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Wang N, Chen L, Kong W, Hsu CY, Tzeng IS. Editorial: Data-driven clinical biosignatures and treatment for neurodegenerative diseases, volume II. Front Neurosci 2024; 18:1396702. [PMID: 38562302 PMCID: PMC10982472 DOI: 10.3389/fnins.2024.1396702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Nizhuan Wang
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Lei Chen
- College of Information Engineering, Shanghai Maritime University, Shanghai, China
| | - Wei Kong
- College of Information Engineering, Shanghai Maritime University, Shanghai, China
| | - Chung Y. Hsu
- College of Medicine, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - I-Shiang Tzeng
- Department of Statistics, School of Business, National Taipei University, New Taipei, Taiwan
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Cai JH, Chuang CC, Chen MH, Yeh CP, Hsu CY. Differences of bioelectrical impedance in the development and healing phase of pressure ulcers and erythema in mouse model. J Tissue Viability 2024:S0965-206X(24)00025-1. [PMID: 38431432 DOI: 10.1016/j.jtv.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/26/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
Pressure ulcers (PUs) are economically burdensome medical conditions. Early changes in pressure ulcers are associated with erythema. In this study, bioelectrical impedance was used to measure the differences between PUs and blanchable erythema. We divided 21 ICR mice into three groups: control, 1000 mmHg-1h, and 1000 mmHg-6h. Healthy skin, blanchable erythema, and PUs were induced on the dorsal skin. The results indicated an immediate increase in impedance, resistance, and reactance values in the pressure group after release, followed by a subsequent decrease until two days after release. Compared with the control group, impedance and reactance significantly increased by 30.9% (p < 0.05) and 30.1% (p < 0.01), respectively, in the 6 h-loading group immediately after release. One and two days after release, the 1 h-loading and 6 h-loading groups exhibited significantly different degrees of decline. One day after release, impedance and resistance decreased by 30.2% (p < 0.05) and 19.8% (p < 0.05), respectively, in the 1 h-loading group; while impedance, resistance, and reactance decreased by 39.2% (p < 0.01), 26.8% (p < 0.01), and 45.7% (p < 0.05), respectively, in the 6 h-loading group. Two days after release, in the 1 h-loading group, impedance and resistance decreased by 28.3% (p < 0.05) and 21.7% (p < 0.05), respectively; while in the 6 h-loading group, impedance, resistance, and reactance decreased by 49.8% (p < 0.001), 34.2% (p < 0.001), and 59.8% (p < 0.01), respectively. One and two days after release the pressure group reductions were significantly greater than those in the control group. Additionally, we monitored changes during wound healing. Distinguishing early PUs from blanchable erythema by noninvasive bioelectrical impedance technology may have applications value in early assessment of PUs.
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Affiliation(s)
- J H Cai
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung Pei Road, Chung Li District, Taoyuan City, Taiwan.
| | - C C Chuang
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung Pei Road, Chung Li District, Taoyuan City, Taiwan.
| | - M H Chen
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung Pei Road, Chung Li District, Taoyuan City, Taiwan.
| | - C P Yeh
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung Pei Road, Chung Li District, Taoyuan City, Taiwan.
| | - C Y Hsu
- Department of Physical Medicine and Rehabilitation, Ten-Chan General Hospital, Yanping Road, Chung Li District, Taoyuan City, Taiwan.
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Yang CF, Hsu CY, Hsiao LT, Chen SW, Chuang SS. Clinicopathological characteristics of myelodysplastic syndromes with del(5q) in Taiwan. Malays J Pathol 2023; 45:405-416. [PMID: 38155382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) are a group of clonal haematopoietic stem cell disorders characterised by ineffective haematopoiesis and cytopenia. Studies have reported differences in MDS between Asian and Western countries, but data from Taiwan are scarce. MATERIALS AND METHODS In this study we analysed the clinical and pathological features of 32 Taiwanese MDS patients with del(5q) (ie, del(5q) alone [Group A, n = 11], del(5q) with one additional cytogenetic abnormality other than monosomy 7 or del(7q) [Group B, del(5q)+1; n = 6], and del(5q) with ≥2 additional cytogenetic abnormalities [Group C, n = 15]). RESULTS Progression-free survival (PFS) and overall survival (OS) were more favourable for Group A than for Groups B (p < 0.05) and C (p ≤ 0.001). Multivariate analysis showed that age >70 years, thrombocytopenia, and karyotype other than del(5q) alone were poor prognostic factors. Among the patients that had World Health Organization (WHO)-defined MDS with isolated del(5q), one patient (9%) had a typical marrow morphology of 5q minus syndrome with erythroid hypoplasia and four patients (36%) had hypolobated megakaryocytes. In addition, PFS and OS were significantly more favorable for the patients with del(5q) alone than for those with del(5q)+1 (p < 0.05). CONCLUSION The bone marrow morphology, clinical features, and prognosis of Taiwanese MDS patients with del(5q) were different from those associated with MDS with isolated del(5q) as defined in the current WHO classification. Researchers should compare different geographic regions and racial populations to determine whether geographic and racial differences exist with respect to MDS with del(5q).
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Affiliation(s)
- C F Yang
- Taipei Veterans General Hospital, Department of Pathology and Laboratory Medicine, Taipei, Taiwan
| | - C Y Hsu
- Taipei Veterans General Hospital, Department of Pathology and Laboratory Medicine, Taipei, Taiwan
| | - L T Hsiao
- National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
| | - S W Chen
- Chi-Mei Hospital, Department of Internal Medicine, Division of Hemato-Oncology, Lioying, Tainan, Taiwan
| | - S S Chuang
- Chi-Mei Medical Center, Department of Pathology, Tainan, Taiwan.
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Wu TY, Tien N, Lin CL, Cheah YC, Hsu CY, Tsai FJ, Fang YJ, Lim YP. Influence of antipsychotic medications on hyperlipidemia risk in patients with schizophrenia: evidence from a population-based cohort study and in vitro hepatic lipid homeostasis gene expression. Front Med (Lausanne) 2023; 10:1137977. [PMID: 37425327 PMCID: PMC10324036 DOI: 10.3389/fmed.2023.1137977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Schizophrenia increases the risk of mortality and cardiovascular disease (CVD) risk. However, the correlation between antipsychotics (APs) and CVD remains controversial. Hyperlipidemia is a significant risk factor for CVD. Methods We conducted a nationwide population-based retrospective cohort study to investigate the effects of APs on the risk of hyperlipidemia and lipid homeostasis gene expression. We used data from the Longitudinal Health Insurance Database of Taiwan on new-onset schizophrenia patients and a comparison cohort without schizophrenia. We used a Cox proportional hazards regression model to analyze the differences in hyperlipidemia development between the two cohorts. Furthermore, we examined the effects of APs on the hepatic expression of lipid homeostasis-related genes. Results After adjusting for potential interrelated confounding factors, the case group (N = 4,533) was found to have a higher hyperlipidemia risk than the control cohort (N = 4,533) [adjusted hazard ratio (aHR), 1.30, p < 0.001]. Patients with schizophrenia without APs had a significantly higher risk of hyperlipidemia (aHR, 2.16; p < 0.001). However, patients receiving APs had a significantly lower risk of hyperlipidemia than patients not receiving APs (all aHR ≤ 0.42, p < 0.001). First-generation antipsychotics (FGAs) induce the expression of hepatic lipid catabolism genes in an in vitro model. Discussion Patients with schizophrenia had a higher risk of hyperlipidemia than controls; however, compared with non-treated patients, AP users had a lower risk of hyperlipidemia. Early diagnosis and management of hyperlipidemia may help prevent CVD.
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Affiliation(s)
- Tien-Yuan Wu
- Graduate Institute of Clinical Pharmacy, College of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Pharmacy, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Ni Tien
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Cun Cheah
- Department of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Division of Medical Genetics, China Medical University Children's Hospital, Taichung, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
| | - Yi-Jen Fang
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Ph.D. Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
- Department of Environmental Health, Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung-Hsing University, Taichung, Taiwan
- Digestive Disease Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yun-Ping Lim
- Department of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Lai PH, Chen W, Hsu CY, Wang JH, Ding DC. Women consuming oral contraceptives containing cyproterone acetate and ethinylestradiol show a higher risk of thyroid cancer than nonusers. Medicine (Baltimore) 2023; 102:e34074. [PMID: 37327266 PMCID: PMC10270523 DOI: 10.1097/md.0000000000034074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023] Open
Abstract
This study explored whether the risk of thyroid cancer in Asian women is associated with consumption of oral contraceptives (Diane-35). We conducted a population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database. From the database, 9865 women aged 18 to 65 years who were prescribed Diane-35 between 2000 and 2012 were included in the Diane-35 group, and 39,460 women who were not prescribed Diane-35 were included in the comparison group and were frequency-matched by age and index year. Both groups were followed until 2013 to calculate the incidence of thyroid cancer. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazard model. The median (standard deviation) follow-up duration was 7.08 (3.63) and 7.04 (3.64) years in the Diane-35 and the comparison group, respectively. The incidence of thyroid cancer was 1.80-fold higher in the Diane-35 group than in the comparison group (2.72 vs 1.51 per 10,000 person-years). The cumulative incidence of thyroid cancer was significantly higher in the Diane-35 group than in the comparison group (log-rank test, P = .03). An elevated hazard ratio of thyroid cancer was observed in the Diane-35 group than in the comparison group (HR: 1.91, 95% CI: 1.10-3.30). In subgroup analysis, patients aged 30 to 39 years showed a higher hazard ratio of developing thyroid cancer after consuming Diane-35 than those in the comparison group (HR: 5.58, 95% CI: 1.84-16.91). The study provides evidence that women aged 30 to 39 years consuming Diane-35 are at increased risk of thyroid cancer. Nevertheless, a larger population with a longer follow-up may be necessary to confirm causality.
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Affiliation(s)
- Pei-Hsuan Lai
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Weishan Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
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Yen FS, Hou MC, Cheng-Chung Wei J, Shih YH, Hsu CY, Hsu CC, Hwu CM. Glucagon-like Peptide-1 Receptor Agonist Use in Patients With Liver Cirrhosis and Type 2 Diabetes. Clin Gastroenterol Hepatol 2023:S1542-3565(23)00482-2. [PMID: 37331413 DOI: 10.1016/j.cgh.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND & AIMS Liver cirrhosis is often associated with type 2 diabetes (T2D), but research on treatment of T2D in cirrhotic patients is scarce. We investigated the long-term outcomes of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with T2D and cirrhosis. METHODS Using propensity-score matching, we selected 467 matched pairs of GLP-1 RA users and nonusers from the National Health Insurance Research Database of Taiwan from January 1, 2008, to December 31, 2019. Multivariable-adjusted Cox proportional hazards models were used to compare the outcomes between GLP-1 RA users and nonusers. RESULTS The mean follow-up time was 3.28 and 3.06 years for GLP-1 RA users and nonusers, respectively. The rates of death were 27.46 and 55.90 per 1000 person-years for GLP-1 RA users and nonusers, respectively. The multivariable-adjusted models showed that GLP-1 RA users had lower risks of mortality (aHR 0.47, 95%CI 0.32-0.69), cardiovascular events (aHR 0.6, 95%CI 0.41-0.87), decompensated cirrhosis (aHR 0.7, 95%CI 0.49-0.99), hepatic encephalopathy (aHR 0.59, 95%CI 0.36-0.97), and liver failure (aHR 0.54, 95%CI 0.34-0.85) than nonusers. A longer cumulative duration of GLP-1 RA use had a lower risk of these outcomes than GLP-1 RA no-use. CONCLUSIONS This population-based cohort study showed that GLP-1 RA users exhibited a significantly lower risk of death, cardiovascular events, decompensated cirrhosis, hepatic encephalopathy, and liver failure in patients with T2D and compensated liver cirrhosis. Additional studies are needed to confirm our results.
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Affiliation(s)
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Ying-Hsiu Shih
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung City, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan.
| | - Chii-Min Hwu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan; Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Tien N, Wu TY, Lin CL, Chu FY, Wang CCN, Hsu CY, Tsai FJ, Fang YJ, Lim YP. Association of epilepsy, anti-epileptic drugs (AEDs), and type 2 diabetes mellitus (T2DM): a population-based cohort retrospective study, impact of AEDs on T2DM-related molecular pathway, and via peroxisome proliferator-activated receptor γ transactivation. Front Endocrinol (Lausanne) 2023; 14:1156952. [PMID: 37334286 PMCID: PMC10272786 DOI: 10.3389/fendo.2023.1156952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/04/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction A potential association between epilepsy and subsequent type 2 diabetes mellitus (T2DM) has emerged in recent studies. However, the association between epilepsy, anti-epileptic drugs (AEDs), and the risk of T2DM development remains controversial. We aimed to conduct a nationwide, population-based, retrospective, cohort study to evaluate this relationship. Methods We extracted data from the Taiwan Longitudinal Generation Tracking Database of patients with new-onset epilepsy and compared it with that of a comparison cohort of patients without epilepsy. A Cox proportional hazards regression model was used to analyze the difference in the risk of developing T2DM between the two cohorts. Next-generation RNA sequencing was used to characterize T2DM-related molecularchanges induced by AEDs and the T2DM-associated pathways they alter. The potential of AEDs to induce peroxisome proliferator-activated receptor γ (PPARγ) transactivation was also evaluated. Results After adjusting for comorbidities and confounding factors, the case group (N = 14,089) had a higher risk for T2DM than the control group (N = 14,089) [adjusted hazards ratio (aHR), 1.27]. Patients with epilepsy not treated with AEDs exhibited a significantly higher risk of T2DM (aHR, 1.70) than non-epileptic controls. In those treated with AEDs, the risk of developing T2DM was significantly lower than in those not treated (all aHR ≤ 0.60). However, an increase in the defined daily dose of phenytoin (PHE), but not of valproate (VPA), increased the risk of T2DM development (aHR, 2.28). Functional enrichment analysis of differentially expressed genes showed that compared to PHE, VPA induced multiple beneficial genes associated with glucose homeostasis. Among AEDs, VPA induced the specific transactivation of PPARγ. Discussion Our study shows epilepsy increases the risk of T2DM development, however, some AEDs such as VPA might yield a protective effect against it. Thus, screening blood glucose levels in patients with epilepsy is required to explore the specific role and impact of AEDs in the development of T2DM. Future in depth research on the possibility to repurpose VPA for the treatment of T2DM, will offer valuable insight regarding the relationship between epilepsy and T2DM.
