WY, Chen YC, Lin YY, Lee YC, Su WJ. Characteristics of IFN-γ responses in IGRA among pulmonary TB suspects in a TB-endemic area. Diagn Microbiol Infect Dis 2013; 77:46-52. [PMID: 23867329 DOI: 10.1016/j.diagmicrobio.2013.05.020] [Citation(s) in RCA: 11] [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: 03/15/2013] [Revised: 05/26/2013] [Accepted: 05/28/2013] [Indexed: 01/31/2023]
Abstract
Although the diagnostic value of interferon-γ (IFN-γ) release assays for active tuberculosis (TB) is limited, the characteristic of non-TB-specific IFN-γ responses among TB suspects deserves further evaluation. We enrolled clinically suspected pulmonary TB (PTB) patients, and QuantiFERON-TB Gold In-Tube (QFT-GIT) was performed. The characteristics of IFN-γ responses were analyzed. Among 392 patients, active PTB patients had stronger IFN-γ responses to TB antigen (TBAg-Nil, P < 0.001) and lower responses to mitogen (Mitogen-Nil, P < 0.001). Lower body mass index (P = 0.001), without bacille Calmette-Guerin vaccination (P = 0.026), and active PTB (P = 0.011) were independent factors associated with lower non-TB-specific IFN-γ responses. Among TB suspects with higher TBAg-Nil (>1.02 U/mL) and lower Mitogen-Nil (<5.5 U/mL), 84.3% were active PTB cases. Among TB suspects with lower TBAg-Nil and higher Mitogen-Nil, only 4.7% were active PTB. The present study suggested that the possibilities of active PTB should be carefully excluded in TB suspects with stronger TB-specific and lower non-TB-specific IFN-γ responses in QFT-GIT.
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Affiliation(s)
- Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan R.O.C
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Huang SF, Su WJ, Ruan SY, Yu CJ, Hsieh SC, Liu YC, Wu YJJ, Lin HY. Risk factors for latent tuberculosis infection in RA patients treated with anti-tumor necrosis factor. Arthritis Res Ther 2012. [PMCID: PMC3332424 DOI: 10.1186/ar3641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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