1
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Kao PY, Yeh HC, Hsia YF, Hsiao YL, Wang JS, Chang DR, Chang SN, Chiang HY, Kuo CC. Paradoxical mortality of high estimated glomerular filtration rate reversed by 24-h urine creatinine excretion rate adjustment: sarcopenia matters. J Cachexia Sarcopenia Muscle 2022; 13:1704-1716. [PMID: 35253387 PMCID: PMC9178165 DOI: 10.1002/jcsm.12951] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Muscle wasting may explain the paradoxical mortality of patients with high estimated glomerular filtration rates (eGFRs) derived from equation methods. However, empirical evidence and solutions remain insufficient. METHODS In this retrospective cohort study, we compared the performance of equation methods for predicting all-cause mortality; we used 24-h creatinine clearance (24-h CrCl), equation-based eGFRs, and a new eGFR estimating equation weighting for population 24-h urine creatinine excretion rate (U-CER). From 2003 to 2018, we identified 4986 patients whose data constituted the first 24-h CrCl measurement data in the Clinical Research Data Repository of China Medical University Hospital and were followed up for at least 5 years after careful exclusion. Three GFR estimation equations [the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD) Study, and Taiwanese MDRD], 24-h CrCl, and 24-h U-CER-adjusted eGFR were used. RESULTS A high correlation was observed among the eGFR levels derived from the equation methods (0.995-1.000); however, the correlation decreased to 0.895-0.914 when equation methods were compared with the 24-h CrCl or 24-h U-CER-adjusted equation-based eGFR. In the Bland-Altman plots, the average discrepancy between the equation methods and the 24-h CrCl method was close to zero (maximal bias range: 5.12 for the Taiwanese MDRD equation vs. 24-h CrCl), but the range in limit of agreement was wide, from ±43.7 mL/min/1.73 m2 for the CKD-EPI equation to ±54.3 mL/min/1.73 m2 for the Taiwanese MDRD equation. A J-shaped dose-response relationship was observed between all equation-based eGFRs and all-cause mortality. Only 24-h CrCl exhibited a non-linear negative dose-response relationship with all-cause mortality. After adjustment for 24-h U-CER in the statistical model, the paradoxical increase in mortality risk for an eGFR of >90 mL/min/1.73 m2 returned to null. When 24-h U-CER was used directly to correct eGFR, the monotonic non-linear negative relationship with all-cause mortality was almost identical to that of 24-h CrCl. CONCLUSIONS The 24-h U-CER-adjusted eGFR and 24-h CrCl are viable options for informing mortality risk. The 24-h U-CER adjustment method can be practically implemented to eGFR-based care and effectively mitigate the inherent confounding biases from individual's muscle mass amount due to both sex and racial differences.
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Affiliation(s)
- Pei-Yu Kao
- Division of Chest Surgery, Department of Surgery, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chieh Yeh
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,AKI-CARE (Acute Kidney Injury Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Ying-Fang Hsia
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Ya-Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jie-Sian Wang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,AKI-CARE (Acute Kidney Injury Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - David Ray Chang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,AKI-CARE (Acute Kidney Injury Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,AKI-CARE (Acute Kidney Injury Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
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2
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Chen PC, Lin FY, Huang HC, Chiang HY, Chang SN, Chen PS, Guo YC, Liao PS, Wei YC, Kuo CC. Diameter Reduction Determined Through Carotid Ultrasound Associated With Cardiovascular and All-Cause Mortality: A Single-Center Experience of 38 201 Consecutive Patients in Taiwan. J Am Heart Assoc 2021; 10:e023689. [PMID: 34779222 PMCID: PMC9075387 DOI: 10.1161/jaha.121.023689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Few studies have evaluated the prognostic significance of diameter‐based carotid sonographic measurements for mortality. We investigated whether a reduction in diameter of different carotid anatomical segments is associated with cardiovascular and all‐cause mortality in a hospital‐based cohort with universal health care. Methods and Results We conducted a retrospective cohort study of 38 201 patients who underwent carotid duplex ultrasound at a medical center in Taiwan. Carotid sonographic parameters were the diameter reduction percentage in carotid bifurcation, the internal carotid artery, the common carotid artery, and the external carotid artery and the overall carotid atherosclerotic burden score, determined by summing the scores from all segments. The vital status was ascertained by linking data to National Death Registry until 2017. During a median follow‐up of 4.2 years, 5644 participants died, with 1719 deaths attributable to cardiovascular diseases. The multivariable‐adjusted hazard ratios (HRs; 95% CIs) for cardiovascular mortality were 1.33 (1.16‒1.53), 1.58 (1.361.84), and 1.89 (1.58, 2.26) for participants with 30% to <40%, 40% to <50%, and ≥50% reduction in carotid bifurcation diameter, respectively, compared with participants with <30% diameter reduction (P for trend <0.001). The corresponding HRs (95% CIs) for all‐cause mortality were 1.25 (1.16‒1.34), 1.42 (1.31‒1.54), and 1.60 (1.45‒1.77), respectively. Diameter reduction at other carotid sites and the carotid atherosclerotic burden score exhibited the same dose–response relationship. Conclusions This study suggests that reduction in carotid artery diameter, which can be determined through routinely available sonography, is an independent risk factor for all‐cause and cardiovascular mortality.