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Affiliation(s)
- Ni Tien
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Tien-Yuan Wu
- Graduate Institute of Clinical Pharmacy, College of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Pharmacy, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Fang-Yi Chu
- Department of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan
| | - Charles C. N. Wang
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Center for Precision Health Research, Asia University, Taichung, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Division of Medical Genetics, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
| | - Yi-Jen Fang
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Ph.D. Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
- Department of Environmental Health, Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung-Hsing University, Taichung, Taiwan
- Digestive Disease Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yun-Ping Lim
- Department of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Chen HY, Lee WK, Chang R, Hung YM, Hsu CY, Shih YH, Chen JS. Immune thrombocytopenia and risk of stroke: Evidence from a nationwide population-based cohort study. Int J Stroke 2023; 18:408-415. [PMID: 36073612 DOI: 10.1177/17474930221125556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research investigating differences in the overall stroke risk between individuals with and without immune thrombocytopenia (ITP) is lacking. METHODS This real-world study used the National Health Insurance Research Database (NHIRD). Risk of stroke was compared between 13,085 individuals with ITP enrolled between 1 January 2000 and 31 December 2015 and a control cohort of 52,340 individuals without ITP (1:4 ratio propensity score-matched by age, sex, index year, relevant comorbidities, and medications). Sub-distribution hazards models were used to estimate adjusted sub-distribution hazard ratio (SHR) and 95% confidence intervals (CIs), with the non-ITP group as the control group. RESULTS Of the 65,425 participants, 13,085 had ITP, 63.3% were women, and the mean age was 52.59 years. The risk of both ischemic and hemorrhagic stroke was 1.14 times (adjusted SHR 1.14, 95% CI, 1.07-1.22) and 1.93 times (adjusted SHR 1.93, 95% CI, 1.70-2.20) higher in the ITP group than in controls. Patients with ITP in the 20- to 29-year subgroup had a higher risk of new-onset stroke (adjusted SHR, 4.06 (95% CI, 2.72-6.07), p value for interaction <0.01) than those aged 20-29 years without ITP. Individuals with severe ITP with splenectomy had a 1.79 times higher overall stroke risk than those without. CONCLUSIONS ITP is associated with increased risk of both ischemic and hemorrhagic stroke.
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Affiliation(s)
- Hsin-Yu Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Wei-Kai Lee
- Department of Emergency Medicine, Sinying Hospital, Ministry of Health and Welfare, Tainan
- Min-Hwei Junior College of Health Care Management, Tainan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung
- College of Health and Nursing, Meiho University, Pingtung
- Institute of Medicine, Chung Shan Medical University, Taichung
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung
| | - Ying-Hsiu Shih
- Management Office for Health Data (DryLab), Clinical Trial Research Center (CTC), China Medical University Hospital, Taichung
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung
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Wang TC, Shen TC, Lin CL, Hsu CY. Risk of obstructive sleep apnea in idiopathic pulmonary fibrosis. Eur J Intern Med 2023; 110:120-121. [PMID: 36564241 DOI: 10.1016/j.ejim.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Tang-Chuan Wang
- Department of Otorhinolaryngology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Te-Chun Shen
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2 Yu-De Road, Taichung 404, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung Y Hsu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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Hsu Y, Hsu CY, Kao YS. The Association between Metformin and the Cancer-Specific Mortality Rate in Nasopharyngeal Cancer Patients: Real-World Evidence. Curr Oncol 2023; 30:3940-3950. [PMID: 37185411 PMCID: PMC10136714 DOI: 10.3390/curroncol30040298] [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] [Received: 02/25/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: Nasopharyngeal cancer is a common cancer in East and South Asia. The radiotherapy and chemotherapy regimen has advanced in recent years. However, many patients still suffer from local recurrence and distant metastasis; thus, identifying medication that can be combined with standard treatment to improve the treatment outcomes in nasopharyngeal cancer patients is an unmet need. Methods: We included nasopharyngeal cancer patients from the Taiwan National Health Insurance Database (NHIRD). The primary endpoint was set as the cancer-specific mortality rate. Metformin cohorts and non-Metformin cohorts were matched by sex, age, and the year of the index date. Propensity score matching with a ratio of 1:1 was applied. Results: A total of 6078 subjects were included in the study, with 3039 patients in each group. Male participants outnumbered female participants. Most of the patients were aged 50 to 64; the mean age was 60.4 ± 10.4 years in Metformin non-users, and that of Metformin users was 59.9 ± 10.5 years. Metformin users had a lower risk of death due to nasopharyngeal cancer (adjusted HR = 0.80; 95% CI = 0.71, 0.90) than controls. Conclusions: We concluded that Metformin might be effective at reducing the cancer-specific mortality rate in nasopharyngeal cancer patients. Further randomized control trials should be completed.
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Wang N, Chen L, Kong W, Hsu CY, Tzeng IS. Editorial: Data-driven clinical biosignatures and treatment for neurodegenerative diseases. Front Neurosci 2023; 17:1171788. [PMID: 37056310 PMCID: PMC10086411 DOI: 10.3389/fnins.2023.1171788] [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] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Nizhuan Wang
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Lei Chen
- College of Information Engineering, Shanghai Maritime University, Shanghai, China
| | - Wei Kong
- College of Information Engineering, Shanghai Maritime University, Shanghai, China
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Cooperative Research Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- *Correspondence: I-Shiang Tzeng
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Zhou B, Lin CL, Kojima S, Fukushima M, Hsu CY. Risk factors of dementia in patients with cerebral vascular diseases based on Taiwan National Health Insurance data. Dement Geriatr Cogn Disord 2023:000530102. [PMID: 36948166 PMCID: PMC10332482 DOI: 10.1159/000530102] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/08/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Vascular factors have been shown to be associated with increased risk of dementia. However, clinical trials have so far been unsuccessful, suggesting new approaches are needed. The aim of this study was to use population-based real world data to investigate risk factors and preventive factors for dementia, including the effects of traditional Chinese medicine. METHODS This is a retrospective cohort study using LHID2000, a dataset randomly selected from Taiwan's National Health Insurance Research Database (NHIRD). Subjects with occlusion and stenosis of precerebral and cerebral arteries, cerebral atherosclerosis without mention of cerebral infarction, and transient cerebral ischemia were included. Subjects with dementia at baseline were excluded. The primary endpoint was dementia. Data for demographic and clinical comorbid status and treatments administered at baseline in 2000 and at the end of follow-up in 2013 were included. RESULTS A total of 4207 subjects with cerebral vascular disease and no cognitive impairment were included, of whom 392 converted to dementia during an average 5.15-year (SD: 3.79) follow-up. Depression, osteoporosis and the use of enalapril were risk factors for dementia, while nitroglycerin was a protecting factor, in subjects with cerebrovascular diseases without mention of cerebral infarction. In total, statins were shown to decrease the risk of dementia; however, no one statin subtype had such an effect. CONCLUSION Depression, osteoporosis and the use of enalapril were associated with a higher risk of dementia, while nitroglycerin might be a protecting factor for dementia, in subjects with cerebrovascular diseases without mention of cerebral infarction.
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Chang JH, Shen TC, Chen KW, Lin CL, Hsu CY, Wen YR, Chang KC. Risk of Acute Myocardial Infarction in Pneumoconiosis: Results from a Retrospective Cohort Study. Biomedicines 2023; 11:biomedicines11030897. [PMID: 36979875 PMCID: PMC10046008 DOI: 10.3390/biomedicines11030897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/21/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Pneumoconiosis (PCN) has several comorbidities, most notably pulmonary and cardiovascular diseases. However, much is still unknown about the relationship between PCN and acute myocardial infarction (AMI). The present study aimed to clarify the association between PCN and subsequent AMI risk using a retrospective cohort study design. Methods: This was a population-based, retrospective cohort study that used data from Taiwan’s National Health Insurance Database. A total of 7556 newly diagnosed patients with PCN and 7556 individuals without PCN were included in the PCN and comparison cohort (PC and CC), respectively, between 2008 and 2018, with propensity score matching for age, gender, comorbidity, medication, and date of PCN diagnosis. The occurrence of AMI was monitored until the end of 2019, and AMI risk was assessed using Cox proportional hazard regression models. Results: The overall incidence of AMI was 1.34-fold higher in the PC than in the CC (4.33 vs. 3.23 per 1000 person-years, respectively, p < 0.05), with an adjusted hazard ratio (aHR) of 1.36 (95% confidence interval (CI): 1.08–1.72) after controlling for age, gender, comorbidity, and medication. Further analyses showed a higher risk of AMI with increased annual number of emergency department visits among patients with PCN (aHR: 1.30, 95% CI: 1.01–1.66 (<1) and aHR: 1.68, 95% CI: 1.13–2.50 (≥1)). Conclusion: Patients with PCN had a significantly higher risk of developing AMI than those without PCN. Clinicians should pay more attention to prevent AMI episodes in patients with PCN.
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Affiliation(s)
- Ju-Hsin Chang
- Graduate Institute of Clinical Medicine Science, China Medical University, No. 91, Xue-Shi Road, Taichung 404, Taiwan
- Department of Anesthesia, China Medical University Hospital, Taichung 404, Taiwan
| | - Te-Chun Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Critical Care Medicine, Chu Shang Show Chwan Hospital, Nantou 557, Taiwan
| | - Ke-Wei Chen
- Graduate Institute of Clinical Medicine Science, China Medical University, No. 91, Xue-Shi Road, Taichung 404, Taiwan
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, No. 2 Yu-De Road, Taichung 404, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
| | - Chung Y. Hsu
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
| | - Yeong-Ray Wen
- Graduate Institute of Clinical Medicine Science, China Medical University, No. 91, Xue-Shi Road, Taichung 404, Taiwan
- Department of Anesthesia, China Medical University Hospital, Taichung 404, Taiwan
- Correspondence: (Y.-R.W.); (K.-C.C.); Tel.: +886-4-2205-3366 (Y.-R.W.); +886-4-2205-2121 (K.-C.C.)
| | - Kuan-Cheng Chang
- School of Medicine, China Medical University, Taichung 404, Taiwan
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, No. 2 Yu-De Road, Taichung 404, Taiwan
- Correspondence: (Y.-R.W.); (K.-C.C.); Tel.: +886-4-2205-3366 (Y.-R.W.); +886-4-2205-2121 (K.-C.C.)
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Pan LF, Chang R, Hsu CY, Tsui KH. Older veterans associated with reduced risk of cancer: Retrospective nationwide matched cohort study in Taiwan. Front Med (Lausanne) 2023; 9:931565. [PMID: 36687435 PMCID: PMC9846208 DOI: 10.3389/fmed.2022.931565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/02/2022] [Indexed: 01/05/2023] Open
Abstract
Importance It remains unknown whether Taiwanese veterans have a lower risk of subsequent cancer compared with non-veterans. Objective To examine whether veterans are associated with reduced cancer risk. Methods From January 2004 to December 2017, this study included 957 veterans and 957 civilians who were propensity score (PS) matched by years of birth, sex, residence, index year, days in the hospital, frequency of outpatient visits, and relevant comorbidities at baseline. Multivariate Cox proportional hazards regression analysis was applied to compare the risks of cancer, overall and by subgroup, and mortality. All the participants were cancer free at the baseline. Exposures Veterans retrieved from Taiwan National Health Insurance Research Database (NHIRD). Main outcome Cancer extracted from the Registry for Catastrophic Illness Patients Database (RCIPD). Results Overall, 1,914 participants were included, and 957 veterans with a mean (SD) age of 75.9 (6.79) years and 946 men (98.9%). The mean follow-up was about 10.5 (±4.51) years. Cancer was recorded in 6.68% (N = 64) and 12.12% (N = 116) of veterans and non-veterans, respectively. Veterans were associated with decreased risk [adjusted hazard ratio (aHR), 0.57; 95% CI: 0.41-0.78; P < 0.001] of cancer compared with civilians after controlling for age, sex, urbanization, hypertension, diabetes, hyperlipidemia, cardiovascular event, COPD, asthma, chronic liver disease, alcohol-related illness, and Parkinson's disease. Cancer subgroup analyses verified this finding (HRs <1.0). The decreased incidence rate was predominantly for liver cancer (aHR, 0.18; 95% CI: 0.05-0.72; P < 0.05). Conclusion Taiwanese older veterans are associated with reduced overall cancer risk than individuals without veteran status.
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Affiliation(s)
- Li-Fei Pan
- Department of General Affair Office, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,College of Finance and Banking, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan,*Correspondence: Renin Chang,
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Kuan-Hao Tsui
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan,Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,Kuan-Hao Tsui,
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Wang IK, Yen TH, Tsai CH, Sun Y, Chang WL, Chen PL, Lai TC, Yeh PY, Wei CY, Lin CL, Hsu KC, Li CY, Sung FC, Hsu CY. Renal function is associated with one-month and one-year mortality in patients with intracerebral hemorrhage. PLoS One 2023; 18:e0269096. [PMID: 36701340 PMCID: PMC9879419 DOI: 10.1371/journal.pone.0269096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/15/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE This study evaluated short-term (1-month) and long-term (1-year) mortality risks associated with the glomerular filtration rate (eGFR) on admission for patients with intracerebral hemorrhage. METHODS From the Taiwan Stroke Registry data from April 2006 to December 2016, we identified and stratified patients with intracerebral hemorrhage into five subgroups by the eGFR level on admission: ≥90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m2 or on dialysis. Risks for 1-month and 1-year mortality after intracerebral hemorrhage were compared by the eGFR levels. RESULTS Both the 1-month and 1-year mortality rates progressively increased with the decrease in eGFR levels. The 1-month mortality rate in patients with eGFR < 15 mL/min/1.73 m2 or on dialysis was approximately 5.5-fold greater than that in patients with eGFR ≥ 90 mL/min/1.73 m2 (8.31 versus 1.50 per 1000 person-days), with an adjusted hazard ratio (HR) of 4.59 [95% confidence interval (CI) = 2.71-7.78]. Similarly, the 1-year mortality in patients with eGFR < 15 mL/min/1.73 m2 or on dialysis was 7.5 times that in patients with eGFR ≥ 90 mL/min/1.73 m2 (2.34 versus 0.31 per 1000 person-days), with an adjusted HR of 4.54 (95% CI 2.95-6.98). CONCLUSION Impairment of renal function is an independent risk factor for mortality in patients with intracerebral hemorrhage in a gradual way. The eGFR level is a prognostic indicator for patients with intracerebral hemorrhage.
