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Tsoi H, Man EPS, Lok J, Cheng CN, Wong LS, Chan SY, Leung MH, Chan WL, Khoo US. Targeting androgen receptor in BQ323636.1 overexpressing oestrogen receptor-positive breast cancer to overcome aromatase inhibitor resistance: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 1:12-13. [PMID: 36919211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Affiliation(s)
- H Tsoi
- Department of Pathology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - E P S Man
- Department of Pathology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - J Lok
- Department of Pathology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C N Cheng
- Department of Pathology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - L S Wong
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - S Y Chan
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - M H Leung
- Department of Pathology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - W L Chan
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - U S Khoo
- Department of Pathology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Lim SS, Huang CC, Hsu PF, Lin CC, Wang YJ, Ding YZ, Liou TL, Wang YW, Huang SS, Lu TM, Chen JW, Chan WL, Lin SJ, Leu HB. Prolonged sitting time links to subclinical atherosclerosis. J Chin Med Assoc 2022; 85:51-58. [PMID: 34861666 DOI: 10.1097/jcma.0000000000000672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study investigates the association between daily sitting time and subclinical atherosclerosis by using coronary computed tomography angiography (CCTA). METHODS The study enrolled 203 subjects (age 57.6 ± 8.8 years) who underwent CCTA at annual medical checkups. Sitting time was categorized as < 5 hours/day (short), 5 to 9 hours/day (moderate) and ≥10 hours/d (long). We analyzed the coronary calcium score, plaque characteristics, and severity of coronary artery stenosis, including the segment involvement score (SIS) and segment stenosis score (SSS). RESULTS Subjects with longer sitting times tended to be male gender and have lower levels of high-density lipoprotein cholesterol (p for trend < 0.05). In addition, those with longer sitting time had higher SIS (1.2 ± 1.5 vs. 1.6 ± 2.1 vs. 2.3 ± 2.0 for short, moderate, and long sitting time, respectively) (p for trend = 0.015) and SSS (1.4 ± 2.0 vs. 1.9 ± 2.7 vs. 2.7 ± 2.6) (p for trend = 0.015), suggesting longer sitting time-correlated with the severity of coronary atherosclerosis. When considering the coronary plaque patterns, subjects with shorter sitting time (<5 hours/d) tended to have more calcified plaque and subjects with longer sitting time (≥10 hours/d) had more mixed plaque (p for trend = 0.018). After adjusting for age, gender, comorbidities, body mass index, and lipid profiles, increased sitting time was independently associated with the presence of mixed plaque, suggesting longer sitting time may be associated with higher risk of the formation of vulnerable plaque. CONCLUSION Longer sitting time was linked to the severity of subclinical atherosclerosis and the presence of high-risk vulnerable plaque in the general population.
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Affiliation(s)
- Su Shen Lim
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pai-Feng Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Chi Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yuan-Jen Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yaw-Zon Ding
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Teh-Ling Liou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Wen Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Sung Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tse-Min Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Hsu PF, Wang YW, Lin CC, Wang YJ, Ding YZ, Liou TL, Huang SS, Lu TM, Chan WL, Lin SJ, Leu HB. The association of the steatosis severity in fatty liver disease with coronary plaque pattern in general population. Liver Int 2021; 41:81-90. [PMID: 33373113 DOI: 10.1111/liv.14637] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 02/06/2020] [Revised: 07/09/2020] [Accepted: 07/25/2020] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Nonalcoholic fatty liver disease (NAFLD) is commonly observed in patients with cardiovascular disease (CVD). However, whether the steatosis severity of NAFLD is independently associated with coronary artery atherosclerosis is still controversial. METHODS Consecutive Taiwanese individuals (1502) who received coronary computed tomography angiography (CCTA) and abdominal sonography as part of a general routine health evaluation were enrolled. The association between steatosis severity, coronary atherosclerosis involvement and various plaque patterns were analysed. RESULTS Compared with non-steatosis, NAFLD subjects had more cardiovascular risk factors that correlated with the severity of steatosis (P for the trend <.05). The presence of atherosclerotic plaques correlated with the severity of steatosis (none: 53%, mild: 64.1%, and moderate to severe: 66.9%; P for the trend <.001). Parameters of coronary atherosclerosis, including atheroma burden obstructive score (ABOS), segment involvement score (SIS) and segment stenosis score (SSS), were higher in the moderate to severe steatosis group. After adjusting for major confounding factors, the severity of steatosis still correlated with the mixed plaque pattern (P = .043). Subgroup analysis of the risk of the presence of overall coronary and mixed plaques showed a significant association with increasing severity of steatosis, especially among these who were <65 years old, male, without metabolic syndrome, and with lower low-density lipoprotein choleseterol values. CONCLUSION In this general population, steatosis severity of NAFLD is associated with coronary artery atherosclerosis burden. Furthermore, steatosis severity correlated with the risk of the presence of coronary plaques, especially high-risk plaques, and was independent of traditional risk factors.
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Affiliation(s)
- Pai-Feng Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Public Health, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Wen Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Chi Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Jen Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yaw-Zon Ding
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Teh-Ling Liou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shao-Sung Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tse-Min Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Wang WT, Hsu PF, Lin CC, Wang YJ, Ding YZ, Liou TL, Wang YW, Huang SS, Lu TM, Huang PH, Chen JW, Chan WL, Lin SJ, Leu HB. Hemoglobin A1C Levels are Independently Associated with the Risk of Coronary Atherosclerotic Plaques in Patients without Diabetes: A Cross-Sectional Study. J Atheroscler Thromb 2019; 27:789-800. [PMID: 31902804 PMCID: PMC7458793 DOI: 10.5551/jat.51425] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIM Coronary atherosclerotic plaques can be detected in asymptomatic subjects and are related to low-density lipoprotein cholesterol (LDL) levels in patients with coronary artery disease. However, researchers have not yet determined the associations between various plaque characteristics and other lipid parameters, such as HDL-C and TG levels, in low-risk populations. METHODS One thousand sixty-four non-diabetic subjects (age, 57.86±9.73 years; 752 males) who underwent coronary computed tomography angiography (CCTA) were enrolled and the severity and patterns of atherosclerotic plaques were analyzed. RESULTS Statin use was reported by 25% of the study population, and subjects with greater coronary plaque involvement (segment involvement score, SIS) were older and had a higher body mass index (BMI), blood pressure, unfavorable lipid profiles and comorbidities. After adjusting for comorbidities, only age (β=0.085, p<0.001), the male gender (β=1.384, p<0.001), BMI (β=0.055, p=0.019) and HbA1C levels (β=0.894, p<0.001) were independent factors predicting the greater coronary plaque involvement in non-diabetic subjects. In the analysis of significantly different (>50%) stenosis plaque patterns, age (OR: 1.082, 95% CI: 10.47-1.118) and a former smoking status (OR: 2.061, 95% CI: 1.013-4.193) were independently associated with calcified plaques. For partial calcified (mixed type) plaques, only age (OR: 1.085, 95% CI: 1.052-1.119), the male gender (OR: 7.082, 95% CI: 2.638-19.018), HbA1C levels (OR: 2.074, 95% CI: 1.036-4.151), and current smoking status (OR: 1.848, 95% CI: 1.089-3.138) were independently associated with the risk of the presence of significant stenosis in mixed plaques. CONCLUSIONS A higher HbA1c levels is independently associated with the presence and severity of coronary artery atherosclerosis in non-diabetic subjects, even when LDL-C levels are tightly controlled.
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Affiliation(s)
- Wei-Ting Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Pai-Feng Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Healthcare and Management Center, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Chung-Chi Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Yuan-Jen Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Yaw-Zon Ding
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Teh-Ling Liou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Ying-Wen Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Shao-Sung Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Healthcare and Management Center, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Tse-Min Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Healthcare and Management Center, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University.,Institute of Clinical Medicine, National Yang-Ming University
| | - Jaw-Wen Chen
- Healthcare and Management Center, Taipei Veterans General Hospital.,Department of Medical Research, Taipei Veterans General Hospital.,Cardiovascular Research Center, National Yang-Ming University.,Institute of Pharmacology, National Yang-Ming University
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Healthcare and Management Center, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Healthcare and Management Center, Taipei Veterans General Hospital.,Cardiovascular Research Center, National Yang-Ming University.,Institute of Clinical Medicine, National Yang-Ming University
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Healthcare and Management Center, Taipei Veterans General Hospital.,School of Medicine, National Yang-Ming University.,Cardiovascular Research Center, National Yang-Ming University.,Institute of Clinical Medicine, National Yang-Ming University
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Li HM, Chau JYM, Woo SB, Lai J, Chan WL. Chinese version of the Rotator Cuff Quality of Life questionnaire: Cross-cultural adaptation and validation in rotator cuff-impaired patients in Hong Kong. Journal of Orthopaedics, Trauma and Rehabilitation 2019. [DOI: 10.1177/2210491719878877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: To adapt the Rotator Cuff Quality of Life (RC-QOL) questionnaire into traditional Chinese (Chi-RC-QOL) and to evaluate the validity and reliability in patients suffering from rotator cuff pathologies in Hong Kong. Methods: The Chi-RC-QOL will be constructed using the forward-translation followed by the backward-translation method. Thirty consecutive patients with clinically and radiologically confirmed rotator cuff pathology were recruited. Descriptive statistics will be followed by validity assessment using comparison with the Constant Shoulder (CS) score, University of California Los Angeles (UCLA) Shoulder Rating Scale, and Western Ontario Rotator Cuff (WORC) score. Parametric data will be tested using Pearson’s correlation coefficient for the total scores. Reliability was assessed using a test–retest interval of 30 min. The Cronbach’s α and intraclass correlation coefficient were calculated. Results: Cronbach’s α and internal consistency scores were high for all parts of the Chi-RC-QOL, with Cronbach’s α ranging between 0.89 and 0.98. Internal consistency scores range from 0.82 to 0.92, which can be regarded as an excellent correlation. Test–retest reliability was excellent for all parts of the Chi-RC-QOL with good absolute reliability. Chi-RC-QOL correlates well with the CS score, UCLA Shoulder Rating Scale, and the WORC score, with all being statistically significant. Conclusions: The current study adapted the RC-QOL to traditional Chinese version. The analysis confirmed the validity and reliability of the Chi-RC-QOL questionnaire. Level of Evidence: III.