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Affiliation(s)
- Pei-Chun Chen
- Department of Public Health China Medical University College of Public Health Taichung Taiwan
| | - Fu-Yu Lin
- Department of Neurology China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan
| | - Han-Chun Huang
- Big Data Center China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan
| | - Shih-Ni Chang
- Big Data Center China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan.,The Ph.D. Program for Cancer Biology and Drug Discovery College of Medicine China Medical University Taichung Taiwan
| | - Pei-Shan Chen
- Big Data Center China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan
| | - Yuh-Cherng Guo
- Department of Neurology China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan
| | - Pei-Shan Liao
- Department of Neurology China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan
| | - Yu-Chyn Wei
- Department of Neurology China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan
| | - Chin-Chi Kuo
- Big Data Center China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan.,Division of Nephrology Department of Internal Medicine China Medical University Hospital and College of MedicineChina Medical University Taichung Taiwan
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3
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Lin YT, Liu YH, Hsiao YL, Chiang HY, Chen PS, Chang SN, Tsai HC, Chen CH, Kuo CC. Pharmacological blood pressure control and outcomes in patients with hypertensive crisis discharged from the emergency department. PLoS One 2021; 16:e0251311. [PMID: 34403407 PMCID: PMC8370605 DOI: 10.1371/journal.pone.0251311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/24/2021] [Indexed: 11/18/2022] Open
Abstract
Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.
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Affiliation(s)
- Yu-Ting Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Hung Liu
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Chen Tsai
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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4
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Yuan KZ, Wang J, Chang SN, Liao QC. [Kounis syndrome: a case report]. Zhonghua Nei Ke Za Zhi 2021; 60:671-673. [PMID: 34619847 DOI: 10.3760/cma.j.cn112138-20200918-00827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- K Z Yuan
- Department of Cardiology, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou 225001, China
| | - J Wang
- Department of Cardiology, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou 225001, China
| | - S N Chang
- Department of Cardiology, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou 225001, China
| | - Q C Liao
- Department of Cardiology, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou 225001, China
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Su FH, Bai CH, Le TN, Muo CH, Chang SN, Te A, Sung FC, Yeh CC. Patients With Chronic Hepatitis C Virus Infection Are at an Increased Risk of Colorectal Cancer: A Nationwide Population-Based Case-Control Study in Taiwan. Front Oncol 2021; 10:561420. [PMID: 33489873 PMCID: PMC7819899 DOI: 10.3389/fonc.2020.561420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/13/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022] Open
Abstract
Aim Studies evaluating colorectal cancer (CRC) risk associated with chronic hepatitis C virus (HCV) infection are limited. Methods In this case-control study, we identify 67,670 CRC cases newly diagnosed from 2005 to 2011 and randomly selected 67,670 controls without HCV and CRC from the same database, frequency matched by age and sex of cases. Results Results of logistic regression analysis revealed that the adjusted odds ratio (aOR) of CRC was 1.16 (95% confidence interval [CI] = 1.08–1.24, p < 0.001) in association with chronic HCV. The CRC risk was slightly greater for women than for men. The risk decreased with age, with the aOR decreased from 2.26 (95% CI = 1.32–3.87, p = 0.003) in patients under 45 years old to 1.31 (95% CI = 1.10–1.55, p = 0.03) in patients aged 50–59, and 1.10 (95% CI = 1.00–1.22, p = 0.061) in patients aged over 70. Conclusions Our findings suggested that patients with chronic HCV infection are at an elevated risk of developing CRC. Our data also imply that the CRC prevention programs are needed to target younger HCV patients.
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Affiliation(s)
- Fu-Hsiung Su
- Department of Family Medicine, Cardinal Tien Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Thi Nga Le
- International Master/PhD Program, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan.,The Ph.D. Program for Cancer Biology and Drug Discovery, School of Medicine, China Medical University, Taichung, Taiwan
| | - Arlene Te
- Department of Family Medicine, Cardinal Tien Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Chih-Ching Yeh
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei, Taiwan
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6
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Chiang HY, Lin KTR, Hsiao YL, Huang HC, Chang SN, Hung CH, Chang Y, Wang YC, Kuo CC. Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy. Diabetes Care 2021; 44:107-115. [PMID: 33177174 PMCID: PMC7783940 DOI: 10.2337/dc19-0963] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/17/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of patients aged ≥18 years who had undergone appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values. RESULTS We included 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR] 1.19; 95% CI 1.06-1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR 1.17; 95% CI 1.07-1.29) than did those with POBG levels of <102 mg/dL. A positive dose-response curve between POBG and an adjusted risk of a LOS of >3 days was observed, although the curve starts to flatten at a POBG level of ∼130 mg/dL. CONCLUSIONS We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy or laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.