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Affiliation(s)
- I-Kuan Wang
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chon-Haw Tsai
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Yu Sun
- Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chang Lai
- Division of Neurology Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Po-Yen Yeh
- Department of Neurology, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kai-Cheng Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Yuan Li
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University College of Medicine, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
- * E-mail:
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Science, China Medical University College of Medicine, Taichung, Taiwan
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Yen FS, Wei JCC, Hung YT, Hsu CY, Hwu CM, Hsu CC. Thiazolidinediones lower the risk of pneumonia in patients with type 2 diabetes. Front Microbiol 2023; 14:1118000. [PMID: 36876083 PMCID: PMC9981669 DOI: 10.3389/fmicb.2023.1118000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction We conducted this study to compare the risk of pneumonia between thiazolidinedione (TZD) use and nonuse in persons with type 2 diabetes (T2D). Methods We identified 46,763 propensity-score matched TZD users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risk of morbidity and mortality associated with pneumonias. Results Compared with the nonuse of TZDs, the adjusted hazard ratios (95% CI) for TZD use in hospitalization for all-cause pneumonia, bacterial pneumonia, invasive mechanical ventilation, and death due to pneumonia were 0.92 (0.88-0.95), 0.95 (0.91-0.99), 0.80 (0.77-0.83), and 0.73 (0.64-0.82), respectively. The subgroup analysis revealed that pioglitazone, not rosiglitazone, was associated with a significantly lower risk of hospitalization for all-cause pneumonia [0.85 (0.82-0.89)]. Longer cumulative duration and higher cumulative dose of pioglitazone were associated with further lower adjusted hazard ratios in these outcomes compared to no-use of TZDs. Discussion This cohort study demonstrated that TZD use was associated with significantly lower risks of hospitalization for pneumonia, invasive mechanical ventilation, and death due to pneumonia in patients with T2D. Higher cumulative duration and dose of pioglitazone were associated with a further lower risk of outcomes.
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Affiliation(s)
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Tung Hung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, National Yang-Ming Chiao Tung University School of Medicine, Taipei, Taiwan.,Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.,National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
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Yen FS, Hou MC, Wei JCC, Shih YH, Hsu CY, Hsu CC, Hwu CM. Liver-related long-term outcomes of alpha-glucosidase inhibitors in patients with diabetes and liver cirrhosis. Front Pharmacol 2022; 13:1049094. [PMID: 36618937 PMCID: PMC9812564 DOI: 10.3389/fphar.2022.1049094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Adequate management of diabetes in patients with liver cirrhosis can be challenging. We conducted this study to investigate the liver-related long term outcomes of alpha-glucosidase inhibitors (AGIs) in patients with diabetes and cirrhosis. Methods: From National Health Insurance Research Database (NHIRD) in Taiwan, we recruited propensity-score matched alpha-glucosidase inhibitor users and non-users from a cohort of type 2 diabetes mellitus (T2DM) with compensated liver cirrhosis between 1 January 2000, and 31 December 2017, and followed them until 31 December 2018. Cox proportional hazards models with robust sandwich standard error estimates were used to assess the risk of main outcomes for alpha-glucosidase inhibitor users versus non-users. Results: The incidence rates of mortality during follow-up were 65.56 vs. 96.06 per 1,000 patient-years for alpha-glucosidase inhibitor users and non-users, respectively. The multivariable-adjusted model shows that alpha-glucosidase inhibitor users had significantly lower risks of all-cause mortality (aHR 0.63, 95% CI 0.56-0.71), hepatocellular carcinoma (aHR 0.55, 95% CI 0.46-0.67), decompensated cirrhosis (aHR 0.74 95% CI 0.63-0.87), hepatic encephalopathy (aHR 0.72, 95% CI 0.60-0.87), and hepatic failure (aHR 0.74, 95% CI 0.62-0.88) than alpha-glucosidase inhibitor non-users. Patients who received alpha-glucosidase inhibitors for a cumulative duration of more than 364 days had significantly lower risks of these outcomes than non-users. Conclusion: Alpha-glucosidase inhibitor use was associated with a lower risk of mortality, hepatocellular carcinoma, decompensated cirrhosis, and hepatic failure in patients with diabetes and compensated cirrhosis. alpha-glucosidase inhibitors may be useful for the management of diabetes in patients with compensated liver cirrhosis. Large-scale prospective studies are required to verify our results.
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Affiliation(s)
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Ying-Hsiu Shih
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Taipei, Miaoli, Taiwan,Department of Health Services Administration, China Medical University, Taichung, Taiwan,Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan,National Center for Geriatrics and Welfare Research, National Health Research Institutes, Taipei, Miaoli, Taiwan,*Correspondence: Chih-Cheng Hsu, ; Chii-Min Hwu,
| | - Chii-Min Hwu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan,Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,*Correspondence: Chih-Cheng Hsu, ; Chii-Min Hwu,
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Chen TS, Yu TS, Lin CL, Hsu CY, Hu WS. Role of sodium-glucose cotransporter-2 inhibitors in risk of chronic kidney disease among patients with type 2 diabetes mellitus. J Nephrol 2022; 36:713-718. [PMID: 36534314 DOI: 10.1007/s40620-022-01522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022]
Abstract
AIM This retrospective analysis aims to explore the risk of chronic kidney disease (CKD) among type 2 diabetes mellitus (DM) patients with different scores of adapted diabetes complications severity index (DCSI) who received sodium-glucose cotransporter-2 inhibitors (SGLT2Is). METHODS This study includes 113,449 DM patients from the Taiwan National Health Insurance Research Database (NHIRD). We analyzed the data collected from 107,440 patients showing a DCSI score change of < 1 per year, 3720 patients with a score change of 1 to 2 per year and 2289 patients with a score change of > 2 per year. Cox proportional hazard models were used to evaluate the CKD risk throughout the overall follow-up period, and were adjusted for sex, age, comorbidities and medications of a-glucosidase inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, biguanides, dipeptidyl peptidase-4 inhibitors, glucagon like peptide-1 receptor agonists, insulin, meglitinides, sulphonylurea and thiazolidinedione. RESULTS The incidence of CKD increased from 18.30 per 1000 person-years in patients with a score change of < 1 per year to 137.55 per 1000 person-years for those with a score change of > 2 per year. Patients with a higher score change (> 2 per year) and receiving SGLT2Is had a lower risk of developing CKD than patients who did not receive SGLT2Is. CONCLUSION The use of SGLT2Is was significantly associated with the reduction in CKD incidence in diabetic patients with a higher DCSI.
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Affiliation(s)
- Tung-Sheng Chen
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Teng-Shun Yu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan.
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Zhang HW, Tsai ZR, Kok VC, Peng HC, Chen YH, Tsai JJP, Hsu CY. Long-term ambient hydrocarbon exposure and incidence of urinary bladder cancer. Sci Rep 2022; 12:20799. [PMID: 36460770 PMCID: PMC9718740 DOI: 10.1038/s41598-022-25425-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
Particulate matter and volatile organic compounds, including total hydrocarbons (THCs), are major ambient air pollutants. Primary nonmethane hydrocarbons (NMHCs) originate from vehicle emissions. The association between air pollution and urinary bladder cancer (UBC) is debatable. We investigated whether long-term exposure to ambient hydrocarbons increases UBC risk among people aged ≥ 20 years in Taiwan. Linkage dataset research with longitudinal design was conducted among 589,135 initially cancer-free individuals during 2000-2013; 12 airborne pollutants were identified. Several Cox models considering potential confounders were employed. The study outcomes were invasive or in situ UBC incidence over time. The targeted pollutant concentration was divided into three tertiles: T1/T2/T3. The mean age of individuals at risk was 42.5 (SD 15.7), and 50.5% of the individuals were men. The mean daily average over 10 years of airborne THC concentration was 2.25 ppm (SD 0.13), and NMHC was 0.29 ppm (SD 0.09). Both pollutants show long-term monotonic downward trend over time using the Mann-Kendall test. There was a dose-dependent increase in UBC at follow-up. UBC incidence per 100,000 enrollees according to T1/T2/T3 exposure to THC was 60.9, 221.2, and 651.8, respectively; it was 170.0/349.5/426.7 per 100,000 enrollees, corresponding to T1/T2/T3 exposure to NMHC, respectively. Without controlling for confounding air pollutants, the adjusted hazard ratio (adj.HR) was 1.83 (95% CI 1.75-1.91) per 0.13-ppm increase in THC; after controlling for PM2.5, adj.HR was even higher at 2.09 (95% CI 1.99-2.19). The adj.HR was 1.37 (95% CI 1.32-1.43) per 0.09-ppm increase in ambient NMHC concentration. After controlling for SO2 and CH4, the adj.HR was 1.10 (95% CI 1.06-1.15). Sensitivity analyses showed that UBC development risk was not sex-specific or influenced by diabetes status. Long-term exposure to THC and NMHC may be a risk factor for UBC development. Acknowledging pollutant sources can inform risk management strategies.
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Affiliation(s)
- Han-Wei Zhang
- Program for Aging, China Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Biomedica Corporation, New Taipei, Taiwan
| | - Zhi-Ren Tsai
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Center for Precision Medicine Research, Asia University, Taichung, Taiwan
| | - Victor C Kok
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, 117 Shatien Rd Shalu Dist., Taichung, 43303, Taiwan.
| | | | - Yau-Hung Chen
- Department of Chemistry, Tamkang University, New Taipei City, 25137, Taiwan
| | - Jeffrey J P Tsai
- Center for Precision Medicine Research, Asia University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
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Fan HC, Chen CM, Tsai JD, Chiang KL, Tsai SCS, Huang CY, Lin CL, Hsu CY, Chang KH. Association between Exposure to Particulate Matter Air Pollution during Early Childhood and Risk of Attention-Deficit/Hyperactivity Disorder in Taiwan. Int J Environ Res Public Health 2022; 19:ijerph192316138. [PMID: 36498210 PMCID: PMC9740780 DOI: 10.3390/ijerph192316138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 05/23/2023]
Abstract
(1) Background: Recently, a growing number of studies have provided evidence to suggest a strong correlation between air pollution exposure and attention-deficit/hyperactivity disorder (ADHD). In this study, we assessed the relationship between early-life exposure to particulate matter (PM)10, PM2.5, and ADHD; (2) Methods: The National Health Insurance Research Database (NHIRD) contains the medical records, drug information, inspection data, etc., of the people of Taiwan, and, thus, could serve as an important research resource. Air pollution data were based on daily data from the Environmental Protection Administration Executive Yuan, R.O.C. (Taiwan). These included particulate matter (PM2.5 and PM10). The two databases were merged according to the living area of the insured and the location of the air quality monitoring station; (3) Results: The highest levels of air pollutants, including PM2.5 (adjusted hazard ratio (aHR) = 1.79; 95% confidence interval (CI) = 1.58-2.02) and PM10 (aHR = 1.53; 95% CI = 1.37-1.70), had a significantly higher risk of ADHD; (4) Conclusions: As such, measures for air quality control that meet the WHO air quality guidelines should be strictly and uniformly implemented by Taiwanese government authorities.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
| | - Chuan-Mu Chen
- The iEGG and Animal Biotechnology Center, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Ph.D. Program in Translational Medicine, Department of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
- Rong Hsing Research Center for Translational Medicine, College of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, Hungkuang University, Taichung 433, Taiwan
| | - Stella Chin-Shaw Tsai
- Ph.D. Program in Translational Medicine, Department of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
- Rong Hsing Research Center for Translational Medicine, College of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Ching-Ying Huang
- Department of Food Science and Biotechnology, National Chung Hsing University, Taichung 402, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan
| | - Kuang-Hsi Chang
- Ph.D. Program in Translational Medicine, Department of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
- Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Center for General Education, China Medical University, Taichung 404, Taiwan
- General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
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Yen FS, Wei JCC, Yu TS, Hsu CY, Hsu CC, Hwu CM. Sulfonylurea Use in Patients with Type 2 Diabetes and COPD: A Nationwide Population-Based Cohort Study. Int J Environ Res Public Health 2022; 19:15013. [PMID: 36429732 PMCID: PMC9690079 DOI: 10.3390/ijerph192215013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/11/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
We conducted this study to investigate the long-term outcomes of sulfonylurea (SU) use in patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D). We used propensity-score matching to identify 6008 pairs of SU users and nonusers from Taiwan's National Health Insurance Research Database from 1 January 2000 to 31 December 2017. Cox proportional hazard models were used to compare the risks of mortality, cardiovascular events, non-invasive positive pressure ventilation, invasive mechanical ventilation, bacterial pneumonia, lung cancer, and hypoglycemia between SU users and nonusers. In the matched cohorts, the mean follow-up time for SU users and nonusers was 6.57 and 5.48 years, respectively. Compared with nonusers, SU users showed significantly lower risks of mortality [aHR 0.53(0.48-0.58)], cardiovascular events [aHR 0.88(0.81-0.96)], non-invasive positive pressure ventilation [aHR 0.74(0.6-0.92)], invasive mechanical ventilation [aHR 0.57(0.5-0.66)], and bacterial pneumonia [aHR 0.78(0.7-0.87)]. A longer cumulative duration of SU use was associated with a lower risk of these outcomes. This nationwide cohort study demonstrated that SU use was associated with significantly lower risks of cardiovascular events, ventilation use, bacterial pneumonia, and mortality in patients with COPD and T2D. SU may be a suitable option for diabetes management in these patients.
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Affiliation(s)
- Fu-Shun Yen
- Dr. Yen’s Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan 33354, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung 40201, Taiwan
- Department of Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung 40201, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan
| | - Teng-Shun Yu
- Management Office for Health Data, China Medical University Hospital, 3F, No. 373-2, Jianxing Road, Taichung 40459, Taiwan
- College of Medicine, China Medical University, No. 91, Xueshi Road, Taichung 40202, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, 168 ChingKuo Road, Taoyuan 33044, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 11221, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei 11217, Taiwan
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22
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Chen FJ, Yin MC, Chen PY, Lin MH, Peng YH, Ho WC, Chen PC, Hsu CY. Association between Statin Use and Diabetes Risk in Patients with Transient Ischemic Attack. Int J Environ Res Public Health 2022; 19:13770. [PMID: 36360652 PMCID: PMC9658048 DOI: 10.3390/ijerph192113770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Statin therapy can effectively reduce recurrent transient ischemic attack (TIA) risk. However, studies have reported that statin use is associated with incidence of diabetes mellitus (DM). Whether statin therapy remains associated with higher DM risk in patients with TIA remains unknown. This study investigated whether statin treatment influences incident DM risk in patients with TIA. We conducted a retrospective cohort study using the Longitudinal Health Insurance Database 2000. Participants who were newly diagnosed with TIA (ICD-9-CM code 435) from 1 January 1997 to 31 December 2011 were recruited. The Kaplan-Meier method and Cox proportional risk model of time-dependent covariance were used. We enrolled 8342 patients with newly diagnosed TIA from 1 January 1997 to 31 December 2011. Of these, 1255 patients were classified as statin users and 7087 as nonusers. During the 14-year follow-up, the incidence of newly diagnosed DM was 0.545-fold lower in the statins group compared with nonusers (95% confidence interval [CI] = 0.457-0.650). According to cumulative defined daily doses (cDDDs), the adjusted hazard ratios for DM were 0.689, 0.594, and 0.463 when patients were treated with statins at cDDDs = 28-89, 90-180, and >180, respectively. In patients with TIA, statin use is associated with a lower incident DM risk compared with the nonuse of statins.