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Affiliation(s)
- Ho-ming Li
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Jackie YM Chau
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - SB Woo
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - J Lai
- Department of Physiotherapy, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - WL Chan
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
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Yang HC, Liang Y, Hsu HC, Shu JH, Chou RH, Hsu PF, Wang YJ, Ding YZ, Liou TL, Wang YW, Huang SS, Lin CC, Lu TM, Leu HB, Chan WL, Lin SJ. InVestiGation of the Association of Physical Activity and Sedentary Behavior with tHe Occurrence of Future Cardiovascular Disease and Long Term Outcome in General Population Using the HEALTHCARE Database ( VGH-HEALTHCARE). Acta Cardiol Sin 2019; 35:534-541. [PMID: 31571803 PMCID: PMC6760128 DOI: 10.6515/acs.201909_35(5).20190126a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 01/26/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Current evidence supports the beneficial effect of physical activity in reducing adverse events, however studies on Asian populations are limited and have reported inconsistent findings. The aim of this study was to investigate the association between physical activity and the development of cardiovascular disease, diabetes, hypertension and malignancy in a large Asian cohort. We also investigated interactions between the intensity of physical activity, environmental exposure and biochemical markers. METHODS Subjects who received annual checkups at Taipei Veterans General Hospital were invited to join this study. Information on physical activity was evaluated using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Associations between the occurrence of clinical events including cardiovascular events, diabetes and malignancies and the intensity of physical activity, biochemical markers, imaging findings, personality trait evaluations and nutrition were evaluated. RESULTS In the initial stage of this study, a total of 1010 patients enrolled, 626 (62%) were male, 74 (7.4%) had diabetes, 183 (18.3%) had hypertension, and 220 (21.8%) were smokers. The total cholesterol was 202.1 ± 36.2 mg/dL and low-density lipoprotein-cholesterol was 125.7 ± 32.9 mg/dL, including 49.3 ± 13.1 mg/dL for serum high-density lipoprotein-cholesterol and 120.7 ± 70.7 mg/dL for triglycerides. The fasting glucose level was 93.8 ± 21.9 mg/dL, and HbA1c was 5.7 ± 0.7%. All information collected will be incorporated with future events to analyze the relationship between biochemical parameters, physical activity and future adverse events. CONCLUSIONS These findings will contribute to the understanding of the value of physical activity in determining future cardiovascular and non-cardiovascular events in Asian populations.
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Affiliation(s)
| | - Ying Liang
- Department of Nursing
- Healthcare and Management Center, Taipei Veterans General Hospital
| | - Hsiu-Chuan Hsu
- Department of Nursing
- Healthcare and Management Center, Taipei Veterans General Hospital
| | - Jiah-Hwang Shu
- Department of Nursing
- Healthcare and Management Center, Taipei Veterans General Hospital
| | | | - Pai-Feng Hsu
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
- Cardiovascular Research Center
| | - Yuan-Jen Wang
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
| | - Yaw-Zon Ding
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
| | - Teh-Ling Liou
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
| | - Ying-Wen Wang
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
| | - Shao-Sung Huang
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
- Cardiovascular Research Center
| | - Chung-Chi Lin
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Tse-Min Lu
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
- Cardiovascular Research Center
| | - Hsin-Bang Leu
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
- Cardiovascular Research Center
| | - Wan-Leong Chan
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
- Cardiovascular Research Center
| | - Shing-Jong Lin
- Healthcare and Management Center, Taipei Veterans General Hospital
- School of Medicine
- Cardiovascular Research Center
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Chen SC, Lin CP, Hsu HC, Shu JH, Liang Y, Hsu PF, Wang YJ, Ding YZ, Liou TL, Wang YW, Chang YC, Chan WL, Chen JW, Lin SJ, Leu HB. Serum bilirubin improves the risk predictions of cardiovascular and total death in diabetic patients. Clin Chim Acta 2019; 488:1-6. [DOI: 10.1016/j.cca.2018.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/25/2018] [Accepted: 10/21/2018] [Indexed: 12/30/2022]
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Huang WC, Teng HI, Hsueh CH, Lin SJ, Chan WL, Lu TM. Intravascular ultrasound guided wiring re-entry technique for complex chronic total occlusions. J Interv Cardiol 2018; 31:572-579. [DOI: 10.1111/joic.12518] [Citation(s) in RCA: 7] [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] [Received: 01/26/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
| | - Hsin-I Teng
- Division of Cardiology, Chiayi&WanQiao Branch; Taichung Veterans General Hospital; Taichung Taiwan, R.O.C
| | - Chien-Hung Hsueh
- Division of Cardiology, Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
| | - Shing-Jong Lin
- Division of Cardiology, Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
- Department of Health Care Center; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
- School of Medicine; National Yang-Ming University; Taipei Taiwan, R.O.C
| | - Wan-Leong Chan
- Department of Health Care Center; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
| | - Tse-Min Lu
- Division of Cardiology, Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
- Department of Health Care Center; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
- School of Medicine; National Yang-Ming University; Taipei Taiwan, R.O.C
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Cheng YL, Shu JH, Hsu HC, Liang Y, Chou RH, Hsu PF, Wang YJ, Ding YZ, Liou TL, Wang YW, Huang SS, Lin CC, Lu TM, Leu HB, Lin SJ, Chan WL. High health literacy is associated with less obesity and lower Framingham risk score: Sub-study of the VGH-HEALTHCARE trial. PLoS One 2018; 13:e0194813. [PMID: 29590183 PMCID: PMC5874050 DOI: 10.1371/journal.pone.0194813] [Citation(s) in RCA: 28] [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: 08/20/2017] [Accepted: 03/09/2018] [Indexed: 02/06/2023] Open
Abstract
Backgrounds Lower health literacy (HL) is associated with several cardiovascular disease (CVD) risk factors such as diabetes, hypertension, and metabolic syndrome (MS). The aim of our study was to investigate the association between HL and the Framingham 10-year risk score of CVD. Methods From 2015–2016, 1010 subjects aged 23 to 88 years receiving health check-up in Taipei Veterans General Hospital had complete clinical evaluations and laboratory examinations. Fatty liver was diagnosed by ultrasonography. The short form questionnaire adapted from the Mandarin Health Literacy Scale was used to assess HL. The Framingham risk score was calculated by patient characteristics. Results Subjects with higher BMIs were associated with lower HL scores. The proportion of subjects with MS was higher in the lower health literacy score group (≤ 9) at 28.8%; further analysis found that lower HL was significantly associated with MS in women but not in men. The Spearman’s rho demonstrated that the HL score was significantly associated with the BMI-based (rho = -0.11; P < 0.001) or lipid-based (rho = -0.09; P < 0.004) Framingham risk score. Conclusions Higher HL scores were associated with less CVD risk such as lower BMIs, less MS in women, and less fatty liver disease. Furthermore, HL had an inverse association with the Framingham risk score as expected. Therefore, HL in patients with CVD risk should be improved and considered as an important issue in terms of CVD reduction.
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Affiliation(s)
- Yuan-Lung Cheng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Jiah-Hwang Shu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Chuan Hsu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying Liang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (YJW); (YL)
| | - Ruey-Hsing Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Pai-Feng Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Jen Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (YJW); (YL)
| | - Yaw-Zon Ding
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teh-Ling Liou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Wen Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shao-Sung Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Chi Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of public health, National Yang-Ming University, Taipei, Taiwan
| | - Tse-Min Lu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Bang Leu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
| | - Wan-Leong Chan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular research center, National Yang-Ming University, Taipei, Taiwan
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10
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Teng HI, Sung SH, Huang SS, Pan JP, Lin SJ, Chan WL, Lee WL, Lu TM, Wu CH. The impact of successful revascularization of coronary chronic total occlusions on long-term clinical outcomes in patients with non-ST-segment elevation myocardial infarction. J Interv Cardiol 2018; 31:302-309. [PMID: 29495125 DOI: 10.1111/joic.12501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess the long-term clinical impact of revascularization of coronary concomitant coronary chronic total occlusion (CTO) in patients with Non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND CTO is associated with poorer prognosis in patients with NSTEMI. The evidence of revascularization of CTO in patients with NSTEMI is still conflicting. METHODS Consecutive patients with NSTEMI and CTO who underwent percutaneous coronary intervention (PCI) within 72 h of admission from 2006 to 2015 were retrospectively recruited and analyzed. A total of 967 patients underwent PCI for NSTEMI. Among them, 106 (11%) patients had concomitant CTO and were recruited for analysis. CTO lesions were revascularized successfully in 67 (63.2%) patients (successful CTO PCI group), while the CTO in the remaining 39 patients were either not attempted or failed (No/failed CTO PCI group). RESULTS The 30-day cardiac death and major adverse cardiac events (MACE) were significantly lower in the successful CTO PCI group (both cardiac death and MACE were 3% vs 30%, P < 0.001, respectively). A landmark analysis set at 30th day for 30-day survivals was performed. After a mean of 2.5-year follow-up, the long-term cardiac death was still significantly lower (16.9% vs 42.3%, P < 0.001), whereas the MACE showed a trend toward lower incidence (26.2% vs 40.7%, P = 0.051) in the successful CTO PCI group. In multivariate Cox regression analysis, successful revascularization of CTO is an independent protective predictor for long-term cardiac death (HR 0.310, 95% CI, 0.109-0.881, P = 0.028) in all population and in propensity-score matched cohort (P = 0.007). CONCLUSIONS Successful revascularization of CTO was associated with reduced risk of long-term cardiac death in patients with NSTEMI and concomitant CTO.