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Affiliation(s)
- Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Ting Robin Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurosurgery, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Ya-Luan Hsiao
- Big Data Center, China Medical University Hospital, Taichung, Taiwan.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Han-Chun Huang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan.,PhD Program for Cancer Biology and Drug Discovery, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Hui Hung
- Department of Medical Quality, China Medical University Hospital, Taichung, Taiwan
| | - Ying Chang
- Department of Nursing, China Medical University Hospital and College of Nursing, Taichung, Taiwan
| | - Yu-Chun Wang
- Department of Medical Quality, China Medical University Hospital, Taichung, Taiwan .,Department of Acute Care Surgery, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan .,College of Medicine, China Medical University, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
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7
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Hsu YL, Chang SN, Kuo CC, Lin CC, Lin HC, Lai HC, Hwang KP, Chiang HY. 1372. Urinary Tract Infections Caused by Gram-Positive Bacteria in Patients Younger than 19 Years: Prediction Analysis in a 13-year Hospital-Based Cohort. Open Forum Infect Dis 2020. [PMCID: PMC7777486 DOI: 10.1093/ofid/ofaa439.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Urinary tract infection (UTI) is one of the common pediatric bacterial infections. Gram positive (GP) pathogens, in contrast to gram negative (GN) bacilli such as E. coli, are less accounted for pediatric UTI. The aim of this study was to identify predictors to enable clinicians to detect GP uropathogens from mostly causative GN bacteria in children with UTI.
Methods
This retrospective cohort study identified 26,066 paired urinalysis and urine culture obtained from the pediatric patients during 2003-2016. Of patients with UTI meeting our criterial, we included children with first-time UTI and classified them into GP-UTI and GN-UTI (Figure 1). Demographic, clinical and laboratory data were collected into analysis. We built a multivariable logistic regression model to predict the GP-UTI. The model performance was examined by using calibration and discrimination plots. We demonstrated a nomogram to predict GP-UTI that could be feasible in the clinical practice.
Figure 1. Flowchart of the Selection Process of the Study Population (N = 3,783 patients).
Results
Of 3,783 children with first-time UTIs, 166 (4.4%) were infected by GP and 3,617 (95.6%) by GN bacteria. The top 3 pathogens for GP uropathogens were vancomycin-resistant (VR) E. faecalis, S. saprophyticus, and coagulase-negative Staphylococcus. Significant risk factors associated with GP-UTI in the multivariable analysis were: age >= 24 months [odds ratio (OR) 3.40, 95% confidence interval (CI) 1.40-8.26], serum white blood cell (WBC) (compared to ≥14.4 x 103/μL) [OR 2.18, 95% CI 1.26-3.77], hemoglobin (compared to < 11.3 g/dL) [OR 1.89, 95% CI 1.04-3.45], negative urine leukocyte esterase [OR 3.12, 95% CI 1.83-5.33], negative urine nitrite [OR 4.14, 95% CI 1.88-9.14] and urine WBC (compared to ≥420/μL) [OR 2.16, 95% CI: 1.09, 4.26] (Table 1). This model had good discrimination (C-statistic 0.874; 95% CI 0.839-0.908) and calibration performance (Figure 2). By using our nomogram, physicians can estimate the probability of UTI that is caused by a GP pathogen, with a probability ranges from 0.04% to 55% (Figure 3).
Table 1. Multivariable Prediction Model for Pediatric Urinary Tract Infections Caused by Gram-Positive Bacteria.
Figure 2. Discrimination Plot (A) and Calibration Plot (B) of the Prediction Model for Pediatric Urinary Tract Infections Caused by Gram-Positive Bacteria.
Figure 3. Nomogram of the Prediction Model for Pediatric Urinary Tract Infections Caused by Gram-Positive Bacteria.