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Affiliation(s)
- Fu-Jun Chen
- Department of Public Health, China Medical University, No. 91, Hsueh-Shih Road, Taichung 404327, Taiwan
- Centers for Disease Control Ministry of Health and Welfare, Taichung 40855, Taiwan
| | - Ming-Chien Yin
- Division of Respiratory Therapy, China Medical University Hospital, Taichung 404327, Taiwan
| | - Pei-Yun Chen
- Department of Public Health, China Medical University, No. 91, Hsueh-Shih Road, Taichung 404327, Taiwan
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Min-Hua Lin
- Department of Dietetics, Yunlin Christian Hospital, Yunlin 64866, Taiwan
- Department of Nutrition, China Medical University, Taichung 404327, Taiwan
| | - Yi-Hao Peng
- Department of Respiratory Therapy, Asia University Hospital, Asia University, Taichung 41354, Taiwan
- Department of Nursing, Asia University, Taichung 41354, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, No. 91, Hsueh-Shih Road, Taichung 404327, Taiwan
| | - Pau-Chung Chen
- Department of Public Health, National Taiwan University, Taipei 10617, Taiwan
- National Institute of Environmental Health Sciences, Miaoli 35053, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404327, Taiwan
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23
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Yun CH, Kao WC, Hsu CY, Chang R, Cheng MF, Hung YM. Nontyphoidal Salmonella Infection Associated with Subsequent Risk of Hematological Malignancies: A Nationwide Population-Based Cohort Study. Int J Environ Res Public Health 2022; 19:12943. [PMID: 36232242 PMCID: PMC9565030 DOI: 10.3390/ijerph191912943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to investigate the relationship between nontyphoidal salmonellosis (NTS) and new-onset hematological malignancy. We conducted a 17-year nationwide, population-based, retrospective cohort study to examine the association between NTS and the risk of hematological malignancies by using the Longitudinal Health Insurance Database (LHID) of Taiwan. Participants were enrolled from 2000 to 2015 and were monitored until 2017. We traced the years 1998-2000 to ensure that the cases included were newly diagnosed with NTS. The NTS cohort included 13,790 patients with newly diagnosed NTS between 2000 and 2015. Each patient was propensity score matched at a 1:4 ratio with people without NTS. Cumulative incidence, hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated after adjusting for age, sex, income, urbanization, and medical comorbidities. The adjusted hazard ratio (aHR) of hematological malignancies for NTS patients relative to those without NTS was 1.42 (95% CI 0.91-2.20). In the age subgroup analysis, NTS had a significantly greater risk of hematological malignancies for patients older than 60 (aHR 3.04, 95% CI 1.46-6.34), with an incidence rate of 11.7 per 10,000 person-years. In patients over 60 years of age, a prominent risk of hematological malignancies was observed at a follow-up of more than 3 years after the index date (aHR 3.93, 95% CI 1.60-9.65). A history of NTS is associated with the risk of subsequent hematological malignancies in Taiwanese subjects older than 60.
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Affiliation(s)
- Chih-Hui Yun
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Wei-Chun Kao
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404328, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- Department of Recreation Sports Management, Tajen University, Pingtung 907101, Taiwan
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung 84001, Taiwan
| | - Ming-Fang Cheng
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- School of Nursing, Fooyin University, Kaohsiung 831301, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Yao-Min Hung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 804051, Taiwan
- College of Health and Nursing, Meiho University, Pingtung 912009, Taiwan
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24
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Yen FS, Hsu CC, Hu KC, Hung YT, Hsu CY, Wei JCC, Hwu CM. Metformin and the Risk of Chronic Urticaria in Patients with Type 2 Diabetes. Int J Environ Res Public Health 2022; 19:11045. [PMID: 36078769 PMCID: PMC9517871 DOI: 10.3390/ijerph191711045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
We conducted this study to determine the effect of metformin use on the risk of new-onset chronic urticaria in patients with type 2 diabetes (T2D). In total, 24,987 pairs of metformin users and nonusers were identified with propensity score-matching from Taiwan's National Health Insurance Research Database from 1 January 2000, to 31 December 2017. Multivariable Cox proportional hazards models were used to compare the risks of chronic urticaria development, severe chronic urticaria, and hospitalization for chronic urticaria between metformin users and nonusers. Compared with metformin nonuse, the aHRs (95% CI) for metformin use in chronic urticaria development, severe chronic urticaria, and hospitalization for chronic urticaria were 1.56 (1.39-1.74), 0.40 (0.12-1.30), and 1.45 (0.82-2.56), respectively. The cumulative incidence of chronic urticaria development was significantly higher in metformin users than in nonusers (p < 0.0001). A longer average cumulative duration of metformin use was associated with higher risks of new-onset and hospitalization for chronic urticaria than metformin nonuse. This nationwide cohort study showed that metformin use was associated with a significantly higher risk of chronic urticaria development. A longer average cumulative duration of metformin use was associated with a higher risk of outcomes. More prospective studies are needed to verify our results.
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Affiliation(s)
- Fu-Shun Yen
- Dr. Yen’s Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan 33354, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, 168 ChingKuo Road, Taoyuan 33044, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
| | - Kai-Chieh Hu
- Management Office for Health Data, China Medical University Hospital, 3F, No. 373-2, Jianxing Road, Taichung 40459, Taiwan
- College of Medicine, China Medical University, No. 91, Xueshi Road, Taichung 40202, Taiwan
| | - Yu-Tung Hung
- Management Office for Health Data, China Medical University Hospital, 3F, No. 373-2, Jianxing Road, Taichung 40459, Taiwan
- College of Medicine, China Medical University, No. 91, Xueshi Road, Taichung 40202, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 40203, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40203, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40202, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 11221, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei 11217, Taiwan
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25
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Liu CT, Hung IL, Hsu CY, Hu KC, Chen YH, Tsai MY. Chinese Herbal Medicine Reduces the Risk of Heart Failure in Hypertensive Patients: A Nationwide, Retrospective, Cohort Study. Front Cardiovasc Med 2022; 9:922728. [PMID: 35898268 PMCID: PMC9313033 DOI: 10.3389/fcvm.2022.922728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hypertension (HTN) is the leading preventable risk factor for cardiovascular disease worldwide. Patients with HTN are at higher risk for heart failure (HF). The currently available therapeutic approaches for HTN do not always optimally control blood pressure or are not suitable for hypertensive patients who have a higher number of comorbidities. This study aimed to determine whether Chinese herbal medicine (CMH)-based interventions could reduce the risk of HF in hypertensive patients. Methods This retrospective study randomly selected 2 million enrollees from the National Health Insurance Research Database and identified 507,608 patients who were newly diagnosed with HTN in 2000–2017. After 1:1 frequency-matching by age, sex, index year, income, urbanization, duration of HTN, comorbidities and antihypertensive medications, we selected 8,912 eligible patients in each group. During 16 years of follow-up, 380 CHM users and 426 CHM non-users developed HF, representing incidence rates of 6.29 and 7.43 per 1,000 person-years, respectively. Results CHM users had significantly lower HF risk compared with CHM non-users (adjusted HR = 0.85, 95% CI 0.74–0.98). The markedly predominant effect was observed in those receiving CHM products for more than 180 days (adjusted HR = 0.65). The frequently prescribed formula, Jia-Wei-Xiao-Yao-San, and the single herbs Ge Gen, Huang Qi, Du Zhong, Huang Qin, and Chuan Xiong were significantly associated with lower risk of HF. Conclusions This population-based study revealed decreased HF risk in hypertensive patients with CHM use. These findings may provide a reference for HF prevention strategies and support the integration of CHM into clinical intervention programs that provide a favorable prognosis for hypertensive patients.
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Affiliation(s)
- Chun-Ting Liu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, Dali Branch, Jen-Ai Hospital, Taichung, Taiwan
| | - I-Ling Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Chinese Medicine, Dali Branch, Jen-Ai Hospital, Taichung, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Kai-Chieh Hu
- Management Office for Health Data, College of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Ming-Yen Tsai
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- *Correspondence: Ming-Yen Tsai ;
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Yeh JJ, Syue SH, Sun YF, Yeh YT, Zheng YC, Lin CL, Hsu CY, Kao CH. Hydroxychloroquine on the Pulmonary Vascular Diseases in Interstitial Lung Disease: Immunologic Effects, and Virus Interplay. Biomedicines 2022; 10:biomedicines10061290. [PMID: 35740313 PMCID: PMC9219797 DOI: 10.3390/biomedicines10061290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/05/2023] Open
Abstract
To investigate the effects of hydroxychloroquine (HCQ) drug use on the risk of pulmonary vascular disease (PVD) in an interstitial lung disease cohort (ILD cohort, ILD+ virus infection), we retrospectively enrolled the ILD cohort with HCQ (HCQ users, N = 4703) and the ILD cohort without HCQ (non-HCQ users, N = 4703) by time-dependence after propensity score matching. Cox models were used to analyze the risk of PVD. We calculated the adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs) for PVD after adjusting for sex, age, comorbidities, index date and immunosuppressants, such as steroids, etc. Compared with the HCQ nonusers, in HCQ users, the aHRs (95% CIs) for PVD were (2.24 (1.42, 3.54)), and the women’s aHRs for PVD were (2.54, (1.49, 4.35)). The aHRs based on the days of HCQ use for PVD of 28−30 days, 31−120 days, and >120 days were (1.27 (0.81, 1.99)), (3.00 (1.81, 4.87)) and (3.83 (2.46, 5.97)), respectively. The medium or long-term use of HCQ or young women receiving HCQ were associated with a higher aHR for PVD in the ILD cohort. These findings indicated interplay of the primary immunologic effect of ILD, comorbidities, women, age and virus in the HCQ users.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Family Medicine, Geriatric Medicine, Chest Medicine and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan;
- College of Medicine, China Medical University, Taichung 406040, Taiwan; (C.-L.L.); (C.Y.H.)
| | - Shih-Hueh Syue
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan; (S.-H.S.); (Y.-F.S.); (Y.-T.Y.); (Y.-C.Z.)
| | - Yi-Fun Sun
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan; (S.-H.S.); (Y.-F.S.); (Y.-T.Y.); (Y.-C.Z.)
| | - Yi-Ting Yeh
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan; (S.-H.S.); (Y.-F.S.); (Y.-T.Y.); (Y.-C.Z.)
| | - Ya-Chi Zheng
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan; (S.-H.S.); (Y.-F.S.); (Y.-T.Y.); (Y.-C.Z.)
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung 406040, Taiwan; (C.-L.L.); (C.Y.H.)
- Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
| | - Chung Y. Hsu
- College of Medicine, China Medical University, Taichung 406040, Taiwan; (C.-L.L.); (C.Y.H.)
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 406040, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
- Correspondence: or ; Tel.: +886-4-22052121
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Yang YS, Chen HH, Huang CN, Hsu CY, Hu KC, Kao CH. GLP-1RAs for Ischemic Stroke Prevention in Patients With Type 2 Diabetes Without Established Atherosclerotic Cardiovascular Disease. Diabetes Care 2022; 45:1184-1192. [PMID: 35275992 DOI: 10.2337/dc21-1993] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/24/2021] [Accepted: 02/11/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assessed the effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on ischemic stroke prevention in the Asian population with type 2 diabetes (T2D) without established cardiovascular disease. RESEARCH DESIGN AND METHODS This retrospective cohort study examined data obtained from the Taiwan National Health Insurance Research Database for the period from 1998 to 2018. The follow-up ended upon the occurrence of hospitalization for ischemic stroke. The median follow-up period was 3 years. The effect of GLP-1RA exposure time on the development of hospitalization for ischemic stroke was assessed. RESULTS The GLP-1RA and non-GLP-1RA user groups both included 6,534 patients. Approximately 53% of the patients were women, and the mean age was 49 ± 12 years. The overall risk of ischemic stroke hospitalization for GLP-1RA users was not significantly lower than that for GLP-1RA nonusers (adjusted hazard ratio [HR] 0.69 [95% CI 0.47-1.00]; P = 0.0506), but GLP-1RA users with a >251-day supply during the study period had a significantly lower risk of ischemic stroke hospitalization than GLP-1RA nonusers (adjusted HR 0.28 [95% CI 0.11-0.71]). Higher cumulative dose of GLP-1 RAs (>1,784 mg) was associated with significantly lower risk of ischemic stroke hospitalization. The subgroup analyses defined by various baseline features did not reveal significant differences in the observed effect of GLP-1RAs. CONCLUSIONS Longer use and higher dose of GLP-1 RAs were associated with a decreased risk of hospitalization for ischemic stroke among Asian patients with T2D who did not have established atherosclerotic cardiovascular diseases, but who did have dyslipidemia or hypertension.
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Affiliation(s)
- Yi-Sun Yang
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Hsin-Hung Chen
- School of Medicine, Institute of Medicine and Public Health, Chung Shan Medical University, Taichung, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan.,Chung Sheng Clinic, Nantou, Taiwan
| | - Chien-Ning Huang
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Kai-Chieh Hu
- Management Office for Health Data, China Medical University Hospital, Taichung.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung
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Yang CH, Lin YS, Ou YC, Weng WC, Huang LH, Lu CH, Hsu CY, Tung MC. Short-term stretched penile length analysis for subsequent erectile dysfunction after robotic-assisted radical prostatectomy with bilateral neurovascular bundle preservation. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.360] [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: 11/15/2022]
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Chen CH, Tsai MK, Lee JH, Lin RT, Hsu CY, Wen C, Wu X, Chu TW, Wen CP. "Sugar-Sweetened Beverages" Is an Independent Risk From Pancreatic Cancer: Based on Half a Million Asian Cohort Followed for 25 Years. Front Oncol 2022; 12:835901. [PMID: 35463371 PMCID: PMC9022008 DOI: 10.3389/fonc.2022.835901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Abstract
Although the link between sugar-sweetened beverages (SSB) and pancreatic cancer has been suggested for its insulin-stimulating connection, most epidemiological studies showed inconclusive relationship. Whether the result was limited by sample size is explored. This prospective study followed 491,929 adults, consisting of 235,427 men and 256,502 women (mean age: 39.9, standard deviation: 13.2), from a health surveillance program and there were 523 pancreatic cancer deaths between 1994 and 2017. The individual identification numbers of the cohort were matched with the National Death file for mortality, and Cox models were used to assess the risk. The amount of SSB intake was recorded based on the average consumption in the month before interview by a structured questionnaire. We classified the amount of SSB intake into 4 categories: 0–<0.5 serving/day, ≥0.5–<1 serving per day, ≥1–<2 servings per day, and ≥2 servings per day. One serving was defined as equivalent to 12 oz and contained 35 g added sugar. We used the age and the variables at cohort enrolment as the reported risks of pancreatic cancers. The cohort was divided into 3 age groups, 20–39, 40–59, and ≥60. We found young people (age <40) had higher prevalence and frequency of sugar-sweetened beverages than the elderly. Those consuming 2 servings/day had a 50% increase in pancreatic cancer mortality (HR = 1.55, 95% CI: 1.08–2.24) for the total cohort, but a 3-fold increase (HR: 3.09, 95% CI: 1.44–6.62) for the young. The risk started at 1 serving every other day, with a dose–response relationship. The association of SSB intake of ≥2 servings/day with pancreatic cancer mortality among the total cohort remained significant after excluding those who smoke or have diabetes (HR: 2.12, 97% CI: 1.26–3.57), are obese (HR: 1.57, 95% CI: 1.08–2.30), have hypertension (HR: 1.90, 95% CI: 1.20–3.00), or excluding who died within 3 years after enrollment (HR: 1.67, 95% CI: 1.15–2.45). Risks remained in the sensitivity analyses, implying its independent nature. We concluded that frequent drinking of SSB increased pancreatic cancer in adults, with highest risk among young people.