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Affiliation(s)
- Hsin-I Teng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shao-Sung Huang
- Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ju-Pin Pan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Lieng Lee
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tse-Min Lu
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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11
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Huang WC, Teng HI, Chan WL, Lu TM. Short-term and long-term clinical outcomes of rotational atherectomy in resistant chronic total occlusion. J Interv Cardiol 2018; 31:458-464. [DOI: 10.1111/joic.12489] [Citation(s) in RCA: 7] [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] [Received: 10/02/2017] [Revised: 12/02/2017] [Accepted: 12/09/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Wei-Chieh Huang
- Division of Cardiology; Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
| | - Hsin-I Teng
- Division of Cardiology; Chia-Yi & Wan-Qiao Branch; Taichung Veterans General Hospital; Taichung Taiwan, R.O.C
| | - Wan-Leong Chan
- Department of Health Care Center; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
| | - Tse-Min Lu
- Division of Cardiology; Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
- Department of Health Care Center; Taipei Veterans General Hospital; Taipei Taiwan, R.O.C
- School of Medicine; National Yang-Ming University; Taipei Taiwan, R.O.C
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12
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Lau KS, Lam KO, Chan WL, Lee VHF, Kwong DLW, Leung TW. S-1 Versus S-1 Plus Cisplatin as First-line Treatment for Metastatic Gastric Cancer. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716810] [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] Open
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13
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Yip KC, Chan WL, Luk MS, Chan CW. A Case of Acute Calcific Tendinitis of the Hand: An Uncommon Condition that is Easily Overlooked and Misdiagnosed. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acute calcific tendinitis of the hand is uncommon, yet it has a high rate of misdiagnosis as it resembles other conditions such as fractures, inflammatory and infectious causes that give rise to pain and swelling in the hand. We present a case of acute calcific tendinitis in a middle age woman affecting the extensor pollicis longus to raise awareness of this uncommon, but easily treatable cause of pain and swelling. This case was first diagnosed as septic arthritis of the interphalangeal joint of the thumb. Correct diagnosis was made after careful review of history, physical examination findings, laboratory results and radiographs. (Hong Kong j. emerg.med. 2015;22:316-319)
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Chan WL, Leung YY, Chan HY, Ng F. Can Emergency Medicine Ward Shorten Hospital Length of Stay in Patients with Nasogastric Tube Related Coffee Ground Aspirate? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The aim of this study was to determine whether elderly patients on nasogastric (NG) tube feeding who presented with coffee ground aspirate could be effectively and safely managed in a local setting of Emergency Medicine Ward (EMW). Method A retrospective study with data retrieved from all the cases admitted with a diagnosis of coffee ground aspirate or vomiting who were on NG tube feeding during three years before and after EMW was launched. Data including patient demographics, length of stay (LOS), types of pharmaceutical treatment received, need of upper endoscopy, in-hospital death and readmission rate within fourteen days were studied. Patients who were haemodynamically unstable, having melaena on per rectal examination, on warfarin or with underlying gastrointestinal malignancy were excluded. Results A total of 223 patients matching the studied criteria were included in the study, with 103 of them being admitted before the opening of EMW. For the 120 cases admitted after EMW was launched, 70 cases were admitted to EMW and 50 admitted to Medical Ward. The LOS for elderly patients on NG tube feeding presented with coffee ground aspirate was significantly shortened after EMW was launched (5.2 days vs. 4.2 days, p=0.046). In-hospital mortality and 14-day readmission rate were similar in the two studied period. Patients admitted to EMW and Medical Ward in the second study period were also analysed. Those admitted to EMW had a shorter LOS than those admitted to Medical ward during the same period (3.4 days vs. 5.3 days, p=0.001). Conclusion The establishment of EMW in local setting can achieve a significant reduction in hospital LOS without jeopardizing patient outcome for elderly patients who are on NG tube feeding presenting with coffee ground aspirate.
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Leung YY, Ma KK, Tsang WT, Lau CL, Ko S, Chan WL, Ng F. A Retrospective Study of Geriatric Patients Presenting with Fever to an Accident and Emergency Department in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790801500204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To study the characteristics and outcome of geriatric patients presenting with fever to an emergency department in Hong Kong and to analyse the factors affecting their length of stay. Methods Retrospective study. Patients aged ≥65 who complained of fever, or with temperature ≥37.5°C (aural) presenting to the Accident and Emergency Department (AED) of Caritas Medical Centre in Hong Kong from 14 November 2006 to 13 December 2006 were enrolled. The demographic data, clinical information and outcomes were studied. The characteristics of short stay and long stay patients were compared. Results There were 370 patients in the study. Their median age was 80. Of these patients, 64.9% were category 3 or above, i.e. urgent, emergent or critical. The most common chief complaints were fever, shortness of breath, dizziness and cough. The admission rate was 81.9%. The median length of stay in hospital was 4.3 days. The most common hospital discharge diagnoses were chest infection, urinary tract infection, and fever with unknown cause. The discharge rate within 48 hours was 24.6%. With further analysis, temperature, walking ability, triage category and neutrophil count were significantly different between short stay (≤48 h) and long stay (>48 h) patients. For those discharged alive either from the AED or ward, 20.1% re-attended the AED within 14 days of discharge, and 17.5% of those previously discharged were admitted again for fever or other problems. Conclusion Elders with fever are a major challenge to the AED and health care facilities. The admission rate for this group of patients is usually high. Elders with poor walking ability, high triage category, high temperature and neutrophil count were prone to have longer stay.
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Lu TM, Lee TS, Lin SJ, Chan WL, Hsu CP. The prognostic value of asymmetric dimethylarginine in patients with cardiac syndrome X. PLoS One 2017; 12:e0188995. [PMID: 29206850 PMCID: PMC5716529 DOI: 10.1371/journal.pone.0188995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 11/16/2017] [Indexed: 11/28/2022] Open
Abstract
Background The pathophysiology of cardiac syndrome X is multifactorial and endothelial dysfunction has been implicated as important contributing factor. Asymmetric dimethylarginine (ADMA), characterized as a circulating endogenous inhibitor of nitric oxide synthase, may have been implicated as an important contributing factor for the development of endothelial dysfunction. In this study, we aim to assess the predictive power of ADMA for long-term prognosis in patients with cardiac syndrome X. Methods and results We enrolled 239 consecutive patients with cardiac syndrome X diagnosed by coronary angiography. The mean age was 58.7±10.1 years. The patients were grouped into tertiles according to the plasma ADMA levels: <0.38 μmol/l (tertile I), 0.38–0.44 μmol/l (tertile II), and >0.44 μmol/l (tertile III). All patients were followed up for a mean period of 6.5±1.5 years (median: 6.3 years, inter-quartile range: 5.7–8.0 years). During the follow-up period, major adverse events (MAE) were observed in 15 patients (6.3%), including 13 deaths. The plasma ADMA levels in patients who developed MAE were significantly higher than those who did not (0.48±0.06 μmol/l vs. 0.42±0.08 μmol/l, p = 0.005). In multivariate Cox regression analysis adjusted for age, eGFR and LVEF, ADMA tertile I and II were identify to be associated with a significantly lower risk of MAE compared to ADMA tertile III (p = 0.017). By considering the plasma ADMA level as a continuous variable, the plasma ADMA level remained a significant independent predictor for outcomes of MAE, and the relative risk of MACE increased by 50% when plasma ADMA level increased by 1 SD of value (p = 0.018). Conclusions In patients with cardiac syndrome X, elevated plasma ADMA levels appeared to be an independent predictor of long-term adverse clinical outcomes.
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Affiliation(s)
- Tse-Min Lu
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- Department of Health Care Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
| | - Tzong-Shyuan Lee
- Department of Physiology, National Yang-Ming University, Taipei, Taiwan, R.O.C.
| | - Shing-Jong Lin
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
| | - Wan-Leong Chan
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- Department of Health Care Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
| | - Chiao-Po Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- * E-mail:
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17
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Wang TJ, Chiang MH, Huang SS, Wu CH, Sung SH, Chan WL, Lin SJ, Lee WL, Lu TM. Clinical outcomes of percutaneous coronary intervention with rotablation in patients with acute or recent myocardial infarction. J Chin Med Assoc 2017; 80:532-538. [PMID: 28690118 DOI: 10.1016/j.jcma.2017.02.009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although rotational atherectomy (RA) has been an accepted and widely used medical procedure for more than 15 years, the clinical outcomes of RA in high-risk populations remain elusive. Therefore, the purpose of this study was to investigate the safety and efficacy of RA for patients with acute or recent myocardial infarction (MI), and report the short- and long-term clinical outcomes in this population. METHODS We enrolled patients undergoing percutaneous coronary intervention (PCI) and RA at two medical centers in Taiwan between January 2004 and December 2013. Individuals who suffered an acute MI within 30 days before RA were assigned to the MI group; the remaining subjects were assigned to the non-MI group. RESULTS A total of 154 subjects were enrolled in our study, among them: 47 (30.5%) had an acute MI within 30 days of RA (MI group), and the remaining 107 (69.5%) patients without MI comprised the non-MI group. PCI and RA procedures were performed successfully in 150 patients. The 30-day and 1-year total death, MI, and major adverse cardiac event (MACE included all-cause death, MI, and clinical-driven target lesion revascularization) rates were 6.5%, 12.3%, and 15.6%, and 9.7%, 15.2%, and 30.5%, at the 30-day and 1-year follow-ups, respectively. MI was identified as an independent predictor for both 30-day MACE and total death (MACE, OR: 3.95, P = 0.006; total death, OR: 4.67, P = 0.043), and remained an independent predictor for 1-year total death and MI (total death, HR: 4.47, P = 0.007; MI, HR: 2.62, P = 0.016). CONCLUSION Our study demonstrated the safety and efficacy of RA in patients with acute or recent MI, and identified MI as an independent predictor of both short- and long-term outcomes.
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Affiliation(s)
- Ta-Jung Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Meng-Hsiu Chiang
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Division of Cardiology, Department of Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shao-Sung Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Taipei Medical University, Taipei, Taiwan, ROC; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wen-Lieng Lee
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tse-Min Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC.
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18
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Li HR, Hsu CP, Sung SH, Shih CC, Lin SJ, Chan WL, Wu CH, Lu TM. Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in Patients with Diabetic Nephropathy and Left Main Coronary Artery Disease. Acta Cardiol Sin 2017; 33:119-126. [PMID: 28344415 DOI: 10.6515/acs20160623a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with diabetic nephropathy and unprotected left main (LM) coronary artery disease suffer from high cardiovascular morbidity and mortality. Although surgical revascularization is currently recommended in this special patient population, the optimal revascularization method for this distinct patient group has remained unclear. METHODS We collected 99 consecutive patients with unprotected LM disease and diabetic nephropathy, including 46 patients who had undergone percutaneous coronary intervention (PCI), and 53 who had coronary artery bypass grafting (CABG), with a mean age of 72 ± 10; with 80.8% male. Diabetic nephropathy was defined as overt proteinuria (proteinuria > 500 mg/day) and estimated glomerular filtration rate (eGFR) by the modified Modification of Diet in Renal Disease (MDRD) equation of less than 60 mL/min/1.73 m2. The baseline characteristics, angiographic results and long-term clinical outcomes were retrospectively analyzed. RESULTS The baseline characteristic of all patients were similar except for smokers, low density lipoprotein (LDL) level and extension of coronary artery disease involvement. The median follow-up period was 3.8 years. There were 73 patients (74%) considered as high risk with additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≥ 6. During follow-up period, the long term rate of all-cause death (PCI vs. CABG: 45.7% vs. 58.5%, p = 0.20) and all-cause death/myocardial infarction (MI)/stroke (PCI vs. CABG: 52.2% vs. 60.4%, p = 0.41) were comparable between the PCI and CABG group, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI vs. CABG: 32.6% vs. 9.4%, p < 0.01). eGFR remained an independent predictor for all-cause death [hazard ratio: 0.97, 95% confidence interval: 0.96 to 0.99; p = 0.002] in multivariate logistic regression. CONCLUSIONS In the real-world practice of high-risk patients with unprotected LM disease and diabetic nephropathy, we found that PCI was a comparable alternative to CABG in terms of long-term risks of all-cause death/MI/stroke, with significantly higher repeat revascularization rate. Given the small patient number and retrospective nature, our findings should be validated by larger-scale randomized studies.