Conclusion
VR E. faecalis is the leading GP uropathogen in the children less than two years of age which need notice of infection control. Our proposed prediction model for GP UTI in children could help clinicians detect potential GP uropathogen and enable them to choose adequate antibiotic regimen early.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
- Yu-Lung Hsu
- Division of Pediatric Infectious Diseases, China Medical University Children’s Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Chin-Chi Kuo
- China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Hsiao-Chuan Lin
- Division of Pediatric Infectious Diseases, China Medical University Children’s Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Huan-Cheng Lai
- Division of Pediatric Infectious Diseases, China Medical University Children’s Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
| | - Kao-Pin Hwang
- Division of Pediatric Infectious Diseases, China Medical University Children’s Hospital, Taichung, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan
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8
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Yeh HC, Lo YC, Ting IW, Chu PL, Chang SN, Chiang HY, Kuo CC. 24-hour Serum Creatinine Variation Associates with Short- and Long-Term All-Cause Mortality: A Real-World Insight into Early Detection of Acute Kidney Injury. Sci Rep 2020; 10:6552. [PMID: 32300213 PMCID: PMC7162857 DOI: 10.1038/s41598-020-63315-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/28/2020] [Indexed: 11/26/2022] Open
Abstract
Real-world evidence describing the variation in serum creatinine (S-Cre) within 24 hours and its prognostic value is unknown. We enrolled 14 912 adults who received two S-Cre measurements within 24 hours at a tertiary hospital between 2003 and 2016. The study population was divided into four groups according to the hospital service settings where the baseline and second S-Cre were measured: Group 1, Outpatient-to-Outpatient; Group 2, Outpatient-to-ED (emergency department) or Inpatient; Group 3, ED-to-ED or Inpatient; and Group 4, Inpatient-to-Inpatient. The main predictors were the difference between the two S-Cre measurements (ΔS-Cre) and the percent change (ΔS-Cre%). The main outcomes were 30-day, 1-year, or 3-year all-cause mortality. A total of 6753 and 8159 patients with an increase and a decrease within-day ΔS-Cre, respectively. Among 6753 patients who had deteriorating ΔS-Cre or ΔS-Cre%, the adjusted hazard ratio (aHR) for 1-year all-cause mortality for each 0.1 mg/dL or 5% change in S-Cre was 1.09 (95% confidence interval [CI]: 1.07, 1.11) and 1.03 (95% CI: 1.03, 1.04). In 8159 patients with improving ΔS-Cre%, the aHR was 0.97 (95% CI: 0.94, 1.00). Groups 3 and 4 had statistically significant positive linear relationships between deteriorating ΔS-Cre% and 30-day and 3-year mortality. The optimal cut-offs for deteriorating ΔS-Cre% for predicting 30-day mortality were approximately 22% for Group 3 and 20% for Group 4. Inpatient within-day deteriorating ΔS-Cre or ΔS-Cre% above 0.2 mg/dL or 20%, respectively, is associated with all-cause mortality. Monitoring 24-hour S-Cre variation identifies acute kidney injury earlier than the conventional criteria.
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Affiliation(s)
- Hung-Chieh Yeh
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Yen-Chun Lo
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Wen Ting
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Lun Chu
- Division of Nephrology, Department of Internal Medicine, Fu Jen Catholic University Hospital, and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
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Lin EPY, Lin CH, Yang CY, Lu TP, Chang SN, Hsiao TH, Huang BT, Yu CJ, Chan KA, Yang PC. Population-Based Cohort Study Reveals Distinct Associations Between Female Lung Cancer and Breast Cancer in Taiwan. JCO Clin Cancer Inform 2019; 2:1-14. [PMID: 30652619 DOI: 10.1200/cci.18.00065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Associations between Asian lung cancer (LC) and breast cancer (BC) are unknown. This study evaluates associations between LC and BC in the Taiwan population. METHODS This study was based on the Taiwan National Health Insurance data and Taiwan Cancer Registry. The cohorts included women with newly diagnosed LC or BC between 2000 and 2011 and an age- and sex-stratified random sample as a noncancer comparison cohort during the same period. Cox proportional hazards regression analysis was used to determine the risks. The National Taiwan University Hospital (NTUH) cohort, which comprised patients with confirmed pathology diagnoses of double BC/LC, was reviewed. RESULTS In 32,824 women with LC, there were increased risks for synchronous BC in patients younger than age 50 years (hazard ratio, 5.80; 95% CI, 1.83 to 18.73), age 50 to 59 years (HR, 2.37; 95% CI, 1.02 to 5.54), and age 60 to 69 years (HR, 4.42; 95% CI, 1.91 to 10.2). In the 88,446 women with BC, there were increased risks for synchronous LC in patients age 40 to 59 years (HR, 5.86; 95% CI, 3.05 to 11.3) and older than 60 years (HR, 1.98; 95% CI, 1.04 to 3.77). In the 128-patient NTUH double LC/BC cohort, 77 (60%) had both cancers diagnosed within 5 years of each other. CONCLUSION LC is associated with an increased risk for synchronous BC in Taiwan and vice versa. Radiotherapy might not be a major risk factor for LC in BC survivors. Etiology for double LC/BC deserves additional exploration and cross-racial genomic studies.