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Affiliation(s)
- Chien Hua Chen
- Digestive Disease Center, Changbing Show-Chwan Memorial Hospital, Lukang, Taiwan.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan
| | - Min Kuang Tsai
- Institue of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - June Han Lee
- Institue of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ro-Ting Lin
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Christopher Wen
- Long Beach VAMC Hospital, University of Irvine Medical Center, Irvine, CA, United States
| | - Xifeng Wu
- Center for Biostatistics, Bioinformatics and Big Data, The Second Affiliated Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.,National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China
| | - Ta-Wei Chu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taipei MJ Health Screening Center, Taipei, Taiwan
| | - Chi Pang Wen
- Institue of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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Hsu CY, Lai JN, Kung WM, Hung CH, Yip HT, Chang YC, Wei CY. Nationwide Prevalence and Outcomes of Long-Term Nasogastric Tube Placement in Adults. Nutrients 2022; 14:nu14091748. [PMID: 35565713 PMCID: PMC9102306 DOI: 10.3390/nu14091748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/05/2023] Open
Abstract
Tube feeding (TF) is commonly used for patients with severe swallowing disturbance, and patients with chronic dysphagia are often provided with a long-term nasogastric tube (NGT). However, nationwide epidemiological data on long-term NGT placement are limited. The present study identified the prevalence and outcomes of patients with long-term NGT placement in Taiwan. Data were obtained from the Longitudinal Health Insurance Database. Patients with NGT placement for more than 3 months between 2000 and 2012 were enrolled in this cohort study. An NGT cohort of 2754 patients was compared with 11,016 controls matched for age, sex, residential area, and comorbidities. The prevalence rate of long-term NGT reached 0.063% in 2005 and then remained stable at 0.05-0.06%. The major causes of NGT placement were stroke (44%), cancer (16%), head injury (14%), and dementia (12%). Men (63%) were more likely to have long-term NGT placement than women (37%). The adjusted hazard ratios were 28.1 (95% CI = 26.0, 30.3) for acute and chronic respiratory infections; 26.8 (95% CI = 24.1, 29.8) for pneumonia, 8.84 (95% CI = 7.87, 9.93) for diseases of the esophagus, stomach, and duodenum; and 7.5 (95% CI = 14.7, 20.8) for mortality. Patients with NGT placement for more than 6 months had a higher odds ratio (1.58, 95% CI = 1.13, 2.20) of pneumonia than those with NGT placement for less than 6 months. Only 13% and 0.62% of the patients underwent rehabilitation therapy and percutaneous endoscopic gastrostomy, respectively. Long-term NGT use was associated with a higher risk of comorbidities and mortality. Stroke was the main illness contributing to long-term NGT use. Further interventions are necessary to improve the negative effects of long-term TF.
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Affiliation(s)
- Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40402, Taiwan;
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan;
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan;
| | - Chao-Hsien Hung
- Department of Neurology, Feng Yuan Hospital, Taichung 42055, Taiwan;
| | - Hei-Tung Yip
- Management Office for Health Data, Clinical Trial Center, China Medical University Hospital, Taichung 40447, Taiwan;
- College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yu-Chen Chang
- Show Chwan International Dementia and Movement Disorder Center, Chang Bing Show Chwan Memorial Hospital, Changhua County 50544, Taiwan;
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan;
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County 50544, Taiwan
- Correspondence: ; Tel.: +886-04-7813888
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31
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Chen PC, Sung FC, Mou CH, Chen CW, Tsai SP, Hsieh DHP, Hsu CY. A cohort study evaluating the risk of stroke associated with long-term exposure to ambient fine particulate matter in Taiwan. Environ Health 2022; 21:43. [PMID: 35439956 PMCID: PMC9017007 DOI: 10.1186/s12940-022-00854-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/11/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Evidences have shown that the stroke risk associated with long-term exposure to particulate matter with an aerodynamic diameter of ≤2.5 μm (PM2.5) varies among people in North America, Europe and Asia, but studies in Asia rarely evaluated the association by stroke type. We examined whether long-term exposure to PM2.5 is associated with developing all strokes, ischemic stroke and hemorrhagic stroke. METHODS The retrospective cohort study consisted of 1,362,284 adults identified from beneficiaries of a universal health insurance program in 2011. We obtained data on air pollutants and meteorological measurements from air quality monitoring stations across Taiwan in 2010-2015. Annual mean levels of all environmental measurements in residing areas were calculated and assigned to cohort members. We used Cox proportional hazards models to estimate hazard ratio (HR) and 95% confidence interval (CI) of developing stroke associated with 1-year mean levels of PM2.5 at baseline in 2010, and yearly mean levels from 2010 to 2015 as the time-varying exposure, adjusting for age, sex, income and urbanization level. RESULTS During a median follow-up time of 6.0 years, 12,942 persons developed strokes, 9919 (76.6%) were ischemic. The adjusted HRs (95% CIs) per interquartile range increase in baseline 1-year mean PM2.5 were 1.03 (1.00-1.06) for all stroke, 1.06 (1.02-1.09) for ischemic stroke, and 0.95 (0.89-1.10) for hemorrhagic stroke. The concentration-response curves estimated in the models with and without additional adjustments for other environmental measurements showed a positively linear association between baseline 1-year mean PM2.5 and ischemic stroke at concentrations greater than 30 μg/m3, under which no evidence of association was observed. There was an indication of an inverse association between PM2.5 and hemorrhagic stroke, but the association no longer existed after controlling for nitrogen dioxide or ozone. We found similar shape of the concentration-response association in the Cox regression models with time-varying PM2.5 exposures. CONCLUSION Long-term exposure to PM2.5 might be associated with increased risk of developing ischemic stroke. The association with high PM2.5 concentrations remained significant after adjustment for other environmental factors.
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Affiliation(s)
- Pei-Chun Chen
- Department of Public Health, China Medical University College of Public Health, 100 Jingmao Rd Sec. 1, Taichung, 406040, Taiwan.
| | - Fung-Chang Sung
- Department of Health Services Administration, China Medical University College of Public Health, 100 Jingmao Rd Sec. 1, Taichung, 406040, Taiwan.
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan.
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chao W Chen
- University of Maryland Global Campus, Adelphi, MD, USA
| | - Shan P Tsai
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - Dennis H P Hsieh
- Department of Environmental Toxicology, University of California, Davis, CA, USA
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University College of Public Health, Taichung, Taiwan
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Chen SW, Lin HJ, Tsai SCS, Lin CL, Hsu CY, Hsieh TL, Chen CM, Chang KH. Exposure to Air Pollutants Increases the Risk of Chronic Rhinosinusitis in Taiwan Residents. Toxics 2022; 10:toxics10040173. [PMID: 35448434 PMCID: PMC9031629 DOI: 10.3390/toxics10040173] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 01/25/2023]
Abstract
Air pollution triggers a tissue-specific inflammatory response. However, studies on the association between exposure to air pollutants and chronic rhinosinusitis (CRS) risk remain limited. Thus, we conducted this nationwide study to define the association between air pollution and CRS. We used the Longitudinal Health Insurance Database (LHID) and Taiwan Air Quality-Monitoring Database (TAQMD) to conduct a population-based cohort study. Study participants were recruited from the LHID, a data subset of the National Health Insurance Research Database that randomly sampled one million individuals. TAQMD has been an air pollutant database since 1998. In univariate and multivariate Cox proportional hazards regression models, adjusted hazard ratios (aHRs) and 95% CIs of CRS in five air pollutants were accounted. We adjusted for age, sex, urbanization level, insurance fee, comorbidities, and pollutant levels in the multivariate model. The total number of participants enrolled in this study was 160,504. The average age was 40.46 ± 14.62 years; males constituted 43.8% of the total participants. The percentages of alcoholism, tobacco dependence, and COPD were 1.5%, 2.8%, and 28.3%, respectively. After adjustment for age, sex, urbanization level, insurance fee, and comorbidities, the highest levels of air pollutants, including PM2.5 (aHR = 1.14, 95% CI = 1.06–1.22), NO2 (aHR = 1.07, 95% CI = 1.00–1.15), and PM10 (aHR = 1.13, 95% CI = 1.05–1.21) had a significantly greater CRS risk; we selected the lower concentration as the reference but did not correlate with CO. We found a significantly increased risk of CRS in residents with air pollutant exposure.
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Affiliation(s)
- Shih-Wei Chen
- Department of Life Sciences and Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan; (H.-J.L.); (S.C.-S.T.); (T.-L.H.)
| | - Han-Jie Lin
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan; (H.-J.L.); (S.C.-S.T.); (T.-L.H.)
| | - Stella Chin-Shaw Tsai
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan; (H.-J.L.); (S.C.-S.T.); (T.-L.H.)
- Rong Hsing Research Center for Translational Medicine, College of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan;
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan;
| | - Tsai-Ling Hsieh
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan; (H.-J.L.); (S.C.-S.T.); (T.-L.H.)
- Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences and Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Rong Hsing Research Center for Translational Medicine, College of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
- The iEGG and Animal Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (K.-H.C.); Tel.: +886-932-971-386 (K.-H.C.)
| | - Kuang-Hsi Chang
- Department of Life Sciences and Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Center for General Education, China Medical University, Taichung 404, Taiwan
- General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Correspondence: (C.-M.C.); (K.-H.C.); Tel.: +886-932-971-386 (K.-H.C.)
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Hsieh WC, Chen CH, Cheng YC, Yu TS, Hsu CY, Ke DS, Lin CM, Hsu CY. The Risk of Herpes Zoster in Women with Polycystic Ovary Syndrome: A Retrospective Population-Based Study. Int J Environ Res Public Health 2022; 19:ijerph19053094. [PMID: 35270787 PMCID: PMC8909925 DOI: 10.3390/ijerph19053094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022]
Abstract
Background: The association between polycystic ovary syndrome (PCOS) and the risk of herpes zoster (HZ) remains unclear. This study investigated the risk of HZ in women with PCOS. Methods: This study used data from the Longitudinal Generation Tracking Database (LGTD 2005) which contains the information of 2 million randomly selected from National Health Insurance beneficiaries. Patients who received a diagnosis of PCOS between 2000 and 2017 were included in the PCOS cohort. Patients who were not diagnosed as having PCOS were randomly selected from the LGTD 2005 and included in the control cohort. Patients who were aged <20 years and had a history of HZ before the index date were excluded. Patients who were in both the cohorts were matched at a ratio of 1:1 through propensity score matching based on age, comorbidities, and medication. The primary outcome was the diagnosis of HZ. Results: A total of 20,142 patients were included in each case and control cohorts. The incidence rates of HZ in the PCOS and control cohorts were 3.92 and 3.17 per 1000 person-years, respectively. The PCOS cohort had a significantly higher risk of HZ than did the control cohort (adjusted hazard ratios [aHR] = 1.26). Among the patients aged 30−39 years, those with PCOS had a significantly higher risk of HZ than did those without PCOS (aHR = 1.31). Among the patients without any comorbidities, those with PCOS had a significantly higher risk of HZ (aHR = 1.26) than did those without PCOS. Conclusion: PCOS is associated with the risk of HZ, especially in young women. The risk of HZ should be addressed while treating patients with PCOS. An HZ vaccine is recommended for these patients.
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Affiliation(s)
- Wen-Che Hsieh
- Department of Chinese Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan;
| | - Chia-Hung Chen
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan; (C.-H.C.); (Y.-C.C.)
- Department of Medical Imaging, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan
| | - Yung-Chi Cheng
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan; (C.-H.C.); (Y.-C.C.)
- Department of Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan
| | - Teng-Shun Yu
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan;
- College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan;
| | - Der-Shin Ke
- Department of Neurology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan;
| | - Chih-Ming Lin
- Department of Laboratory Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan
- Correspondence: (C.-M.L.); (C.-Y.H.)
| | - Chao-Yu Hsu
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan; (C.-H.C.); (Y.-C.C.)
- Department of Optometry/Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung 406, Taiwan
- Center for General Education, National Taichung University of Science and Technology, Taichung 404, Taiwan
- Department of General Education, National Chin-Yi University of Technology, Taichung 411, Taiwan
- Correspondence: (C.-M.L.); (C.-Y.H.)
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Ko YP, Chen PY, Hsu CY, Chang R, Hu KC, Chiu LT, Hung YM, Mar GY. Scabies Infestation and Risk of Acute Myocardial Infarction: A Population-Based Cohort Study. J Pers Med 2022; 12:jpm12020229. [PMID: 35207717 PMCID: PMC8880438 DOI: 10.3390/jpm12020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Scabies is an infectious inflammatory skin disease. Cytokine-mediated inflammatory responses may be one of the pathological mechanisms underlying myocardial infarction. Objective: We explore the association between scabies and subsequent acute myocardial infarction (AMI) and all-cause mortality; Methods: We conducted a nationwide population-based study using data from the National Health Insurance Research Database (NHIRD) in Taiwan. Patients with scabies (n = 30,184) and 120,739 controls without scabies were included. The primary outcomes were incidental AMI and all-cause mortality. Using Cox proportional-hazards regression analysis, we estimated the risk of acute myocardial infarction for the study cohort; Results: The mean age of the study cohort was 51.81 ± 19.89 years. The adjusted sub-distribution hazard ratios (aSHRs) of AMI were 1.214 (95% CI, 1.068–1.381) after adjusting for demographic characteristics, income, OPD utility frequency, days in hospital, co-morbidities, and medication. The adjusted hazard ratio (aHR) of all-cause mortality after adjusting for age, gender, income, OPD utility frequency, days in hospital, co-morbidities, co-medication, and urbanization was 1.612 (95% CI, 1.557–1.669). Conclusions: Our study showed that patients with scabies infestations were at higher risk for subsequent AMI and all-cause mortality.
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Affiliation(s)
- Yao-Ping Ko
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan; (Y.-P.K.); (R.C.)
| | - Pei-Yun Chen
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
- Department of Physical Medicine and Rehabilitation, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan;
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan; (Y.-P.K.); (R.C.)
| | - Kai-Chieh Hu
- Management Office for Health Data, China Medical University Hospital, Taichung 40402, Taiwan; (K.-C.H.); (L.-T.C.)
- College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Lu-Ting Chiu
- Management Office for Health Data, China Medical University Hospital, Taichung 40402, Taiwan; (K.-C.H.); (L.-T.C.)