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Affiliation(s)
- Hsin-Ru Li
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University
| | - Chiao-Po Hsu
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital; ; School of Medicine, National Yang-Ming University
| | - Shih-Hsien Sung
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital; ; School of Medicine, National Yang-Ming University
| | - Shing-Jong Lin
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tse-Min Lu
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Lu DY, Huang CC, Huang PH, Chen JW, Chen TJ, Lin SJ, Chan WL, Lee CY, Leu HB. Usefulness of the CHADS 2 Score for Prognostic Stratification in Patients With Coronary Artery Disease Having Coronary Artery Bypass Grafting. Am J Cardiol 2017; 119:839-844. [PMID: 28057218 DOI: 10.1016/j.amjcard.2016.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 11/29/2022]
Abstract
Current risk model for long-term survival prediction in isolated coronary artery bypass graft surgery is complicated, whereas a simple useful model is still lacking. We aim to investigate if CHADS2 score could predict long-term outcome for patients after coronary artery bypass graft surgery. From 2000 to 2007, we identified a study cohort consisting of patients who underwent coronary bypass surgery in the Taiwan National Health Insurance Research Database. After operation, all cases were followed to track the incidence of major adverse cardiovascular events and overall mortality. During a mean 5.1-year follow-up, 638 patients experienced major cardiovascular events. Six hundred twenty-five patients passed away at the end of follow-up, whereas 204 died of cardiovascular cause. Subjects with higher CHADS2 scores had significantly higher 10-year overall mortality and cardiovascular death, as well as the incidence of major adverse cardiovascular events. After adjustment with co-morbid condition and prescribed medications, CHADS2 was independently associated with increased risks of all-cause mortality (hazard ratio 1.36, 95% CI 1.29 to 1.44) and cardiovascular mortality (hazard ratio 1.37, 95% CI 1.24 to 1.52). In conclusion, CHADS2 score provides a quick and useful tool in predicting long-term outcome for patients after coronary artery bypass surgery.
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Affiliation(s)
- Dai-Yin Lu
- Division of Cardiology, Department of 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
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of 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
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of 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
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Yang Lee
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Hsin-Bang Leu
- Division of Cardiology, Department of 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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Lu TM, Hsu CP, Chang CF, Lin CC, Lee TS, Lin SJ, Chan WL. Asymmetric dimethylarginine predicts the risk of contrast-induced acute kidney injury in patients undergoing cardiac catheterization. Atherosclerosis 2016; 254:161-166. [DOI: 10.1016/j.atherosclerosis.2016.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/17/2016] [Accepted: 10/05/2016] [Indexed: 11/24/2022]
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Chou RH, Chiu CC, Huang CC, Chan WL, Huang PH, Chen YC, Chen TJ, Chung CM, Lin SJ, Chen JW, Leu HB. Prediction of vascular dementia and Alzheimer's disease in patients with atrial fibrillation or atrial flutter using CHADS2 score. J Chin Med Assoc 2016; 79:470-6. [PMID: 27234974 DOI: 10.1016/j.jcma.2016.02.007] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/21/2016] [Accepted: 02/02/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with an increased risk of dementia. However, limited data are available on the predictors of dementia in patients with AF. This study aimed to evaluate whether the CHADS2 score could be a useful tool for risk stratification with regard to dementia occurrence among patients with AF. METHODS AF patients were identified from the National Health Insurance sampling database, which has accumulated a total of 1,000,000 participants since 2000. After excluding patients diagnosed with dementia prior to the index day of enrollment, CHADS2 score was measured to investigate its association with the occurrence of dementia, including vascular dementia and Alzheimer's disease. RESULTS During the mean follow-up period of 3.71 ± 2.78 years, 1135 dementia cases (7.36%) were identified, including 241 cases of vascular dementia and 894 cases of Alzheimer's disease. In multivariate analysis, an increase of 1 point in the CHADS2 score was independently associated with a 54% increase in the risk of vascular dementia (hazard ratio = 1.54; 95% confidence interval, 1.41-1.69; p < 0.001) and a 40% increase in Alzheimer's disease (hazard ratio = 1.40; 95% confidence interval, 1.34-1.46; p < 0.001). CONCLUSION CHADS2 score is a useful predictor for the development of vascular dementia as well as Alzheimer's disease in patients with AF.
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Affiliation(s)
- Ruey-Hsing Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chun-Chih Chiu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Chun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Informatics, University of Heidelberg, Heidelberg, Germany
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chia-Min Chung
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, ROC
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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Yang TL, Lin LY, Huang CC, Huang PH, Lin SJ, Chen JW, Chan WL, Leu HB. Response to Comment on Yang et al. Association of Statin Use and Reduced Risk of Lower-Extremity Amputation Among Patients With Diabetes: A Nationwide Population-Based Cohort Observation. Diabetes Care 2016;39:e54-e55. Diabetes Care 2016; 39:e161-2. [PMID: 27555635 DOI: 10.2337/dci16-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Tsung-Lin Yang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Liang-Yu Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Chou Huang
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
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Teng HI, Huang CC, Chiang CH, Huang PH, Chung CM, Lin SJ, Chen JW, Leu HB, Chan WL, Lee CY. Sleep apnea and risk of aortic dissection: A nonrandomized, pair-matched cohort study. J Chin Med Assoc 2016; 79:422-7. [PMID: 27174510 DOI: 10.1016/j.jcma.2015.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/25/2015] [Accepted: 10/18/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Sleep apnea (SA) was associated with increased prevalence of aortic dissection (AD) in studies that were criticized for either their small sample size or lack of prospective observation. Using a considerably larger nationwide, population-based database and a long-term prospective cohort design, our study strived to explore the relationship between SA and the subsequent development of AD. METHODS From 2000 to 2007, we gathered a study cohort consisting of 15,848 newly diagnosed cases of SA from Taiwan's National Health Insurance Research Database. For the control group, another 39,826 individuals without SA were matched for age, sex, and comorbidity. The two cohorts were followed-up to observe the occurrence of AD. RESULTS During an average 3.59 ± 2.41 years of follow-up, we observed 33 cases of new AD occurrence [non-SA (22, 0.1%) vs. SA (11, 0.1%), p=0.669], and the incidence of AD was similar for both groups. After adjusting for age, sex, and comorbidity, only age [hazard ratio (HR) 1.03; 95% confidence interval (CI), 1.01-1.06; p=0.006], male gender (HR 2.49; 95% CI, 1.07-5.79; p=0.034), and hypertension (HR 6.28; 95% CI, 2.36-16.67; p<0.001) were independently associated with AD diagnosis. CONCLUSION SA was not associated with an increased risk of AD using a large nationwide cohort database. Nonetheless, larger prospective studies or meta-analyses are recommended to confirm our findings.
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Affiliation(s)
- Hsin-I Teng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chia-Hung Chiang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chia-Min Chung
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, ROC
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiu-Yang Lee
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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Abstract
We report an 82-year-old woman who underwent fixation with a long-spanning cable-plate for a bisphosphonate-induced Vancouver B1 periprosthetic femoral fracture. Non-union and breakage of the plate occurred at 16 months and necessitated revision surgery using a long-stem femoral prosthesis augmented with a cable-plate construct. Bone union was achieved eventually after 10 months.
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Affiliation(s)
- S B Woo
- Department of Orthopaedics & Traumatology, Kwong Wah Hospital, Hong Kong
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Lu TM, Lee WL, Hsu PF, Lin TC, Sung SH, Wang KL, Huang SS, Chan WL, Shih CC, Lin SJ, Hsu CP. Long-term results of stenting versus coronary artery bypass surgery for left main coronary artery disease-A single-center experience. J Chin Med Assoc 2016; 79:356-62. [PMID: 26935852 DOI: 10.1016/j.jcma.2016.01.005] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 11/04/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) for unprotected left main (LM) coronary artery disease, but the results of both treatments are less clear in real-world practice. We aimed to assess the long-term outcomes of unprotected LM disease treated with CABG or PCI with stenting in high-risk population from a single center. METHODS We collected 478 consecutive patients with unprotected LM disease (PCI/CABG: 208/270; mean age: 70 ± 11 years; 85% male), and 252 patients were considered to be at high risk (European System for Cardiac Operative Risk Evaluation ≥6). The median follow-up was 4.3 years (interquartile range: 2.7-6.5 years). RESULTS All-cause death (PCI/CABG: 27.4%/31.5%; p = 0.36) and all-cause death/myocardial infarction (MI)/stroke (PCI/CABG: 30.8%/35.9%; p = 0.49) were comparable between the two groups, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI/CABG: 22.6%/11.0%; p < 0.01). These results remained similar after adjustment with the propensity score. Notably, CABG tended to be associated with higher periprocedural mortality (adjusted p = 0.08) and long-term stroke (adjusted p = 0.05), while PCI was associated with higher long-term MI (adjusted p = 0.09). Analyses of the diabetic subgroup (PCI/CABG: 98/124) yielded similar results. CONCLUSION PCI was a comparable alternative to CABG for high-risk patients with unprotected LM disease in terms of long-term risks of all-cause death/MI/stroke, but with a significantly higher repeat revascularization rate.