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Affiliation(s)
- Emily Pei-Ying Lin
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Yao Yang
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Pin Lu
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Hung Hsiao
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
| | - Bo-Tsang Huang
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
| | - Chong-Jen Yu
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
| | - K Arnold Chan
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
| | - Pan-Chyr Yang
- Emily Pei-Ying Lin and Ching-Yao Yang, National Taiwan University Hospital; Chong-Jen Yu, K. Arnold Chan, and Pan-Chyr Yang, National Taiwan University Hospital and College of Medicine; Tzu-Pin Lu, National Taiwan University; Bo-Tsang Huang and Pan-Chyr Yang, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Ching-Heng Lin, Shih-Ni Chang, and Tzu-Hung Hsiao, Taichung Veterans General Hospital; and Shih-Ni Chang, China Medical University Hospital, Taichung, Taiwan
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Lai HC, Chang SN, Lin HC, Hsu YL, Wei HM, Kuo CC, Hwang KP, Chiang HY. Association between urine pH and common uropathogens in children with urinary tract infections. J Microbiol Immunol Infect 2019; 54:290-298. [PMID: 31604680 DOI: 10.1016/j.jmii.2019.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/19/2019] [Accepted: 08/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE Urinary tract infections (UTIs) are one of the most common pediatric infections. Our objective in this study is to investigate the association between urine pH and uropathogens in pediatric patients. METHODS The source population comprised 26 066 paired urinalysis (UA) and urine culture (UC) samples obtained from pediatric patients. We classified the paired UA-UC samples into UTI positive (N = 6348) and UTI negative (N = 19 718) according to the colony forming units corresponding to the sampling source. We included UTI positive patients with infection caused by a single species of pathogen (N = 5201) and frequency matched them with UTI negative patients (N = 4729) by age, sex, sampling source, and visit type. RESULTS This study included 5201 pediatric patients with UTIs and found that urine with Proteus mirabilis or Pseudomonas aeruginosa demonstrated the least acidic pH (mean pH = 6.72 and 6.62, respectively), whereas urine with Escherichia coli or Klebsiella pneumoniae exhibited the most acidic pH (pH = 6.21 and 6.18). After stratifying the UTI samples by their pH range (<6, 6-6.9, 7-7.9, and ≥8). The prevalence of P. mirabilis increased significantly across increasing pH categories. CONCLUSION This research is the first epidemiological study that linked urine pH to specific uropathogens in a pediatric population. Both urine pH and age are associated with certain causative uropathogens. Urine that grew P. mirabilis or P. aeruginosa had the least acidic pH. Additional studies should validate the role of urine pH in predicting uropathogens and UTI.
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Affiliation(s)
- Huan-Cheng Lai
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan; The PhD Program for Cancer Biology and Drug Discovery, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiao-Chuan Lin
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Lung Hsu
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Hsiu-Mei Wei
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Kao-Pin Hwang
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan.
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Tsai CW, Huang HC, Chiang HY, Chung CW, Chang SN, Chu PL, Kuo CC. Longitudinal lipid trends and adverse outcomes in patients with CKD: a 13-year observational cohort study. J Lipid Res 2019; 60:648-660. [PMID: 30642880 DOI: 10.1194/jlr.p084590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 01/01/2019] [Indexed: 02/06/2023] Open
Abstract
Studies on the effects of longitudinal lipid trajectories on end-stage renal disease (ESRD) development and deaths among patients with chronic kidney disease (CKD) are limited. We conducted a registry-based prospective study using data from a 13-year multidisciplinary pre-ESRD care program. The final study population comprised 4,647 patients with CKD. Using group-based trajectory modeling, we dichotomized longitudinal trajectories of total cholesterol (T-CHO), triglyceride (TG), LDL cholesterol (LDL-C), and HDL cholesterol (HDL-C). Time to ESRD or death was analyzed using multiple Cox regression. At baseline, higher levels of T-CHO and LDL-C were associated with rapid progression to ESRD, whereas only HDL-C was positively associated with all-cause mortality [adjusted hazard ratio (HR), 1.20; 95% CI, 1.06-1.36; P-value, 0.005]. Compared with those with a normal T-CHO trajectory, the fully adjusted HR of patients with a high T-CHO trajectory for ESRD risk was 1.21 (P-value, 0.019). Subgroup analysis showed that a high TG trajectory was associated with a 49% increase in mortality risk in CKD patients without diabetes (P-value for interaction, 0.012). In contrast to what was observed based on baseline HDL-C, patients with a trajectory of frequent hypo-HDL cholesterolemia had higher risk of all-cause mortality (adjusted HR, 1.53; P-value, 0.014). Thus, only T-CHO, both at baseline and over the longitudinal course, demonstrated a significant potential risk of incident ESRD. The inconsistency in the observed directions of association between baseline levels and longitudinal trajectories of HDL-C warrants further research to unveil specific pathogenic mechanisms underlying the HDL-C metabolism in patients with CKD.
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Affiliation(s)
- Ching-Wei Tsai
- Big Data Center, China Medical University, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine China Medical University Hospital, China Medical University, Taichung, Taiwan.,College of Medicine China Medical University, Taichung, Taiwan
| | - Han-Chun Huang
- Big Data Center, China Medical University, Taichung, Taiwan
| | | | - Chih-Wei Chung
- Big Data Center, China Medical University, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University, Taichung, Taiwan
| | - Pei-Lun Chu
- Division of Nephrology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan .,School of Medicine Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University, Taichung, Taiwan .,Division of Nephrology, Department of Internal Medicine China Medical University Hospital, China Medical University, Taichung, Taiwan.,College of Medicine China Medical University, Taichung, Taiwan
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12
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Tang KT, Chen YM, Chang SN, Lin CH, Chen DY. Psoriatic patients with chronic viral hepatitis do not have an increased risk of liver cirrhosis despite long-term methotrexate use: Real-world data from a nationwide cohort study in Taiwan. J Am Acad Dermatol 2018; 79:652-658. [PMID: 29753054 DOI: 10.1016/j.jaad.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Methotrexate (MTX) is commonly used in the treatment of patients with moderate-to-severe psoriasis. OBJECTIVE We conducted a nationwide population-based cohort study to investigate the impact of long-term MTX use on the risk of chronic viral hepatitis-related cirrhosis among psoriatic patients in Taiwan. METHODS This study obtained data from the National Health Insurance Research Database in Taiwan. We identified 2417 psoriatic patients with chronic hepatitis B (CHB) (370 MTX users and 2047 nonusers of MTX) and 1127 psoriatic patients with chronic hepatitis C (CHC) (174 MTX users and 953 nonusers of MTX) from January 1, 2000, to December 31, 2010. RESULTS After a mean follow-up of more than 9 years since the diagnosis of chronic viral hepatitis, a total of 125 patients with CHB (5%) and 120 patients with CHC (11%) developed liver cirrhosis. Comparable proportions of MTX users and nonusers of MTX developed liver cirrhosis (4% vs 5% in patients with CHB and 11% vs 11% in patients with CHC [both P >.05]). LIMITATIONS There is possible selection bias and medication nonadherence. CONCLUSION Our real-world data show that long-term MTX use may not be associated with an increased risk of liver cirrhosis among psoriatic patients with chronic viral hepatitis.