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan;
- College of Health and Nursing, Meiho University, Pingtung 91202, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Guang-Yuan Mar
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan;
- Correspondence: (G.-Y.M.); Tel.: +886-07-5533522
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Wen CP, Lee YC, Sun YT, Huang CY, Tsai CH, Chen PL, Chang WL, Yeh PY, Wei CY, Tsai MJ, Sun Y, Lin CH, Lee JT, Lai TC, Lien LM, Lin MC, Lin CL, Lee JH, Wang HK, Hsu CY. Low-Density Lipoprotein Cholesterol and Mortality in Patients With Intracerebral Hemorrhage in Taiwan. Front Neurol 2022; 12:793471. [PMID: 35113980 PMCID: PMC8802633 DOI: 10.3389/fneur.2021.793471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: Lower serum low-density lipoprotein cholesterol (LDL-C) levels are associated with increased intracerebral hemorrhage (ICH) risk. However, reverse causality and residual confounding has not attracted public attention. Therefore, we assessed whether people with LDL-C have increased risk of mortality adjusting for potential confounders using two large Taiwan cohorts. Methods: The Mei-Jhao (MJ) cohort has 414,372 adults participating in a medical screening program with 378 ICH deaths within 15 years of follow-up (1994–2008). Cox proportional hazards regressions estimated hazard death ratios according to LDL-C levels. We identified 4,606 ICH patients from the Taiwan Stroke Registry (TSR) and analyzed the impact of LDL-C on 3-month mortality. Results: Low cholesterol (LDL-C <100 mg/dL), found in 1/4 of the MJ cohort, was highly prevalent (36%) among young adults (age 20–39). There was a graded relationship between cholesterol and mortality for ICH [Hazard ratio, 1.56; 95% confidence interval (CI), 1.13–2.16]. Compared with patients with an LDL-C of 110–129 mg/dL in TSR, the risk for mortality was 1.84 (95% CI, 1.28–2.63) with an LDL-C of <100 mg/dL. Conclusion: Lower serum LDL-C level independently predicts higher mortality after acute ICH. While its causative role may vary, low cholesterol may pose potential harms in Taiwan.
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Affiliation(s)
- Chi-Pang Wen
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Yi-Che Lee
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Nephrology, E-Da Hospital, Kaohsiung, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Yuan Huang
- Department of Surgery, Faculty of Neurosurgical Service, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chon-Haw Tsai
- Division of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Lun Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Yen Yeh
- Department of Neurology, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Jun Tsai
- Department of Neurology, Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Chih-Hao Lin
- Department of Neurology, Lin Shin Hospital, Taichung, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, New Taipei City, Taiwan
| | - Ta-Chang Lai
- Department of Neurology, Cheng Hsin General Hospital, New Taipei City, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho Su Memorial Hospital, New Taipei City, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - June-Han Lee
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Hao-Kuang Wang
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chung Y Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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Yogendrakumar V, Wu TY, Churilov L, Tatlisumak T, Strbian D, Jeng JS, Kleinig TJ, Sharma G, Campbell BCV, Zhao H, Hsu CY, Meretoja A, Donnan GA, Davis SM, Yassi N. Does tranexamic acid affect intraventricular hemorrhage growth in acute ICH? An analysis of the STOP-AUST trial. Eur Stroke J 2022; 7:15-19. [DOI: 10.1177/23969873211072402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Trials of tranexamic acid (TXA) in acute intracerebral hemorrhage (ICH) have focused on the imaging outcomes of intraparenchymal hematoma growth. However, intraventricular hemorrhage (IVH) growth is also strongly associated with outcome after ICH. Revised definitions of hematoma expansion incorporating IVH growth have been proposed. Aims We sought to evaluate the effect of TXA on IVH growth. Methods We analyzed data from the STOP-AUST trial, a prospective randomized trial comparing TXA to placebo in ICH patients presenting ≤ 4.5 h from symptom onset with a CT-angiography spot sign. New IVH development at follow-up, any interval IVH growth, and IVH growth ≥ 1 mL were compared between the treatment groups using logistic regression. The treatment effect of TXA against placebo using conventional (> 6 mL or 33%), and revised definitions of hematoma expansion (> 6 mL or 33% or IVH expansion ≥ 1 mL, > 6 mL or 33%, or any IVH expansion, and > 6 mL or 33% or new IVH development) were also assessed. Treatment effects were adjusted for baseline ICH volume. Results The analysis population consisted of 99 patients (50 placebo, 49 TXA). New IVH development at follow-up was observed in 6/49 (12%) who received TXA and 13/50 (26%) who received placebo (aOR: 0.38 [95% CI: 0.13–1.13]). Any interval IVH growth was observed in 12/49 (25%) who received TXA versus 26/50 (32%) receiving placebo (aOR: 0.69 [95% CI: 0.28–1.66]). IVH growth ≥ 1 mL did not differ between the two groups. Using revised definitions of hematoma expansion, no significant difference in treatment effect was observed between TXA and placebo. Conclusions IVH may be attenuated by TXA following ICH; however, studies with larger cohorts are required to investigate this further. Registration http://www.clinicaltrials.gov ; Unique identifier: NCT01702636.
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Affiliation(s)
- Vignan Yogendrakumar
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Leonid Churilov
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Gagan Sharma
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Bruce CV Campbell
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Henry Zhao
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Chung Y Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Atte Meretoja
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Geoffrey A Donnan
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Stephen M Davis
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Nawaf Yassi
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
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37
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Wang IK, Yen TH, Chen CH, Hsu SP, Sun Y, Lien LM, Chang WL, Lai TC, Chen PL, Chen CC, Huang PH, Lin CH, Su YC, Lin MC, Li CY, Sung FC, Hsu CY. Intravenous tissue plasminogen activator for acute ischemic stroke in patients with renal dysfunction. QJM 2022; 114:848-856. [PMID: 32770252 DOI: 10.1093/qjmed/hcaa237] [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] [Received: 05/14/2020] [Revised: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study used the Taiwan Stroke Registry data to evaluate the efficacy and safety of intravenous tissue plasminogen activator (tPA) in treating acute ischemic stroke in patients with renal dysfunction. DESIGN We identified 3525 ischemic stroke patients and classified them into two groups according to the estimated glomerular filtration rate (eGFR) at the emergency department: ≥60, and <60 ml/min/1.73 m2 or on dialysis and by the propensity score from August 2006 to May 2015. The odds ratio of poor functional outcome (modified Rankin Scale ≥2) was calculated for patients with tPA treatment (N = 705), compared to those without tPA treatment (N = 2820), by eGFR levels, at 1, 3 and 6 months after ischemic stroke. We also evaluated the risks of intracerebral hemorrhage, upper gastrointestinal bleeding, mortality, between the two groups by eGFR levels. RESULTS Among patients with eGFR levels of <60 ml/min/1.73 m2, tPA therapy reduced the odds ratio of poor functional outcome to 0.60 (95% confidence interval = 0.42-0.87) at 6 months after ischemic stroke. The tPA therapy was not associated with increased overall risk of upper gastrointestinal bleeding, but with increased risk of intracerebral hemorrhage. The low eGFR was not a significant risk factor of intracerebral hemorrhage among ischemic stroke patients receiving tPA treatment. CONCLUSIONS tPA for acute ischemic stroke could improve functional outcomes without increasing the risks of upper gastrointestinal bleeding for patients with or without renal dysfunction. The low eGFR was not a significant risk factor for intracerebral hemorrhage among patients receiving tPA treatment.
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Affiliation(s)
- I-K Wang
- From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - T-H Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - C-H Chen
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Stroke Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - S-P Hsu
- Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Y Sun
- Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - L-M Lien
- Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - W-L Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - T-C Lai
- Division of Neurology Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - P-L Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-C Chen
- Department of Neurology, St Martin De Porres Hospital, Chiayi City, Taiwan
| | - P-H Huang
- Department of Neurology, Cathay General Hospital, Taipei, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - C-H Lin
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Y-C Su
- Management Office for Health Data
| | - M-C Lin
- Management Office for Health Data
| | - C-Y Li
- From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - F-C Sung
- Department of Health Services Administration, China Medical University College of Public Health, Taichung 404, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Lioufeng Road, Wufeng, Taichung, Taiwan
| | - C Y Hsu
- From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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38
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Qureshi AI, Huang W, Lobanova I, Chandrasekaran PN, Hanley DF, Hsu CY, Martin RH, Steiner T, Suarez JI, Yamamoto H, Toyoda K. Effect of Moderate and Severe Persistent Hyperglycemia on Outcomes in Patients With Intracerebral Hemorrhage. Stroke 2021; 53:1226-1234. [PMID: 34844422 DOI: 10.1161/strokeaha.121.034928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE We evaluated the effect of persistent hyperglycemia on outcomes in 1000 patients with intracerebral hemorrhage enrolled within 4.5 hours of symptom onset. METHODS We defined moderate and severe hyperglycemia based on serum glucose levels ≥140 mg/dL-<180 and ≥180 mg/dL, respectively, measured at baseline, 24, 48, and 72 hours. Persistent hyperglycemia was defined by 2 consecutive (24 hours apart) serum glucose levels. We evaluated the relationship between moderate and severe hyperglycemia and death or disability (defined by modified Rankin Scale score of 4-6) at 90 days in the overall cohort and in groups defined by preexisting diabetes. RESULTS In the multivariate analysis, both moderate (odds ratio, 1.8 [95% CI, 1.1-2.8]) and severe (odds ratio, 1.8 [95% CI, 1.2-2.7]) hyperglycemia were associated with higher 90-day death or disability after adjusting for Glasgow Coma Scale score, hematoma volume, presence or absence of intraventricular hemorrhage, hyperlipidemia, cigarette smoking, and hypertension (no interaction between hyperglycemia and preexisting diabetes, P=0.996). Among the patients without preexisting diabetes, both moderate (odds ratio, 1.8 [95% CI, 1.0-3.2]) and severe (odds ratio, 2.0 [95% CI, 1.1-3.7]) hyperglycemia were associated with 90-day death or disability after adjusting for above mentioned potential confounders. Among the patients with preexisting diabetes, moderate and severe hyperglycemia were not associated with 90-day death or disability. CONCLUSIONS Persistent hyperglycemia, either moderate or severe, increased the risk of death or disability in nondiabetic patients with intracerebral hemorrhage. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01176565.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, St Cloud, MN (A.I.Q., W.H., I.L.).,Department of Neurology, University of Missouri, Columbia (A.I.Q., W.H., I.L., P.N.C.)
| | - Wei Huang
- Zeenat Qureshi Stroke Institute, St Cloud, MN (A.I.Q., W.H., I.L.).,Department of Neurology, University of Missouri, Columbia (A.I.Q., W.H., I.L., P.N.C.)
| | - Iryna Lobanova
- Zeenat Qureshi Stroke Institute, St Cloud, MN (A.I.Q., W.H., I.L.).,Department of Neurology, University of Missouri, Columbia (A.I.Q., W.H., I.L., P.N.C.)
| | | | - Daniel F Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD. (D.F.H.)
| | - Chung Y Hsu
- Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan (C.Y.H.)
| | - Renee H Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (R.H.M.)
| | - Thorsten Steiner
- Department of Neurology, University of Heidelberg, Germany (T.S.)
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. (J.I.S.)
| | - Haruko Yamamoto
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan. (H.Y.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. (K.T.)
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Yassi N, Zhao H, Churilov L, Campbell BCV, Wu T, Ma H, Cheung A, Kleinig T, Brown H, Choi P, Jeng JS, Ranta A, Wang HK, Cloud GC, Grimley R, Shah D, Spratt N, Cho DY, Mahawish K, Sanders L, Worthington J, Clissold B, Meretoja A, Yogendrakumar V, Ton MD, Dang DP, Phuong NTM, Nguyen HT, Hsu CY, Sharma G, Mitchell PJ, Yan B, Parsons MW, Levi C, Donnan GA, Davis SM. Tranexamic acid for intracerebral haemorrhage within 2 hours of onset: protocol of a phase II randomised placebo-controlled double-blind multicentre trial. Stroke Vasc Neurol 2021; 7:158-165. [PMID: 34848566 PMCID: PMC9067256 DOI: 10.1136/svn-2021-001070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Rationale Haematoma growth is common early after intracerebral haemorrhage (ICH), and is a key determinant of outcome. Tranexamic acid, a widely available antifibrinolytic agent with an excellent safety profile, may reduce haematoma growth. Methods and design Stopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units (STOP-MSU) is a phase II double-blind, randomised, placebo-controlled, multicentre, international investigator-led clinical trial, conducted within the estimand statistical framework. Hypothesis In patients with spontaneous ICH, treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with placebo. Sample size estimates A sample size of 180 patients (90 in each arm) would be required to detect an absolute difference in the primary outcome of 20% (placebo 39% vs treatment 19%) under a two-tailed significance level of 0.05. An adaptive sample size re-estimation based on the outcomes of 144 patients will allow a possible increase to a prespecified maximum of 326 patients. Intervention Participants will receive 1 g intravenous tranexamic acid over 10 min, followed by 1 g intravenous tranexamic acid over 8 hours; or matching placebo. Primary efficacy measure The primary efficacy measure is the proportion of patients with haematoma growth by 24±6 hours, defined as either ≥33% relative increase or ≥6 mL absolute increase in haematoma volume between baseline and follow-up CT scan. Discussion We describe the rationale and protocol of STOP-MSU, a phase II trial of tranexamic acid in patients with ICH within 2 hours from onset, based in participating mobile stroke units and emergency departments.
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Affiliation(s)
- Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia .,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Henry Zhao
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Teddy Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Henry Ma
- Department of Neurology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Andrew Cheung
- Department of Interventional Neuroradiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Helen Brown
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Philip Choi
- Department of Neurology, Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia
| | - Jiann-Shing Jeng
- Stroke Centre and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Annemarei Ranta
- Department of Medicine, Dunedin School of Medicine, University of Otago, Wellington, New Zealand
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-Da Hospital, Yanchao, Kaohsiung, Taiwan
| | - Geoffrey C Cloud
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Clinical Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Rohan Grimley
- Department of Medicine, Sunshine Coast University Hospital, Nambour, Queensland, Australia
| | - Darshan Shah
- Department of Neurology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Neil Spratt
- Department of Neurology, John Hunter Hospital, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Der-Yang Cho
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Karim Mahawish
- Department of Internal Medicine, Palmerston North Hospital, Palmerston North, New Zealand
| | - Lauren Sanders
- Department of Neurology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - John Worthington
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ben Clissold
- Department of Neurology, Geelong Hospital, Geelong, Victoria, Australia
| | - Atte Meretoja
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Vignan Yogendrakumar
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Mai Duy Ton
- Stroke Center, Bach Mai Hospital, Hanoi, Viet Nam
| | - Duc Phuc Dang
- Stroke Department, 103 Military Hospital, Hanoi, Hanoi, Viet Nam
| | | | - Huy-Thang Nguyen
- Department of Cerebrovascular Disease, 115 Hospital, Ho Chi Minh City, Viet Nam
| | - Chung Y Hsu
- Department of Neurology, China Medical University, Taichung, Taiwan
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Bernard Yan
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark W Parsons
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Liverpool Hospital, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Sydney, New South Wales, Australia
| | - Christopher Levi
- Department of Neurology, John Hunter Hospital, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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Kao YS, Hsu Y, Hsu CY. Radiotherapy Increases the Incidence of Herpes Zoster in Oral Cavity Cancer Patients - a National Population-based Cohort Study. In Vivo 2021; 35:3547-3553. [PMID: 34697193 DOI: 10.21873/invivo.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Oral cavity cancer is a major health problem worldwide. The herpes zoster vaccine is an effective method to protect against herpes zoster infection. In this study we aimed to determine the relationship between herpes zoster and oral cavity cancer. PATIENTS AND METHODS The Longitudinal Generation Tracking Database in Taiwan was used to select oral and non-oral cavity cancer patients. The primary endpoint was herpes zoster. RESULTS We included 3131 oral cavity cancer patients and 3131 non-oral cavity cancer patients. Patients with oral cavity cancer [adjusted hazard ratio (HR)=1.66, 95% confidence interval (CI)=1.27-2.16] had a significantly higher risk of herpes zoster compared to the control group. The oral cavity patients who received radiotherapy (adjusted HR=1.79, 95%CI=1.12-2.86) had a significantly higher risk of herpes zoster compared to the oral cavity patients who did not receive radiotherapy. CONCLUSION Radiotherapy increases the incidence of herpes zoster infection in oral cavity cancer patients.