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Affiliation(s)
- Tse-Min Lu
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Liang Lee
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Pai-Feng Hsu
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ting-Chao Lin
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Hsien Sung
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kang-Ling Wang
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Sung Huang
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Leong Chan
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chun-Che Shih
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shing-Jong Lin
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiao-Po Hsu
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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Hsu CY, Chen YT, Huang PH, Leu HB, Su YW, Chiang CH, Chen JW, Chen TJ, Lin SJ, Chan WL. The association between urinary calculi and increased risk of future cardiovascular events: A nationwide population-based study. J Cardiol 2016; 67:463-70. [DOI: 10.1016/j.jjcc.2015.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/06/2015] [Accepted: 07/17/2015] [Indexed: 01/24/2023]
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Lai CH, Lee WL, Sung SH, Hsu PF, Chen YH, Chan WL, Lin SJ, Lu TM. Comparison of Bare-Metal Stent and Drug-Eluting Stent for the Treatment of Patients Undergoing Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease - Long-Term Result from a Single Center Experience. Acta Cardiol Sin 2016; 31:381-9. [PMID: 27122897 DOI: 10.6515/acs20140630g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has become an alternative treatment for left main (LM) coronary artery disease. The aim of our study was to compare long-term clinical outcomes of patients undergoing unprotected LM PCI with bare-metal stent (BMS) or drug-eluting stent (DES) in a high-risk population. METHODS AND RESULTS We enrolled 223 consecutive patients with unprotected LM coronary artery disease undergoing PCI (mean age: 71.1 ± 11.2 years, 187 male), including 94 patients receiving BMS and 129 patients receiving DES. The patients receiving DES had a significantly higher SYNTAX score (p = 0.05). During the mean follow-up period of 2.5 years, there were 31 cardiovascular deaths (BMS: 21 cases, DES: 10 cases, p = 0.04 by log-rank test), 56 major adverse cardiovascular events (MACE, including cardiovascular death, non-fatal myocardial infarction (MI) and clinical-driven target lesion revascularization; BMS: 33 cases, DES: 23 cases, p = 0.03 by log-rank test) and 6 cases with definite/probable stent thrombosis (BMS: 5 cases, DES: 1 cases, p = 0.09). In multivariate Cox analysis, the use of DES was identified as an independent protective factor against cardiovascular death [hazard ratio (HR) = 0.34, 95% confidence interval (Cl) = 0.15-0.79, p = 0.01] and MACE (HR = 0.50, 95% CI = 0.28-0.88, p = 0.02). The clinical outcome analyses in propensity-score matched the cohort (87 matched pair of patients receiving BMS and DES) and yielded similar results. CONCLUSIONS In the general practice among a high-risk population undergoing unprotected LM PCI, the use of DES appeared to be beneficial in reducing the risk of long-term cardiovascular death and MACE. KEY WORDS Bare-mental stent; Drug-eluting stent; Left main coronary artery disease; Percutaneous coronary intervention.
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Affiliation(s)
- Chih-Hung Lai
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; School of Medicine, National Yang-Ming University
| | - Wen-Lieng Lee
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; School of Medicine, National Yang-Ming University
| | - Shih-Hsien Sung
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pai-Feng Hsu
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Hwa Chen
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shing-Jong Lin
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tse-Min Lu
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Yang TL, Lin LY, Huang CC, Huang PH, Lin SJ, Chen JW, Chan WL, Leu HB. Association of Statin Use and Reduced Risk of Lower-Extremity Amputation Among Patients With Diabetes: A Nationwide Population-Based Cohort Observation. Diabetes Care 2016; 39:e54-5. [PMID: 26861927 DOI: 10.2337/dc15-2376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/11/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Tsung-Lin Yang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Yu Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
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Huang SS, Chan WL, Leu HB, Huang PH, Lin SJ, Chen JW. Serum bilirubin levels predict future development of metabolic syndrome in healthy middle-aged nonsmoking men. Am J Med 2015; 128:1138.e35-41. [PMID: 25912203 DOI: 10.1016/j.amjmed.2015.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 04/05/2015] [Accepted: 04/11/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite epidemiologic research demonstrating an inverse relationship between serum bilirubin levels and the prevalence of metabolic syndrome, prospective data on serum bilirubin as a predictor of incident metabolic syndrome are limited. METHODS Serum bilirubin was examined as a risk marker for incident metabolic syndrome in a prospective study of 468 Taiwanese middle-aged men who were free of metabolic syndrome and other systemic diseases at baseline. These subjects were followed up in annual health examinations between 2001 and 2009 for the development of metabolic syndrome, which was defined according to unified criteria set by several major organizations. RESULTS Among the study subjects, 377 were nonsmokers and 91 were current smokers. All individuals were then stratified into 3 groups according to their baseline serum bilirubin levels (low, normal, and high). During a mean follow-up period of 7.58 years, 66 subjects developed metabolic syndrome. The incidence of metabolic syndrome was significantly reduced in the high-bilirubin group compared with the low-bilirubin group (6.4% vs 22.4%, P < .001). Multivariate Cox regression analysis revealed that the hazard ratio for incident metabolic syndrome between the highest and lowest tertiles of serum bilirubin levels was 0.246 (95% confidence interval 0.120-0.503). However, although it remained clearly evident in nonsmokers, the inverse correlation was attenuated in current smokers. CONCLUSIONS Increased serum bilirubin was associated with a reduced future risk of metabolic syndrome in apparently healthy middle-aged, nonsmoking men. Our findings support the predictive role of serum total bilirubin for future development of metabolic syndrome.
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Affiliation(s)
- Shao-Sung Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wan-Leong Chan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Bang Leu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Hsun Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jaw-Wen Chen
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
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Yan CH, Chan WL, Yuen WH, Yung PSH, Ip KY, Fan JCH, Chiu KY. Efficacy and safety of hylan G-F 20 injection in treatment of knee osteoarthritis in Chinese patients: results of a prospective, multicentre, longitudinal study. Hong Kong Med J 2015; 21:327-32. [PMID: 26087755 DOI: 10.12809/hkmj144329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To study the efficacy and safety of single intra-articular injection of 6-mL hylan G-F 20 in Chinese patients with symptomatic knee osteoarthritis. DESIGN Prospective case series. SETTING Six government hospitals in Hong Kong. PATIENTS Patients with primary knee osteoarthritis were recruited from six government hospitals from 1 October 2010 to 31 May 2012. All patients received 6-mL intra-articular injection of hylan G-F 20. MAIN OUTCOME MEASURES Pain visual analogue scale, functional visual analogue scale, and 5-point Likert scale on change of pain and function were assessed. Adverse events were checked. Radiographs were taken pre-injection and at 3 months and 1 year. RESULTS A total of 110 knees of 95 patients with primary knee osteoarthritis were treated. The mean age of the patients was 62 (standard deviation, 9.8) years. All patients completed 1 year of follow-up. The mean pain visual analogue scale, functional visual analogue scale, and Likert value for pain and function showed statistically significant improvements at 6 weeks, 3 months, 6 months, and 1 year compared with the pre-injection values. No significant correlations were found between changes in visual analogue scale and age, body mass index, pre-injection radiological osteoarthritis severity, serum erythrocyte sedimentation rate, or C-reactive protein. Serial radiographs did not show any changes in the radiological severity of knee osteoarthritis. Overall, 16.4% of the patients experienced mild and self-limiting adverse events. CONCLUSION Hylan G-F 20 is a safe and effective therapy to relieve pain and improve function for up to 1 year in Chinese patients with knee osteoarthritis.
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Affiliation(s)
- C H Yan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - W L Chan
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - W H Yuen
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - Patrick S H Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - K Y Ip
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, Hong Kong
| | - Jason C H Fan
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - K Y Chiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Ho RMY, Cheung HHK, Lai TTS, Tam VFL, Yan CK, Chan WL, Yuen KK. Use of the Historical, Clinical, Risk Management-20 to assess the risk of violence by discharged psychiatric patients. Hong Kong Med J 2015; 21 Suppl 2:45-47. [PMID: 25852103] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Chang CC, Chiu CC, Chiang CH, Huang CC, Chan WL, Huang PH, Chen YC, Chen TJ, Chung CM, Lin SJ, Chen JW, Leu HB. Obstructive sleep apnea and the risk of ischemic stroke in patients with atrial fibrillation. Int J Cardiol 2015; 181:144-6. [DOI: 10.1016/j.ijcard.2014.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
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Lu DY, Huang CC, Huang PH, Chung CM, Lin SJ, Chen JW, Chan WL, Leu HB. Metformin use in patients with type 2 diabetes mellitus is associated with reduced risk of deep vein thrombosis: a non-randomized, pair-matched cohort study. BMC Cardiovasc Disord 2014; 14:187. [PMID: 25510597 PMCID: PMC4274716 DOI: 10.1186/1471-2261-14-187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 12/11/2014] [Indexed: 12/20/2022] Open
Abstract
Background Metformin, an insulin-sensitizer, may correct several physiologic abnormalities owing to insulin resistance in patients with type 2 diabetes mellitus (DM). The effects of metformin on venous thrombosis in patient with type 2 DM have not been reported. Our study strived to explore the relationship of metformin therapy and the subsequent development of deep vein thrombosis (DVT) using a nationwide, population-based database. Methods From 1997 to 2003, we identified a study cohort consisting of patients with type 2 DM using metformin 7154 cases in the National Health Insurance Research Database. A control cohort without metformin, matched for age, sex, comorbidities, and medications was selected for comparison. Results Of the 14945 patients (7167 patients with metformin vs. 7778 control), 60 (0.40%) patients developed DVT during a mean follow-up period of 3.74 years, including 16 (0.21%) from the cohort with metformin and 44 (0.56%) from the control group. Subjects with metformin experienced a 0.427 fold (95% confidence interval 0.240-0.758; P = 0.004) changes of risk reduction in development of DVT, which was independent of age, sex and co-morbidities. Kaplan-Meier analysis also revealed metformin therapy is associated with lower occurrence of DVT (log-rank test, P = 0.001). Conclusions Metformin may have protective effect in patients with type 2 DM for DVT.
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Affiliation(s)
| | | | | | | | | | | | | | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Huang SS, Chen YH, Chan WL, Huang PH, Chen JW, Lin SJ. Usefulness of the CHADS2 score for prognostic stratification of patients with acute myocardial infarction. Am J Cardiol 2014; 114:1309-14. [PMID: 25205632 DOI: 10.1016/j.amjcard.2014.07.063] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 11/15/2022]
Abstract
The Thrombolysis In Myocardial Infarction (TIMI) score and Global Registry of Acute Coronary Events (GRACE) score have been validated as predictors of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). This study was undertaken to determine whether the CHADS2 score had good accuracy for predicting clinical outcome in patients with AMI and to compare the discriminatory performance of the 3 risk scores (RSs). We calculated the TIMI RS, GRACE RS, and CHADS2 score for 747 consecutive patients with AMI. The study end point was the combined occurrence of MACE, including death, nonfatal myocardial infarction, and ischemic stroke. All patients were followed up for at least 3 years or until the occurrence of a major event. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of each score at different time points. Higher CHADS2 scores were associated with adverse outcome at discharge and 1-year and 3-year follow-ups (chi-square test for linear trend, p <0.001). Both CHADS2 score and GRACE RS demonstrated better discrimination than TIMI RS in predicting 1-year and 3-year MACE (p <0.001). Multivariate Cox regression analysis revealed that the CHADS2 score was an independent predictor of future MACE in patients with AMI (hazard ratio 1.349, 95% confidence interval 1.196 to 1.522). In conclusion, the CHADS2 score provides potentially valuable prognostic information on clinical outcome when applied to patients with AMI.