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Affiliation(s)
- Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
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Abstract
OBJECTIVES It has been proven that statin can protect synovial joints from developing osteoarthritis through its anti-inflammatory effects. However, studies on the effect of statins on spinal degenerative joint diseases are few and limited to in vitro studies. Therefore, we investigated the relationship between the statin dosage and the development of spinal degenerative joint diseases. DESIGN A retrospective cohort study. SETTING Patients registered in Taiwan National Health Insurance Research Database. PARTICIPANTS Patients aged 40-65 years old from 2001 to 2010 were included. Those who received statin treatment before 2001, were diagnosed with spinal degenerative joint diseases or received any spinal surgery before 2004 or had any spinal trauma before 2011 were excluded. A total of 7238 statin users and 164 454 non-users were identified and followed up for the next 7 years to trace the development of spinal degenerative joint disease. OUTCOME MEASURES The incident rate of spinal degenerative joint diseases and HRs among the groups treated with different statin dosages. RESULTS A higher dosage of statins was associated with a significantly lower risk of developing spinal degenerative joint disease in patients with hypercholesterolaemia. Compared with the group receiving less than 5400 mg of a statin, the HR of the 11 900-28 000 mg group was 0.83 (95% CI 0.70 to 0.99), and that of the group receiving more than 28 000 mg was 0.81 (95% CI 0.68 to 0.97). Results of subgroup analysis showed a significantly lower risk in men, those aged 50-59 years and those with a monthly income less than US$600. CONCLUSIONS Our study's findings clearly indicated that a higher dosage of statins can reduce the incidence of spinal degenerative joint disease in patients with hypercholesterolaemia, and it can be beneficial for people with a higher risk of spine degeneration.
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Affiliation(s)
- Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Lan Kao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Tz-Shiang Wei
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Yeh CC, Lai CY, Chang SN, Hsieh LL, Tang R, Sung FC, Lin YK. Polymorphisms of MTHFR C677T and A1298C associated with survival in patients with colorectal cancer treated with 5-fluorouracil-based chemotherapy. Int J Clin Oncol 2017; 22:484-493. [DOI: 10.1007/s10147-016-1080-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/19/2016] [Indexed: 02/07/2023]
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Lin YS, Yeh CC, Lin YC, Su CT, Sung FC, Chang SN, Liu YR, Su FH. Kidney Cancer Linked to Chronic Hepatitis in the Asia-Pacific: A Population-Based Analysis. Am J Nephrol 2016; 45:22-31. [PMID: 27866208 DOI: 10.1159/000453045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/12/2016] [Accepted: 10/31/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The association of renal cancer with viral hepatitis infection remains unclear. Using an insurance data set, this population-based case-control study evaluated the association of renal cancer with chronic hepatitis virus infection in an endemic area of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. METHODS We enrolled 17,747 patients with renal cancer during the period from 2000 to 2011 from the National Health Insurance Research Database of Taiwan. The control group comprised 35,494 randomly selected people without renal cancer matched by age and gender to the patients in the study group. ORs were calculated to assess the association of chronic hepatitis virus infection with renal cancer by using logistic regression analysis. RESULTS Renal cancer was associated with HBV and HCV infection (OR 1.38, 95% CI 1.24-1.54; OR 1.24, 95% CI 1.07-1.44, respectively). An analysis stratified by gender and age revealed that young male HBV carriers had a higher risk of renal cancer compared with men without viral hepatitis (age <55 years: OR 1.94, 95% CI 1.57-2.39; 55≤ age <64 years: OR 1.40, 95% CI 1.05-1.86). Male HCV-infected patients aged <55 years (OR 1.90, 95% CI 1.11-3.26) and female HCV carriers aged between 55 and 64 years (OR 1.59, 95% CI 1.00-2.53) had a significantly higher risk of renal cancer compared with their counterparts. CONCLUSIONS Renal cancer is significantly associated with chronic hepatitis infection, particularly in younger HBV-infected men.