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Affiliation(s)
- Yung-Shuo Kao
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan, R.O.C.;
| | - Yen Hsu
- Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C
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41
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Hu WS, Lin CL, Hsu CY. Effect of acupuncture on atrial fibrillation stratified by CHA2DS2-VASc score-a nationwide cohort investigation. QJM 2021; 114:398-402. [PMID: 34014330 DOI: 10.1093/qjmed/hcab147] [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] [Received: 03/30/2021] [Revised: 05/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This research aimed to make statements regarding the reduction in atrial fibrillation (AF) risk due to acupuncture, stratified by CHA2DS2-VASc score. METHODS The Kaplan-Meier method was performed to calculate cumulative incidence of outcomes for each group, and the log-rank test were performed to compare differences between groups. Incidences and hazard ratios (HRs) were estimated by univariate Cox proportional hazards models, and adjusted HRs (aHRs) were estimated by multivariate Cox proportional hazards models including demographic covariates and comorbid status. RESULTS In CHA2DS2-VASc scores of 0-1, 2-3, 4-5 and >5, cases with acupuncture were all associated with decreased incidence of AF (aHR 0.46 with 95% CI 0.42-0.51, P < 0.001 in the CHA2DS2-VASc scores of 0-1; aHR 0.53 with 95% CI 0.50-0.57, P < 0.001 in the CHA2DS2-VASc scores of 2-3; aHR 0.56 with 95% CI 0.52-0.61, P < 0.001 in the CHA2DS2-VASc scores of 4-5; and aHR 0.64 with 95% CI 0.55-0.74, P < 0.001 in the CHA2DS2-VASc scores of >5). CONCLUSION Protective effect of acupuncture on AF was observed in this study, and the effect was more obvious for those with fewer comorbidities.
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Affiliation(s)
- W-S Hu
- From the School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung 40447, Taiwan
| | - C-L Lin
- Management Office for Health Data, China Medical University Hospital, 2, Yuh-Der Road, Taichung 40447, Taiwan
| | - C Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
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Ho TC, Chen YC, Lin CC, Tai HC, Wei CY, Yeh YH, Hsu CY. Reduced Risk of Atrial Fibrillation Following Cholecystectomy: A Nationwide Population-Based Study. Front Aging Neurosci 2021; 13:706815. [PMID: 34539379 PMCID: PMC8445074 DOI: 10.3389/fnagi.2021.706815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Gallstone disease (GD) is associated with a high risk of cardiovascular disease. However, it is unknown whether GD contributes to atrial fibrillation (AF). We aimed to investigate the association between GD and AF. Methods: We performed a population-based cohort study using data from the Taiwan National Health Insurance Research Database between 2001 and 2011. A GD cohort of 230,076 patients was compared with a control cohort consisting of an equal number of patients matched for age, sex, cardiovascular and gastrointestinal comorbidities. Results: In total, 5,992 (49.8/10,000 person-years) patients with GD and 5,804 (44.5/10,000 person-years) controls developed AF. GD increased AF risk with a hazard ratio (HR) of 1.20 [95% confidence interval (CI), 1.16-1.25]. In patients with GD but without cholecystectomy, the HR of AF reached 1.57 (95% CI = 1.50-1.63). After cholecystectomy, the HR of AF significantly decreased to 0.85 (95% CI = 0.81-0.90). Among the three age groups with GD (<45, 45-64, and ≥65 years), the adjusted HRs of AF were 1.59 (95% CI = 1.08-2.33), 1.31 (95% CI = 1.18-1.45), and 1.18 (95% CI = 1.13-1.22), respectively. Compared with patients with a CHA2DS2-VASc score equal to 0, the HRs of AF risk among total cohort patients and a score equal to 1, 2, 3, and ≥ 4 were 1.28 (95% CI = 1.15-1.43), 2.26 (95% CI = 2.00-2.56), 3.81 (95% CI = 3.35-4.34), and 5.09 (95% CI = 4.42-5.87), respectively. Conclusion: This population-based longitudinal follow-up study showed that patients with GD had an increased AF risk. Moreover, cholecystectomy was related to reduced AF risk. Cardiovascular checkups may be necessary for patients with GD, especially those who are young and have other typical risk factors.
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Affiliation(s)
- Tung Ching Ho
- Department of Cardiology, Chang Hua Hospital, Changhua County, Taiwan.,Department of Bioinformatics and Medical Engineering, College of Information and Electrical Engineering, Asia University, Taichung, Taiwan
| | - Yu-Ching Chen
- Department of Bioinformatics and Medical Engineering, College of Information and Electrical Engineering, Asia University, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hsu-Chih Tai
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan.,Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Yung-Hsiang Yeh
- Digestive Disease Center, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Liang CL, Chen HJ, Lee YC, Wu CC, Tsai CH, Chen PL, Chang WL, Yeh PY, Wei CY, Tsai MJ, Sun Y, Lin CH, Lee JT, Lai TC, Lien LM, Lin MC, Lin CL, Wang HK, Hsu CY. Smoking Status and Functional Outcomes in Young Stroke. Front Neurol 2021; 12:658582. [PMID: 34539539 PMCID: PMC8440842 DOI: 10.3389/fneur.2021.658582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Stroke in young adults is uncommon, and the etiologies and risk factors of stroke in young adults differ from those in older populations. Smoker's paradox is an unexpected favorable outcome, and age difference is used to explain the association between smoking and the favorable functional outcome. This study aimed to investigate the existence of this phenomenon in young stroke patients. Methods: We analyzed a total of 9,087 young stroke cases registered in the nationwide stroke registry system of Taiwan between 2006 and 2016. Smoking criteria included having a current history of smoking more than one cigarette per day for more than 6 months. After matching for sex and age, a Cox model was used to compare mortality and function outcomes between smokers and non-smokers. Results: Compared with the non-smoker group, smoking was associated with older age, higher comorbidities, and higher alcohol consumption. Patients who report smoking with National Institutes of Health Stroke Scale scores of 11-15 had a worse functional outcome (adjusted odds ratio, 0.81; 95% confidence interval, 0.76 - 0.87). Conclusion: Smokers had a higher risk of unfavorable functional outcomes at 3 months after stroke, and therefore, we continue to strongly advocate the importance of smoking cessation.
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Affiliation(s)
- Cheng-Loong Liang
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Han-Jung Chen
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Yi-Che Lee
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.,Department of Nephrology, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheng-Chun Wu
- Department of Nephrology, E-Da Hospital, Kaohsiung, Taiwan
| | - Chon-Haw Tsai
- Division of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Lun Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Yen Yeh
- Department of Neurology, St. Martin de Porres Hospital, Chiayi, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Jun Tsai
- Department of Neurology, Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei, Taiwan
| | - Chih-Hao Lin
- Department of Neurology, Lin Shin Hospital, Taichung, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan
| | - Ta-Chang Lai
- Department of Neurology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Hao-Kuang Wang
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chung Y Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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Toyoda K, Yoshimura S, Fukuda-Doi M, Qureshi AI, Martin RH, Palesch YY, Ihara M, Suarez JI, Okada Y, Hsu CY, Itabashi R, Wang Y, Yamagami H, Steiner T, Sakai N, Yoon BW, Inoue M, Minematsu K, Yamamoto H, Koga M. Intensive blood pressure lowering with nicardipine and outcomes after intracerebral hemorrhage: An individual participant data systematic review. Int J Stroke 2021; 17:494-505. [PMID: 34542358 DOI: 10.1177/17474930211044635] [Citation(s) in RCA: 4] [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: 11/16/2022]
Abstract
BACKGROUND AND AIMS Nicardipine has strong, rapidly acting antihypertensive activity. The effects of acute systolic blood pressure levels achieved with intravenous nicardipine after onset of intracerebral hemorrhage on clinical outcomes were determined. METHODS A systematic review and individual participant data analysis of articles before 1 October 2020 identified on PubMed were performed (PROSPERO: CRD42020213857). Prospective studies involving hyperacute intracerebral hemorrhage adults treated with intravenous nicardipine whose outcome was assessed using the modified Rankin Scale were eligible. Outcomes included death or disability at 90 days, defined as the modified Rankin Scale score of 4-6, and hematoma expansion, defined as an increase ≥6 mL from baseline to 24-h computed tomography. SUMMARY OF REVIEW Three studies met the eligibility criteria. For 1265 patients enrolled (age 62.6 ± 13.0 years, 484 women), death or disability occurred in 38.2% and hematoma expansion occurred in 17.4%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio (aOR) 1.12, 95% confidence interval (CI) 1.00-1.26 per 10 mmHg) and hematoma expansion (1.16, 1.02-1.32). Mean hourly systolic blood pressure from 1 h to any timepoint during the initial 24 h was positively associated with death or disability. Later achievement of systolic blood pressure to ≤140 mmHg increased the risk of death or disability (aOR 1.02, 95% CI 1.00-1.05 per hour). CONCLUSIONS Rapid lowering of systolic blood pressure by continuous administration of intravenous nicardipine during the initial 24 h in hyperacute intracerebral hemorrhage was associated with lower risks of hematoma expansion and 90-day death or disability without increasing serious adverse events.
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Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mayumi Fukuda-Doi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.,Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, USA
| | - Renee' Hebert Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Yuko Y Palesch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jose I Suarez
- Division of Neurosciences Critical Care, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Yasushi Okada
- Departments of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung
| | - Ryo Itabashi
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan
| | | | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Haruko Yamamoto
- Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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45
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Wang IK, Yu TM, Yen TH, Chiu LT, Lien LM, Sun Y, Wei CY, Hsu KC, Lai PC, Li CY, Sung FC, Hsu CY. Renal dysfunction is associated with lower odds of home discharge for patients with stroke. Postgrad Med 2021; 133:865-872. [PMID: 34351833 DOI: 10.1080/00325481.2021.1964198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Studies on the association of estimated glomerular filtration rate (eGFR) levels with hospital discharge disposition after stroke are limited with inconsistent results. This study investigated the odds of home discharge with eGFR levels at admission for patients with stroke using the Taiwan Stroke Registry (TSR) data. METHODS From the TSR database, a total of 51,338 stroke patients from 2006 to 2015 were categorized into five groups based on eGFR levels at admission. The proportion of home discharge by the eGFR levels was calculated and logistic regression analysis was used to estimate the related odds ratio (OR) and 95% confidence interval. RESULTS Near 85% of stroke patients were discharged to home. The proportion of home discharges decreased as the eGFR level declined. Compared to patients with eGFR ≥90 mL/min/1.73 m2, the adjusted ORs of home discharge were 0.91, 0.85, 0.63, 0.56 for patients with eGFR 60-89, eGFR 30-59, eGFR 15-29, and eGFR < 15 mL/min/1.73 m2 or on dialysis, respectively, in a graded relationship. The trends were consistent in the ischemic stroke and hemorrhagic stroke patients. The areas under the receiver operating characteristic curve for all stroke patients, ischemic stroke patients, and hemorrhagic stroke patients were 0.801, 0799, 0.815, respectively. CONCLUSION The odds of home discharge for stroke patients decreased with a significant independent graded association with declining eGFR levels. Renal function could predict home discharge after stroke.
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Affiliation(s)
- I-Kuan Wang
- Graduate Institute Of Biological Sciences, College Of Medicine, China Medical University, Taichung, Taiwan.,Divisions Of Nephrology, China Medical University Hospital, Taichung, Taiwan.,Department Of Medicine, College Of Medicine, China Medical University, Taichung, Taiwan
| | - Tung-Min Yu
- Division Of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division Of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.,College Of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lu-Ting Chiu
- Management Office For Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Li-Ming Lien
- Department Of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.,Department Of Neurology, College Of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu Sun
- Department Of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Cheng-Yu Wei
- Department Of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan.,Department Of Exercise And Health Promotion, College Of Education, Chinese Culture University, Taipei, Taiwan
| | - Kai-Cheng Hsu
- Artificial Intelligence Center For Medical Diagnosis, China Medical University, Taichung, Taiwan.,Department Of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Ping-Chin Lai
- Divisions Of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Yuan Li
- Graduate Institute Of Biological Sciences, College Of Medicine, China Medical University, Taichung, Taiwan.,Department Of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office For Health Data, China Medical University Hospital, Taichung, Taiwan.,Department Of Health Services Administration, China Medical University College Of Public Health, Taichung, Taiwan.,Department Of Food Nutrition And Health Biotechnology, Asia University, Taichung, Taiwan
| | - Chung Y Hsu
- Graduate Institute Of Biological Sciences, College Of Medicine, China Medical University, Taichung, Taiwan
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46
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Tseng YJ, Hung YC, Kuo CE, Chung CJ, Hsu CY, Muo CH, Hsu SF, Hu WL. Prescription of Radix Salvia miltiorrhiza in Taiwan: A Population-Based Study Using the National Health Insurance Research Database. Front Pharmacol 2021; 12:719519. [PMID: 34393796 PMCID: PMC8358316 DOI: 10.3389/fphar.2021.719519] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: While radix Salvia miltiorrhiza (Danshen; RSM) is commonly used in Chinese herbal medicine, its current usage has not yet been analyzed in a large-scale survey. This study aimed to investigate the conditions for which RSM is prescribed and the utilization of RSM in Taiwan. Methods: 1 million beneficiaries enrolled in the Taiwan National Health Insurance Research Database were sampled to identify patients who were prescribed RSM. Next, the diagnoses of these patients based on the International Classification of Diseases 9th Revision Clinical Modification code were analyzed. Logistic regression analysis was employed to estimate the odds ratio (OR) for RSM utilization. Results: Patients with disorders of menstruation and abnormal bleeding from the female genital tract due to other causes were the diagnostic group most commonly treated with RSM (9.48%), followed by those with general (9.46%) and cardiovascular symptoms (4.18%). Subjects treated with RSM were mostly aged 35–49 years (30.1%). The most common combination of diseases for which RSM was prescribed (0.17%) included menopausal disorders and general symptoms. Women were more likely to receive RSM than men (OR = 1.75, 95% confidence interval = 1.73–1.78). RSM was frequently combined with Yan-Hu-Suo and Jia-Wei-Xiao-Yao-San for clinical use. Conclusion: To date, this is the first study to identify the most common conditions for which RSM is used in modern Taiwan. The results indicate RSM as a key medicinal herb for the treatment of gynecological diseases, including menstrual disorders, female genital pain, menopausal disorders, etc. The most common combination for which RSM is prescribed is menopausal disorders and general symptoms. Further research is needed to elucidate the optimal dosage, efficacy, and safety of RSM.