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Affiliation(s)
- Shao-Sung Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hwa Chen
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wan-Leong Chan
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute and Department of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
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Lin CC, Huang KW, Luo JC, Wang YW, Hou MC, Lin HC, Lee FY, Chan WL. Hypertension is an important predictor of recurrent colorectal adenoma after screening colonoscopy with adenoma polypectomy. J Chin Med Assoc 2014; 77:508-12. [PMID: 25153016 DOI: 10.1016/j.jcma.2014.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/27/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The predictors of recurrent colorectal adenoma have not been fully examined. This study aimed to evaluate the predictors of recurrent colorectal adenoma after initial screening colonoscopy with adenoma polypectomy. METHODS A retrospective cohort study was conducted at the Taipei Veterans General Hospital from 2003 to 2011. After screening, 356 patients who had undergone two consecutive colonoscopies with colorectal adenoma polypectomy at the initial colonoscopy were enrolled. The recurrence group was patients with recurrent colorectal adenoma at the second colonoscopy, whereas the nonrecurrence group was patients without recurrence. Anthropometric data, biochemical tests, metabolic comorbidities, and adenoma characteristics at initial colonoscopy were compared between the two groups. Cox proportional hazard regression analysis was conducted to identify the predictors of recurrent colorectal adenoma. RESULTS During a mean follow-up interval of 3.07 ± 1.42 years, 94 patients (26.4%) were in the recurrence group, 262 patients (73.6%) were in the nonrecurrence group. The recurrence group was older, had a wider waist circumference, higher levels of serum alanine aminotransferase (ALT) and triglyceride, a higher prevalence of smoking, nonalcoholic fatty liver disease, metabolic syndrome, and hypertension, and a higher occurrence of initial multiply-located adenomas when compared with the nonrecurrence group (p < 0.05). Cox regression analysis showed that hypertension, smoking, higher ALT level (>40 IU/mL), and multiply-located adenomas were independent predictors for recurrent colorectal adenoma. The risk of recurrent adenoma increased when hypertension was combined with smoking, high ALT level, or multiply-located adenomas. CONCLUSION Hypertension is an important predictor for recurrent colorectal adenoma after screening colonoscopy with polypectomy.
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Affiliation(s)
- Chung-Chi Lin
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kuang-Wei Huang
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Shuang-Ho Hospital and Taipei Medical University, Taipei, Taiwan, ROC
| | - Jiing-Chyuan Luo
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
| | - Ying-Wen Wang
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Han-Chieh Lin
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Leong Chan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Chan WL, Lee VHF, Siu SWK, Leung TW. Inoperable Adenoid Cystic Carcinoma of Trachea: Complete Remission after Multi-modality Treatment. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1413202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chan WL, Yang KP, Chao TF, Huang CC, Huang PH, Chen YC, Chen TJ, Lin SJ, Chen JW, Leu HB. The association of asthma and atrial fibrillation--a nationwide population-based nested case-control study. Int J Cardiol 2014; 176:464-9. [PMID: 25127961 DOI: 10.1016/j.ijcard.2014.07.087] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/21/2014] [Accepted: 07/26/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Asthma and atrial fibrillation (AF) have been reported to be related to an increased risk of cardiovascular events. However, the relationship between asthma and AF has not been fully elucidated. The purpose of this study was to examine the association between asthma and AF risk. METHODS We conducted a population-based nested case-control study including a total of 7439 newly-diagnosed adult patients with AF and 10,075 age-, gender-, comorbidity-, and cohort entry date-matched subjects without AF from the Taiwan National Health Insurance database. Exposure to asthma as well as medications including bronchodilators and corticosteroid before the index date was evaluated to investigate the association between AF and asthma as well as concurrent medications. RESULTS AF patients were 1.2 times (adjusted OR 1.2, 95% CI 1.109-1.298) more likely to be associated with a future occurrence of asthma independent of comorbidities and treatment with corticosteroids and bronchodilator. In addition, the risks of new-onset AF were significantly higher among current users of inhaled corticosteroid, oral corticosteroids, and bronchodilators. Newly users (within 6 months) have the highest risk (inhaled corticosteroid: OR, 2.13; 95% CI, 1.226-3.701, P=0.007; oral corticosteroid: OR, 1.932; 95% CI, 1.66-2.25, P<0.001; non-steroid bronchodilator: OR, 2.849; 95% CI, 2.48-3.273, P<0.001). A graded association with AF risk was also observed among subjects treated with corticosteroid (inhaled and systemic administration) and bronchodilators. New users (within 6 months) of these medications had the highest risk of AF (ICS: OR, 2.13; 95% CI, 1.226-3.701, P=0.007; oral corticosteroid: OR, 1.932; 95% CI, 1.66-2.25, P<0.001; non-steroid bronchodilator: OR, 2.849; 95% CI, 2.48-3.273, P<0.001). A graded association with AF risk was also observed among subjects treated with ICS or bronchodilator. CONCLUSIONS Asthma was associated with an increased risk of developing future AF.
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Affiliation(s)
- Wan-Leong Chan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
| | - Kun-Pin Yang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Bang Leu
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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Huang KW, Leu HB, Luo JC, Chan WL, Hou MC, Lin HC, Lee FY, Kuan YC. Different peptic ulcer bleeding risk in chronic kidney disease and end-stage renal disease patients receiving different dialysis. Dig Dis Sci 2014; 59:807-13. [PMID: 24318806 DOI: 10.1007/s10620-013-2973-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/19/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND End stage renal disease (ESRD) patients receiving hemodialysis (HD) have a higher risk of peptic ulcer bleeding (PUB). AIMS Whether ESRD patients receiving peritoneal dialysis (PD) also carries a higher risk of PUB has not been studied. METHODS This was a cohort study using Taiwan's National Health Insurance research database, whereby 11,408 patients, including 2,239 PD, 2,328 HD, 2,267 chronic kidney disease (CKD) and 4,574 controls with age-sex matching were recruited. The log-rank test was used to analyze differences in accumulated PUB-free survival rates between groups. Cox proportional hazard regression was performed to evaluate independent risk factors for PUB in all the enrollees. RESULTS During the 7-year follow-up, PD and CKD patients had a significantly higher rate of PUB than matched controls. The risk of PUB between PD and CKD was not significantly different. Moreover, patients receiving HD carried a higher risk of PUB than those receiving PD, with CKD and controls (p all <0.05, by log-rank test). Cox proportional hazard regression analysis showed that CKD (HR 3.99, 95 % CI 2.24-7.13), PD (HR 3.71, 95 % CI 2.00-6.87) and HD (HR 11.96, 95 % CI 7.04-20.31) were independently associated with an increased risk of PUB. Being elderly, male, having hypertension, diabetes, cirrhosis, and nonsteroidal anti-inflammatory drugs and steroid use were other independent risk factors of PUB in all enrollees. CONCLUSIONS Patients with CKD and ESRD receiving PD or HD carried a higher risk for PUB. They should be screened for risk factors for PUB and receive some protective measures to prevent PUB.
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Affiliation(s)
- Kuang-Wei Huang
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Chiang CH, Liu CJ, Chen PJ, Huang CC, Hsu CY, Chan WL, Huang PH, Chen TJ, Lin SJ, Chen JW, Leu HB. Primary Sjögren’s syndrome and risk of ischemic stroke: a nationwide study. Clin Rheumatol 2014; 33:931-7. [DOI: 10.1007/s10067-014-2573-7] [Citation(s) in RCA: 16] [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: 10/31/2013] [Accepted: 03/02/2014] [Indexed: 01/05/2023]
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Wang R, Wang J, Deng B, Liu C, Wei X, Tsang KM, Chan WL. A combined method to estimate parameters of the thalamocortical model from a heavily noise-corrupted time series of action potential. Chaos 2014; 24:013128. [PMID: 24697390 DOI: 10.1063/1.4867658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A combined method composing of the unscented Kalman filter (UKF) and the synchronization-based method is proposed for estimating electrophysiological variables and parameters of a thalamocortical (TC) neuron model, which is commonly used for studying Parkinson's disease for its relay role of connecting the basal ganglia and the cortex. In this work, we take into account the condition when only the time series of action potential with heavy noise are available. Numerical results demonstrate that not only this method can estimate model parameters from the extracted time series of action potential successfully but also the effect of its estimation is much better than the only use of the UKF or synchronization-based method, with a higher accuracy and a better robustness against noise, especially under the severe noise conditions. Considering the rather important role of TC neuron in the normal and pathological brain functions, the exploration of the method to estimate the critical parameters could have important implications for the study of its nonlinear dynamics and further treatment of Parkinson's disease.