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Affiliation(s)
- Yu-Shan Lin
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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Kamiza AB, Su FH, Wang WC, Sung FC, Chang SN, Yeh CC. Chronic hepatitis infection is associated with extrahepatic cancer development: a nationwide population-based study in Taiwan. BMC Cancer 2016; 16:861. [PMID: 27821099 PMCID: PMC5100218 DOI: 10.1186/s12885-016-2918-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [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: 07/13/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023] Open
Abstract
Background Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the major causes of chronic hepatitis infection (CHI). This longitudinal cohort study investigated the association of CHI with hepatic and extrahepatic cancer development in Taiwan. Methods Patients with HBV infection and HCV infection were identified from the Taiwan National Health Insurance Research Database. A Cox proportional hazard model was used to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs) for determining the association between CHI and cancer development. Results The patients with HBV infection exhibited an increased risk of colorectal cancer (HR: 1.36, 95 % CI: 1.09–1.70), liver cancer (HR: 21.47, 95 % CI: 18.0–25.6), gallbladder and extrahepatic bile duct cancer (HR: 2.05, 95 % CI: 1.07–3.91), pancreatic cancer (HR: 2.61, 95 % CI: 1.47–4.61), kidney cancer (HR: 1.72, 95 % CI: 1.10–2.68), ovarian cancer (HR: 2.31, 95 % CI: 1.21–4.39), and non-Hodgkin’s lymphoma (HR: 2.10, 95 % CI: 1.25–3.52). The patients with HCV infection exhibited an increased risk of liver cancer (HR: 25.10, 95 % CI: 20.9–30.2), gallbladder and extrahepatic bile duct cancer (HR: 2.60, 95 % CI: 1.42–4.73), ovarian cancer (HR: 5.15, 95 % CI: 1.98–13.4), and non-Hodgkin’s lymphoma (HR: 2.30, 95 % CI: 1.34–3.96). Conclusion The present population-based study revealed that in addition to its association with primary liver cancer, CHI is associated with an increased risk of extrahepatic cancer.
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Affiliation(s)
- Abram Bunya Kamiza
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, 11031, Taiwan
| | - Fu-Hsiung Su
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, 11031, Taiwan.,Department of Family Medicine, Taipei Medical University Hospital, No. 252 Wu-Hsing Street, Taipei, 11031, Taiwan.,Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, 11031, Taiwan.,School of Medicine, Flinders University, Bedford Park, Australia
| | - Wen-Chang Wang
- The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, 11031, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, No. 2 Yude Road, Taichung, 40402, Taiwan.,Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Shih-Ni Chang
- Management Office for Health Data, China Medical University Hospital, No. 2 Yude Road, Taichung, 40402, Taiwan.,Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Chih-Ching Yeh
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, 11031, Taiwan. .,Department of Public Health, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.
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Yeh CC, Wang WC, Wu CS, Sung FC, Su CT, Shieh YH, Chang SN, Su FH. Correction: Association of Sjögren's Syndrome in Patients with Chronic Hepatitis Virus Infection: A Population-Based Analysis. PLoS One 2016; 11:e0164911. [PMID: 27749926 PMCID: PMC5066952 DOI: 10.1371/journal.pone.0164911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Yeh CC, Wang WC, Wu CS, Sung FC, Su CT, Shieh YH, Chang SN, Su FH. Association of Sjögrens Syndrome in Patients with Chronic Hepatitis Virus Infection: A Population-Based Analysis. PLoS One 2016; 11:e0161958. [PMID: 27560377 PMCID: PMC4999293 DOI: 10.1371/journal.pone.0161958] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/15/2016] [Indexed: 12/18/2022] Open
Abstract
Objective The association between Sjögren’s syndrome (SS) and chronic hepatitis virus infection is inconclusive. Hepatitis B (HBV) and hepatitis C virus (HCV) infections are highly prevalent in Taiwan. We used a population-based case-control study to evaluate the associations between SS and HBV and HCV infections. Materials and Methods We identified 9,629 SS patients without other concomitant autoimmune diseases and 38,516 sex- and age-matched controls without SS from the Taiwan National Health Insurance claims data between 2000 and 2011. We utilized multivariate logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the associations between SS and HBV and HCV infections. Sex- and age-specific (<55 and ≥55 years) risks of SS were evaluated. Results The risk of SS was higher in patients with HCV than in those without chronic viral hepatitis (OR = 2.49, 95% CI = 2.16–2.86). Conversely, HBV infection was not associated with SS (OR = 1.10, 95% CI = 0.98–1.24). Younger HCV patients were at a higher risk for SS (<55 years: OR = 3.37, 95% CI = 2.62–4.35; ≥55 years: OR = 2.20, 95% CI = 1.84–2.62). Men with HCV were at a greater risk for SS (women: OR = 2.26, 95% CI = 1.94–2.63; men: OR = 4.22, 95% CI = 2.90–6.16). Only men with chronic HBV exhibited a higher risk of SS (OR = 1.61, 95% CI = 1.21–2.14). Conclusion HCV infection was associated with SS; however, HBV only associated with SS in men.