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Affiliation(s)
- Ying-Jung Tseng
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-En Kuo
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Chia-Jung Chung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung Y Hsu
- College of Medicine, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Feng Hsu
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taipei, Taiwan
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Fooyin University College of Nursing, Kaohsiung, Taiwan
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47
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Qureshi AI, Huang W, Lobanova I, Barsan WG, Hanley DF, Hsu CY, Lin CL, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Yamamoto H. Outcomes of Intensive Systolic Blood Pressure Reduction in Patients With Intracerebral Hemorrhage and Excessively High Initial Systolic Blood Pressure: Post Hoc Analysis of a Randomized Clinical Trial. JAMA Neurol 2021; 77:1355-1365. [PMID: 32897310 DOI: 10.1001/jamaneurol.2020.3075] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The safety and efficacy of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage who present with systolic blood pressure greater than 220 mm Hg appears to be unknown. Objective To evaluate the differential outcomes of intensive (goal, 110-139 mm Hg) vs standard (goal, 140-179 mm Hg) systolic blood pressure reduction in patients with intracerebral hemorrhage and initial systolic blood pressure of 220 mm Hg or more vs less than 220 mm Hg. Design, Setting, and Participants This post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage-II trial was performed in November 2019 on data from the multicenter randomized clinical trial, which was conducted between May 2011 to September 2015. Patients with intracerebral hemorrhage and initial systolic blood pressure of 180 mm Hg or more, randomized within 4.5 hours after symptom onset, were included. Interventions Intravenous nicardipine infusion titrated to goals. Main Outcomes and Measures Neurological deterioration and hematoma expansion within 24 hours and death or severe disability at 90 days, plus kidney adverse events and serious adverse events until day 7 or hospital discharge. Results A total of 8532 patients were screened, and 999 individuals (mean [SD] age, 62.0 [13.1] years; 620 men [62.0%]) underwent randomization and had an initial SBP value. Among 228 participants with initial systolic blood pressures of 220 mm Hg or more, the rate of neurological deterioration within 24 hours was higher in those who underwent intensive (vs standard) systolic blood pressure reduction (15.5% vs 6.8%; relative risk, 2.28 [95% CI, 1.03-5.07]; P = .04). The rate of death and severe disability (39.0% vs 38.4%; relative risk, 1.02 [95% CI, 0.73-1.78]; P = .92) was not significantly different between the 2 groups. There was a significantly higher rate of kidney adverse events in participants randomized to intensive systolic blood pressure reduction (13.6% vs 4.2%; relative risk, 3.22 [95% CI, 1.21-8.56]; P = .01), but no difference was observed in the rate of kidney serious adverse events. Conclusions and Relevance The higher rate of neurological deterioration within 24 hours associated with intensive treatment in patients with intracerebral hemorrhage and initial systolic blood pressure of 220 mm Hg or more, without any benefit in reducing hematoma expansion at 24 hours or death or severe disability at 90 days, warrants caution against generalization of recommendations for intensive systolic blood pressure reduction.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, University of Missouri, Columbia.,Department of Neurology, University of Missouri, Columbia
| | - Wei Huang
- Zeenat Qureshi Stroke Institute, University of Missouri, Columbia.,Department of Neurology, University of Missouri, Columbia
| | - Iryna Lobanova
- Zeenat Qureshi Stroke Institute, University of Missouri, Columbia.,Department of Neurology, University of Missouri, Columbia
| | - William G Barsan
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Robert Silbergleit
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany.,Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jose I Suarez
- Division of Neurosciences Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Haruko Yamamoto
- Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center, Suita, Japan
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Hsu CY, Wu MH, Chiu SN, Lin MT, Lai LP, Chen WJ, Lin TT, Juang JM. Investigate clinical characteristics and genetic mutations of CPVT patients in Taiwan and risk stratification. Europace 2021. [DOI: 10.1093/europace/euab116.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology
Background
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare and lethal arrhythmia in children and young adults. RYR2 mutation accounts for 60% of CPVT patients. While many articles about CPVT are published in the Caucasian population, only a few studies are based on Asian ethnicity. A CPVT scorecard proposed using Caucasian patients is proven effective in reducing the burden of variants of uncertain significance (VUS) of RYR2 mutations is not yet tested in the Asian population.
Purpose
Identify mutations among Taiwanese CPVT patients and compare genetic and clinical results with other ethnicities. We also tested the efficacy of the CPVT scorecard in Taiwanese CPVT patients.
Methods
40 clinically diagnosed CPVT patients and their family members were consecutively enrolled from multi-centers. We compared clinical characteristics and genetic results with other ethnicities, and applied the Caucasian CPVT scorecard to test whether it is applicable in Taiwanese CPVT patients.
Results
This is the first nationwide CPVT cohort in Taiwan. Among the 29 patients with CPVT-related gene mutation, 12 RYR2 variants was identified in our cohort with 5 of them unreported in previous studies. The RYR2 yield rate was 55%, similar to other ethnicities. Exercise-induced symptoms including syncope and cardiac arrest were more severe in Taiwanese CPVT cohort, compared to Japanese and Caucasian cohorts. The CPVT scorecard also successfully reduced the VUS rate for the Taiwanese cohort.
Conclusions
Our study demonstrated genetic difference in CPVT patients across ethnicities, suggesting the importance of genetic testing in Taiwan. The CPVT scorecard is applicable to Taiwanese CPVT patients and is a helpful tool in interpreting genetic test results in clinical practice. Clinical characteristics of the cohort Gender (male, %) 15 (52%) Mean age of onset (years) 18 ± 15 Exercise-related syncope or cardiac arrest (n, %) 23 (79%) Exercise-related cardiac arrest (n, %) 14 (48%) Family history of unexplained sudden cardiac death (n, %) 5 (17%) Heart rate (bpm) 73 ± 16 Exercise stress test or Holter positive (n, %) 14 (48%) Ventricular arrhythmia (n, %) 23 (79%) Beta-blockers only (n, %) 10 (35%) Intracardiac defibrillator implantation (n, %) 15 (52%) CPVT score 6 ± 3
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Affiliation(s)
- CY Hsu
- National Taiwan University, College of Medicine, Taipei, Taiwan
| | - MH Wu
- National Taiwan University Hospital, Taipei, Taiwan
| | - SN Chiu
- National Taiwan University Hospital, Taipei, Taiwan
| | - MT Lin
- National Taiwan University Hospital, Taipei, Taiwan
| | - LP Lai
- National Taiwan University Hospital, Taipei, Taiwan
| | - WJ Chen
- National Taiwan University Hospital, Taipei, Taiwan
| | - TT Lin
- National Taiwan University, College of Medicine, Taipei, Taiwan
| | - JM Juang
- National Taiwan University, College of Medicine, Taipei, Taiwan
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49
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Yeh CH, Chang WL, Chan PC, Mou CH, Chang KS, Hsu CY, Tsay SL, Tsai MT, Hsu MH, Sung FC. Women With Osteoarthritis Are at Increased Risk of Ischemic Stroke: A Population-Based Cohort Study. J Epidemiol 2021; 31:628-634. [PMID: 33536376 PMCID: PMC8593576 DOI: 10.2188/jea.je20200042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Osteoarthritis (OA) is more prevalent in women with age. Comorbidities are prevalent in OA patients. In this study, we conducted a follow-up study to evaluate whether women with OA are at an increased risk of ischemic stroke using insurance claims data of Taiwan. Methods We identified 13,520 women with OA aged 20–99 newly diagnosed in 2000–2006 and 27,033 women without OA for comparison, frequency matched by age and diagnosis date. Women with baseline history of hypertension and other disorders associated with stroke were excluded for this study. Incident ischemic stroke was assessed by the end of 2013. A nested case-control analysis was used to identify factors associated with the stroke in the OA cohort. Results The incidence rate of ischemic stroke in the OA cohort was 1.5-fold greater than that in comparisons (1.93 versus 1.26 per 1,000 person-years), with an adjusted hazard ratio of 1.34 (95% confidence interval [CI], 1.09–1.66). The nested case-control analysis showed that stroke cases were twice as likely to develop hypertension during the follow-up period than controls without stroke. The ischemic stroke risk was significantly associated with hypertension (odds ratio [OR] 1.84; 95% CI, 1.37–2.46) and atrial fibrillation (OR 2.25; 95% CI, 1.24–4.09). Ischemic stroke was not associated with the use of non-steroidal anti-inflammatory drugs or aspirin. Conclusion Women with OA are at an elevated risk of ischemic stroke. A close monitoring of hypertension, atrial fibrillation, and other stroke related comorbidities is required for stroke prevention for OA patients.
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Affiliation(s)
- Chung-Hsin Yeh
- Department of Nursing, College of Nursing and Health Sciences, Da-Yeh University.,Department of Neurology, Yuan Sheng Hospital
| | - Wei-Lun Chang
- Department of Neurology, Show Chwan Memorial Hospital
| | - Po-Chi Chan
- Department of Neurology, Show Chwan Memorial Hospital
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital
| | | | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University
| | - Shiow-Luan Tsay
- Department of Nursing, College of Nursing and Health Sciences, Da-Yeh University
| | | | - Min-Hsien Hsu
- Department of Neurology, Show Chwan Memorial Hospital
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital.,Department of Health Services Administration, China Medical University College of Public Health.,Department of Food Nutrition and Health Biotechnology, Asia University
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50
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Campbell BCV, Ma H, Parsons MW, Churilov L, Yassi N, Kleinig TJ, Hsu CY, Dewey HM, Butcher KS, Yan B, Desmond PM, Wijeratne T, Curtze S, Barber PA, De Silva DA, Thijs V, Levi CR, Bladin CF, Sharma G, Bivard A, Donnan GA, Davis SM. Association of Reperfusion After Thrombolysis With Clinical Outcome Across the 4.5- to 9-Hours and Wake-up Stroke Time Window: A Meta-Analysis of the EXTEND and EPITHET Randomized Clinical Trials. JAMA Neurol 2021; 78:236-240. [PMID: 33137171 DOI: 10.1001/jamaneurol.2020.4123] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Intravenous alteplase reduces disability after ischemic stroke in patients 4.5 to 9 hours after onset and with wake-up onset stroke selected using perfusion imaging mismatch. However, whether the benefit is consistent across the 4.5- to 6-hours, 6- to 9-hours, and wake-up stroke epochs is uncertain. Objective To examine the association of reperfusion with reduced disability, including by onset-to-randomization time strata in the Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) and Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) randomized clinical trials. Design, Setting, and Participants Individual patient meta-analysis of randomized clinical trials performed from August 2001 to June 2018 with 3-month follow-up. Patients had acute ischemic stroke with 4.5-to 9-hours poststroke onset or with wake-up stroke were randomized to alteplase or placebo after perfusion mismatch imaging. Analysis began July 2019 and ended May 2020. Exposures Reperfusion was defined as more than 90% reduction in time to maximum of more than 6 seconds' lesion volume at 24- to 72-hour follow-up. Main Outcomes and Measures Ordinal logistic regression adjusted for baseline age and National Institutes of Health Stroke Scale score was used to analyze functional improvement in day 90 modified Rankin Scale score overall, including a reperfusion × time-to-randomization multiplicative interaction term, and in the 4.5- to 6-hours, 6- to 9-hours, and wake-up time strata. Symptomatic hemorrhage was defined as large parenchymal hematoma with a National Institutes of Health Stroke Scale score increase of 4 points or more. Results Reperfusion was assessable in 270 of 295 patients (92%), 68 of 133 (51%) in the alteplase group, and 38 of 137 (28%) in the placebo reperfused group (P < .001). The median (interquartile range) age was 76 (66-81) years in the reperfusion group vs 74 (64.5-81.0) years in the group with no reperfusion. The median (interquartile range) baseline National Institutes of Health Stroke Scale score was 10 (7-15) in the reperfusion group vs 12 (8.0-17.5) in the no reperfusion group. Overall, reperfusion was associated with improved functional outcome (common odds ratio, 7.7; 95% CI, 4.6-12.8; P < .001). Reperfusion was associated with significantly improved functional outcome in each of the 4.5- to 6-hours, 6- to 9-hours, and wake-up time strata, with no evidence of association between time to randomization and beneficial effect of reperfusion (P = .63). Symptomatic hemorrhage, assessed in all 294 patients, occurred in 3 of 51 (5.9%) in the 4.5- to 6-hours group, 2 of 28 (7.1%) in the 6- to 9-hours group, and 4 of 73 (5.5%) in the wake-up stroke in patients treated with alteplase (Fisher P = .91). Conclusions and Relevance Strong benefits of reperfusion in all time strata without differential risk in symptomatic hemorrhage support the consistent treatment effect of alteplase in perfusion mismatch-selected patients throughout the 4.5- to 9-hours and wake-up stroke time window.
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Affiliation(s)
- Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Henry Ma
- Department of Medicine, School of Clinical Science, Monash University, Clayton, Victoria, Australia
| | - Mark W Parsons
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Leonid Churilov
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Helen M Dewey
- Department of Neurosciences, Eastern Health and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Kenneth S Butcher
- Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Bernard Yan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Patricia M Desmond
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Tissa Wijeratne
- Department of Medicine, Melbourne Medical School, University of Melbourne and Western Health, Sunshine Hospital, St Albans, Victoria, Australia.,New South Wales and Maridulu Budyari Gumal, The Sydney Partnership for Health, Education Research and Enterprise (SPHERE), University of New South Wales, Sydney, Australia
| | - Sami Curtze
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - P Alan Barber
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Deidre A De Silva
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Christopher R Levi
- New South Wales and Maridulu Budyari Gumal, The Sydney Partnership for Health, Education Research and Enterprise (SPHERE), University of New South Wales, Sydney, Australia.,Department of Neurology, Priority Research Centre for Stroke and Brain Injury, John Hunter Hospital, University of Newcastle, Newcastle, Australia
| | - Christopher F Bladin
- Department of Neurosciences, Eastern Health and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia
| | - Gagan Sharma
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew Bivard
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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