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Affiliation(s)
- Ruofan Wang
- Department of Electrical and Automation Engineering, Tianjin University, Tianjin, China
| | - Jiang Wang
- Department of Electrical and Automation Engineering, Tianjin University, Tianjin, China
| | - Bin Deng
- Department of Electrical and Automation Engineering, Tianjin University, Tianjin, China
| | - Chen Liu
- Department of Electrical and Automation Engineering, Tianjin University, Tianjin, China
| | - Xile Wei
- Department of Electrical and Automation Engineering, Tianjin University, Tianjin, China
| | - K M Tsang
- Department of Electrical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - W L Chan
- Department of Electrical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Huang CC, Chung CM, Leu HB, Lin LY, Chiu CC, Hsu CY, Chiang CH, Huang PH, Chen TJ, Lin SJ, Chen JW, Chan WL. Diabetes mellitus and the risk of Alzheimer's disease: a nationwide population-based study. PLoS One 2014; 9:e87095. [PMID: 24489845 PMCID: PMC3906115 DOI: 10.1371/journal.pone.0087095] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [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: 07/25/2013] [Accepted: 12/19/2013] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Possible association between diabetes mellitus (DM) and Alzheimer's disease (AD) has been controversial. This study used a nationwide population-based dataset to investigate the relationship between DM and subsequent AD incidence. METHODS Data were collected from Taiwan's National Health Insurance Research Database, which released a cohort dataset of 1,000,000 randomly sampled people and confirmed it to be representative of the Taiwanese population. We identified 71,433 patients newly diagnosed with diabetes (age 58.74 ± 14.02 years) since January 1997. Using propensity score, we matched them with 71,311 non-diabetic subjects by time of enrollment, age, gender, hypertension, hyperlipidemia, and previous stroke history. All the patients were followed up to December 31, 2007. The endpoint of the study was occurrence of AD. RESULTS Over a maximum 11 years of follow-up, diabetic patients experienced a higher incidence of AD than non-diabetic subjects (0.48% vs. 0.37%, p<0.001). After Cox proportional hazard regression model analysis, DM (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.50-2.07, p<0.001), age (HR, 1.11; 95% CI, 1.10-1.12, p<0.001), female gender (HR, 1.24; 95% CI, 1.06-1.46, p=0.008), hypertension (HR, 1.30; 95% CI, 1.07-1.59, p=0.01), previous stroke history (HR, 1.79; 95% CI, 1.28-2.50, p<0.001), and urbanization status (metropolis, HR, 1.32; 95% CI, 1.07-1.63, p=0.009) were independently associated with the increased risk of AD. Neither monotherapy nor combination therapy with oral antidiabetic medications were associated with the risk of AD after adjusting for underlying risk factors and the duration of DM since diagnosis. However, combination therapy with insulin was found to be associated with greater risk of AD (HR, 2.17; 95% CI, 1.04-4.52, p=0.039). CONCLUSION Newly diagnosed DM was associated with increased risk of AD. Use of hypoglycemic agents did not ameliorate the risk.
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Affiliation(s)
- Chin-Chou Huang
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chia-Min Chung
- Environment-Omics-Disease Research Centre, China Medical University Hospital, Taichung, Taiwan, R.O.C
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, R.O.C
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Liang-Yu Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chun-Chih Chiu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chien-Yi Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chia-Hung Chiang
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Zhudong Veterans Hospital, HsinChu, Taiwan, R.O.C
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Shing-Jong Lin
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Jaw-Wen Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
- * E-mail: (WLC); (JWC)
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- * E-mail: (WLC); (JWC)
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Tsai DC, Huang CC, Chen SJ, Chou P, Chung CM, Chan WL, Huang PH, Lin SJ, Chen JW, Leu HB. Increased risk of erectile dysfunction among males with central serous chorioretinopathy -- a retrospective cohort study. Acta Ophthalmol 2013; 91:666-71. [PMID: 22998678 DOI: 10.1111/j.1755-3768.2012.02528.x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Central serous chorioretinopathy (CSCR) mostly affects middle-aged men and has been associated with stress and hypercortisolism. We hypothesized that some factors prone to inducing CSCR could also have a harmful effect on erectile function. This study aimed to investigate the risk of subsequent erectile dysfunction after CSCR using Taiwan National Health Insurance Research Database. METHODS The study cohort (n = 1220) consisted of newly diagnosed CSCR men aged 19-64 years between 1999 and 2007, and men matched for age, monthly income and time of enrolment were randomly selected as the control group (n = 10870). Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of clinically diagnosed erectile dysfunction (including organic origin and/or psychogenic origin) for the two groups. Erectile dysfunction-free survival analysis was assessed using a Kaplan-Meier method. RESULTS Twenty-five patients (2.0%) from the CSCR cohort and 103 (0.9%) from the control group were diagnosed erectile dysfunction clinically during a mean observation period of 4.3 years. Patients with CSCR had a significantly higher incidence of erectile dysfunction diagnosis than those without CSCR (p < 0.001). After adjusting for age, geographic location, chronic comorbidities and medication habits, patients with CSCR were found to have a 2.22-fold [95% confidence interval (CI), 1.42-3.46] higher hazard ratio of a subsequent erectile dysfunction diagnosis than the matched controls. The adjusted HR for organic and psychogenic erectile dysfunction were 2.14 (95% CI: 1.34-3.44) and 3.83 (95% CI: 1.47-10.01), respectively. CONCLUSIONS Central serous chorioretinopathy was independently associated with an increased risk of being diagnosed with erectile dysfunction.
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Affiliation(s)
- Der-Chong Tsai
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, TaiwanDepartment of Ophthalmology, National Yang-Ming University Hospital, Taipei, TaiwanInstitute of Pharmacology, National Yang-Ming University, Taipei, TaiwanCardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Medical Research and Education, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Ophthalmology, Taipei Veterans General Hospital, Taipei, TaiwanInstitute of Biomedical Sciences, Academia Sinica, Taipei, TaiwanHealthcare and Management Center, Taipei Veterans General Hospital, Taipei, TaiwanInstitute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Yang TL, Wu TC, Huang CC, Huang PH, Chung CM, Lin SJ, Chen JW, Chan WL, Chiang CH, Leu HB. Association of tamoxifen use and reduced cardiovascular events among asian females with breast cancer. Circ J 2013; 78:135-40. [PMID: 24107360 DOI: 10.1253/circj.cj-13-0266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tamoxifen is used for breast cancer treatment and has been reported to be beneficial for the cardiovascular system, but it is unclear whether tamoxifen exhibits a favorable cardiovascular effect in Asian patients. METHODS AND RESULTS From January, 1998 to December, 2006, a breast cancer cohort study was conducted using the Taiwan National Health Insurance database. Patients were divided according to whether tamoxifen was used. Study endpoints were occurrence of acute myocardial infarction (AMI), ischemic or hemorrhagic stroke and total cardiovascular events. A total of 3,690 female subjects were enrolled (mean age 50.1±11.3), 2,056 of whom received tamoxifen and 1,634 did not. During a mean follow-up of 6.9 years, the tamoxifen group had a significantly lower incidence of AMI (0.15% vs. 0.67%, P=0.008), ischemic stroke (1.99% vs. 3.30%, P=0.008), hemorrhagic stroke (0.15% vs. 0.55%, P=0.029), and total cardiovascular events (2.24% vs. 4.16%, P<0.001) than the non-exposed group. After adjusting for comorbidities, tamoxifen was independently associated with a reduced risk of myocardial infarction (hazard ratio [HR] 0.22; 95% confidence interval [CI] 0.07-0.70, ischemic stroke (HR 0.52; 95% CI 0.35-0.78), hemorrhagic stroke (HR 0.25; 95% CI 0.07-0.92), and total cardiovascular events (HR 0.54; 95% CI 0.37-0.78). CONCLUSIONS In Asian female breast cancer patients, tamoxifen use was associated with reduced risks of AMI, ischemic, hemorrhagic stroke and total cardiovascular events.
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Affiliation(s)
- Tsung-Lin Yang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
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Huang CC, Chan WL, Chen YC, Chen TJ, Chung CM, Huang PH, Lin SJ, Chen JW, Leu HB. The beneficial effects of statins in patients undergoing hemodialysis. Int J Cardiol 2013; 168:4155-9. [DOI: 10.1016/j.ijcard.2013.07.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 06/15/2013] [Accepted: 07/13/2013] [Indexed: 11/24/2022]
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Tsai DC, Chen SJ, Huang CC, Chou P, Chung CM, Huang PH, Lin SJ, Chen JW, Chen TJ, Leu HB, Chan WL. Epidemiology of idiopathic central serous chorioretinopathy in Taiwan, 2001-2006: a population-based study. PLoS One 2013; 8:e66858. [PMID: 23826160 PMCID: PMC3691239 DOI: 10.1371/journal.pone.0066858] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 05/13/2013] [Indexed: 12/02/2022] Open
Abstract
Objectives The epidemiology of idiopathic central serous chorioretinopathy (CSCR) is not well understood in an Asian population. The present study aimed to investigate the incidence and risk factors for corticosteroid-unrelated CSCR using Taiwan’s National Health Insurance Research Database. Methods and Results From 2001 to 2006, a total of 786 patients (500 [63.6%] males) who were newly diagnosed with CSCR, aged from 20 to 64 years and had no history of corticosteroid prescription were identified as incident cases of idiopathic CSCR. 3606 age-, gender-, and enrollment time-matched subjects were randomly selected as the control group. The mean annual incidence was 0.21‰ (0.27‰ for males, and 0.15‰ for females; P<0.001), with a male/female ratio of 1.74. The peak incidence was in the 35- to 39-year-old age group (0.30‰), followed by the 40- to 44-year-old age group (0.26‰). Males had a significantly higher mean annual incidence than female only in the middle age groups. Conditional logistic regression was used to estimate the odds ratios (ORs) for potential risk factors of idiopathic CSCR. Only exposure to anti-anxiety drugs (OR, 1.63; 95% confidence interval, 1.09–2.44) was found to be independently associated with idiopathic CSCR among males. No risk factors of idiopathic CSCR were found for females. Conclusions This study provides the nationwide, population-based data on the incidence of idiopathic CSCR in adult Asians, and suggests that exposure to anti-anxiety drugs is an independent risk factor for idiopathic CSCR among males.
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Affiliation(s)
- Der-Chong Tsai
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan, R.O.C
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chin-Chou Huang
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chia-Min Chung
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, R.O.C
| | - Po-Hsun Huang
- Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Shing-Jong Lin
- Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Jaw-Wen Chen
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Tseng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Hsin-Bang Leu
- Cardiovascular Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- * E-mail:
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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Hsu PF, Sung SH, Cheng HM, Yeh JS, Liu WL, Chan WL, Chen CH, Chou P, Chuang SY. Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study. Diabetes Care 2013; 36:894-900. [PMID: 23223349 PMCID: PMC3609481 DOI: 10.2337/dc12-0916] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Hypoglycemia is associated with serious health outcomes for patients treated for diabetes. However, the outcome of outpatients with type 2 diabetes who have experienced hypoglycemia episodes is largely unknown. RESEARCH DESIGN AND METHODS The study population, derived from the National Health Insurance Research Database released by the Taiwan National Health Research Institutes during 1998-2009, comprised 77,611 patients with newly diagnosed type 2 diabetes. We designed a prospective study consisting of randomly selected hypoglycemic type 2 diabetic patients and matched type 2 diabetic patients without hypoglycemia. We investigated the relationships of hypoglycemia with total mortality and cardiovascular events, including stroke, coronary heart disease, cardiovascular diseases, and all-cause hospitalization. RESULTS There were 1,844 hypoglycemic events (500 inpatients and 1,344 outpatients) among the 77,611 patients. Both mild (outpatient) and severe (inpatient) hypoglycemia cases had a higher percentage of comorbidities, including hypertension, renal diseases, cancer, stroke, and heart disease. In multivariate Cox regression models, including diabetes treatment adjustment, diabetic patients with hypoglycemia had a significantly higher risk of cardiovascular events during clinical treatment periods. After constructing a model adjusted with propensity scores, mild and severe hypoglycemia still demonstrated higher hazard ratios (HRs) for cardiovascular diseases (HR 2.09 [95% CI 1.63-2.67]), all-cause hospitalization (2.51 [2.00-3.16]), and total mortality (2.48 [1.41-4.38]). CONCLUSIONS Symptomatic hypoglycemia, whether clinically mild or severe, is associated with an increased risk of cardiovascular events, all-cause hospitalization, and all-cause mortality. More attention may be needed for diabetic patients with hypoglycemic episodes.
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Affiliation(s)
- Pai-Feng Hsu
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
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Huang SS, Leu HB, Lu TM, Wu TC, Chen YH, Chen JW, Lin SJ, Chan WL. The Impacts of In-Hospital Invasive Strategy on Long-Term Outcome in Elderly Patients with Non-ST-Elevation Myocardial Infarction. Acta Cardiol Sin 2013; 29:115-123. [PMID: 27122695 PMCID: PMC4804773] [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] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 02/06/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND The benefit of utilizing an invasive strategy in elderly Chinese patients with non-ST-elevation myocardial infarction (NSTEMI) remains unclear. The aim of this study was to determine whether in-hospital revascularization is associated with long-term prognosis in elderly Chinese patients with NSTEMI, as compared with younger patients. METHODS All patients were followed up for at least 3 years or until the occurrence of a major event. The primary endpoint was all-cause mortality, and the secondary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including death, nonfatal MI, and ischemic stroke. RESULTS A total of 343 consecutive NSTEMI patients (148 over the age of 75 years and 195 aged < 75 years) were enrolled. Coronary angiography was performed less frequently in elderly patients (66% vs. 76%; p = 0.027). Multiple logistic regression analysis confirmed the benefit of in-hospital revascularization in the elderly and younger patients, with a statistically significant reduction in the odds of all-cause death and MACE at 1 year and 3 years, respectively. In a multivariable Cox regression analysis, in-hospital revascularization was an independent predictor of future MACE not only in elderly patients [hazard ratio (HR), 0.61; 95% confidence interval (CI), 0.38-0.97] but also in younger patients as well (HR, 0.51; 95% CI, 0.31-0.84). CONCLUSIONS In Chinese patients with NSTEMI, in-hospital revascularization was associated with significant benefits at 1 year and 3 years in both younger and elderly groups. These results are consistent with the published literature and suggest that advanced age alone should not be regarded as a contraindication to invasive management following presentation with NSTEMI. KEY WORDS Elderly; Invasive strategy; Myocardial infarction.
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Affiliation(s)
- Shao-Sung Huang
- Healthcare and Management Center, Taipei Veterans General Hospital
- Institute of Clinical Medicine
| | - Hsin-Bnag Leu
- Healthcare and Management Center, Taipei Veterans General Hospital
- Institute of Clinical Medicine
| | - Tse-Min Lu
- Division of Cardiology, Department of Internal Medicine
- Institute of Clinical Medicine
| | - Tao-Cheng Wu
- Division of Cardiology, Department of Internal Medicine
- Institute of Clinical Medicine
| | - Ying-Hwa Chen
- Division of Cardiology, Department of Internal Medicine
- Institute of Clinical Medicine
| | - Jaw-Wen Chen
- Department of Medical Research and Education
- Institute and Department of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Department of Medical Research and Education
- Institute of Clinical Medicine
| | - Wan-Leong Chan
- Healthcare and Management Center, Taipei Veterans General Hospital
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Luo JC, Leu HB, Hou MC, Huang KW, Lin HC, Lee FY, Chan WL, Lin SJ, Chen JW. Nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients. Am J Med 2013; 126:264.e25-32. [PMID: 23410569 DOI: 10.1016/j.amjmed.2012.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 09/07/2012] [Accepted: 09/20/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hemodialysis patients carry a higher risk of peptic ulcer bleeding. Whether hemodialysis patients also have a higher occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding needs further evaluation. METHODS Using Taiwan's National Health Insurance research database, the occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding was compared among the hemodialysis patients, chronic kidney disease patients, and controls using log-rank test. Risk factors were identified by Cox regression analysis. RESULTS A total of 20,830 patients were enrolled, including 8210 hemodialysis and 4190 chronic kidney disease patients and 8430 age- and sex-matched controls in a 2:1:2 ratio. In the 7-year follow-up period, hemodialysis patients had a significantly higher cumulative hazard of nonpeptic ulcer, nonvariceal gastrointestinal bleeding than chronic kidney disease patients and controls (P <.001, by log-rank test). The hazard also was significantly higher in the chronic kidney disease patients than in controls. Cox regression analysis revealed that older age, the comorbidities of diabetes mellitus, cirrhosis, and chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, chronic kidney disease (hazard ratio 5.17), hemodialysis (hazard ratio 9.43), and use of selective serotonin reuptake inhibitors were independent risk factors for nonpeptic ulcer, nonvariceal gastrointestinal bleeding in all study patients. Old age, diabetes mellitus, cirrhosis, chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, and use of selective serotonin reuptake inhibitors were independent risk factors in hemodialysis patients. CONCLUSIONS There is a higher risk of developing nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients after adjustments for age, sex, underlying comorbidities, and ulcerogenic medication. The risk has increased since patients had chronic kidney disease.
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Affiliation(s)
- Jiing-Chyuan Luo
- Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan.
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Chiang CH, Liu CJ, Chen PJ, Leu HB, Hsu CY, Huang PH, Chen TJ, Lin SJ, Chen JW, Chan WL. Primary Sjögren's Syndrome and the Risk of Acute Myocardial Infarction: A Nationwide Study. Acta Cardiol Sin 2013; 29:124-131. [PMID: 27122696 PMCID: PMC4804774] [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] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/06/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND Patients with autoimmune diseases have a high cardiovascular risk. However, few data are available on the risk of acute myocardial infarction (AMI) in patients diagnosed with primary Sjögren's syndrome (PSS). We conducted a large nationwide cohort study to investigate the possible association between PSS and the risk of AMI. METHODS Between the years 2000-2006, a total of 5205 patients with newly diagnosed PSS and no history of AMI were identified from the Registry of Catastrophic Illness, a sub-dataset of the National Health Insurance Research Database in Taiwan. The control group, which consisted of subjects without systemic autoimmune disease or previous AMI, was matched by the date of enrollment, age, gender, history of coronary artery disease, diabetes, hypertension, chronic kidney disease, and hyperlipidemia. The study endpoints were the occurrence of AMI. RESULTS Of the 5205 subjects with PSS and 5205 controls included in the study, 77 (35 PSS patients and 42 controls) developed AMI during the mean 3.7-year (interquartile range, 2.1-5.1 years) follow-up period. The incidence of AMI was similar in PSS patients and controls (1.91/1000 versus 2.25/1000 person-years). Multivariate analysis adjusted for baseline covariates demonstrated an insignificant association between PSS and AMI [adjusted hazard ratio, 0.86; 95% confidence interval (CI), 0.55-1.35; p = 0.506], suggesting that PSS does not increase the risk of AMI. CONCLUSIONS PSS is not associated with a higher risk of subsequent AMI. KEY WORDS Acute myocardial infarction; Atherosclerosis; Primary Sjögren's syndrome.
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Affiliation(s)
- Chia-Hung Chiang
- Division of Cardiology, Department of Medicine, Zhudong Veterans Hospital, Hsinchu
- Division of Cardiology, Department of Medicine
- Cardiovascular Research Center
- Institute of Clinical Medicine
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine
- Department of Internal Medicine, National Yang-Ming University Hospital, Yilan
- Institute of Public Health & School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine and Department of Geriatric Medicine, Chi-Mei Medical Center, Tainan
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine
- Healthcare and Management Center
- Cardiovascular Research Center
- Institute of Clinical Medicine
| | - Chien-Yi Hsu
- Division of Cardiology, Department of Medicine
- Cardiovascular Research Center
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine
- Cardiovascular Research Center
- Institute of Clinical Medicine
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine
- Department of Medical Research and Education
- Cardiovascular Research Center
- Institute of Clinical Medicine
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine
- Department of Medical Research and Education
- Cardiovascular Research Center
- Institute of Pharmacology
| | - Wan-Leong Chan
- Division of Cardiology, Department of Medicine
- Healthcare and Management Center
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Hsu PF, Chuang SY, Yu WC, Leu HB, Chan WL, Chen CH. The Impacts of Serum Uric Acid on arterial hemodynamics and Cardiovascular Risks. Acta Cardiol Sin 2013; 29:142-150. [PMID: 27122698 PMCID: PMC4804776] [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] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/06/2013] [Indexed: 06/05/2023]
Abstract
UNLABELLED Hyperuricemia, and its clinical manifestation gout, is a metabolic disease process that has been recognized since the dawn of medical inquiry. Uric acid was hypothesized to be a mediator of cardiovascular disease for period of time. Epidemiological correlations of hyperuricemia with hypertension and cardiovascular events were evident for two centuries' studies. With recent animal studies shedding light on the causal mechanisms of hypertension, and clinical trials suggesting that urate-lowering therapy can lower blood pressure, there appears to be growing evidence of a connection between hyperuricemia and cardiovascular disease. To help bring this recent uric acid research into context, we have undertaken this narrative review of hyperuricemia, hypertension, its hemodynamics and its outcomes, and the risk for cardiovascular diseases. KEY WORDS Cardiovascular risk; Hemodynamics; Uric acid.
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Affiliation(s)
- Pai-Feng Hsu
- Healthcare and Management Center
- Department of Cardiology
- Institute of Public Health
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Hsin-bang Leu
- Healthcare and Management Center
- Department of Cardiology
| | - Wan-Leong Chan
- Healthcare and Management Center
- Department of Cardiology
| | - Chen-Huan Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei
- Institute of Public Health
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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