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Affiliation(s)
- Chih-Ching Yeh
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Wen-Chang Wang
- The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chien-Sheng Wu
- Division of Allergy, Immunology, and Rheumatology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Fung-Chang Sung
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Chien-Tien Su
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ying-Hua Shieh
- Department of Family Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan
| | - Shih-Ni Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Fu-Hsiung Su
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Family Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Medicine, Flinders University, Bedford Park, Australia
- * E-mail:
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Harnod T, Li YF, Lin CL, Chang SN, Sung FC, Kao CH. Higher-dose uses of zolpidem will increase the subsequent risk of developing benign brain tumors. J Neuropsychiatry Clin Neurosci 2016; 27:e107-11. [PMID: 25923854 DOI: 10.1176/appi.neuropsych.14010006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study identified 37,810 patients with anxiety or sleep disorder (mean age=53.2 years, SD=16.0 years) who had zolpidem prescribed for at least 2 months from January 1, 2000 through December 31, 2009. Another non-zolpidem cohort was selected by 1:1 matching with the zolpidem cohort on the estimated probability (propensity score) of being treated. The zolpidem cohort had a higher incidence of benign brain tumors compared with the non-zolpidem cohort, particularly for elderly patients. The matched propensity score analysis showed that the highest risk of benign brain tumors occurred in participants with zolpidem exposure ≥520 mg/year (hazard ratio=1.85, 95% confidence interval=1.21-2.82) compared with those not taking zolpidem.
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Affiliation(s)
- Tomor Harnod
- From the Dept. of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan (TH); the College of Medicine, Tzu Chi University, Hualien, Taiwan (TH); the Institute of Biostatistics, China Medical University, Taichung, Taiwan (Y-FL); the Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (C-LL, S-NC, F-CS); the Dept. of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK); and the Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (F-CS, C-HK)
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Feng A, Chuang E, Wu SH, Wang JC, Chang SN, Lin CL, Kao CH. The effect of statins on the occurrence of peptic ulcer. Eur J Intern Med 2015; 26:731-5. [PMID: 26226858 DOI: 10.1016/j.ejim.2015.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study was to determine the association between the use of statins and the occurrence of peptic ulcer diseases (PUD). METHODS Using the National Health Insurance Research Database to conduct a population-based cohort study. We identified 48,562 patients who were newly diagnosed with hyperlipidemia during the period of 1998 to 2011 and who were divided into two groups based on their use of statins. The non-statin cohort (without statin treatment, 24,139 patients) were 1:1 frequency matched with sex, age, year of diagnosis of hyperlipidemia and index-year to the statin cohort (24,423 patients). The relative risk of patients with and without statins treatment on the occurrence of PUD and concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin were analyzed using the univariable and multivariable Cox proportional hazards regression model. RESULTS The incidence of PUD increased with age in both cohorts and female had a higher occurrence rate than male in both cohorts. Compared with the non-statin cohort, the statin cohort was associated with a significant lower risk of PUD for all age group. The concomitant use of aspirin and/or NSAIDs had higher incidence of PUD than those without in both cohorts. Analyzing the cumulative defined daily dose (DDD) of statins indicated that high-dose groups (≧ 575 DDD) exhibited significantly decreased risk compared with non-statin users. CONCLUSION The results of the present study indicated that statins might be associated with the protection of peptic ulcer in a dose-respondent manner.
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Affiliation(s)
- Anning Feng
- Division of Cardiology, Cheng Hisn General Hospital, Taipei, Taiwan; Nation Yang-Ming University, Taipei, Taiwan
| | - Eric Chuang
- UC Berkeley Mishler Lab Undergraduate Researcher, Intended B.S. Molecular and Cell Biology, University of CA, Berkeley, USA
| | - Szu-Hsien Wu
- Department of Physical Medicine and Rehabilitation, Veterans General Hospital Taipei, Taipei, Taiwan; National Yang-Ming University, Taipei, Taiwan
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Veterans General Hospital Taipei, Taipei, Taiwan; National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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Wang IK, Lin CL, Lin PC, Chang SN, Chou CY, Yen TH, Chang CT, Huang CC, Sung FC. Seasonal influenza vaccination is associated with reduced morbidity and mortality in peritoneal dialysis patients. Nephrol Dial Transplant 2015; 31:269-74. [PMID: 26453199 DOI: 10.1093/ndt/gfv360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 09/13/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Studies on the effectiveness of seasonal influenza vaccination in peritoneal dialysis (PD) patients are limited. The aim of the present study is to evaluate the effectiveness of seasonal influenza vaccination in reducing morbidity and mortality in incident end-stage renal disease patients on PD. METHODS From Taiwan's National Health Insurance Research Database, we identified 2089 incident PD patients with seasonal influenza vaccination and 2089 propensity score matched incident PD patients without the vaccination during 1998-2010. Each study subject was followed up to measure the 12-month incident cardiovascular and infectious diseases, and deaths. The effects of multi-year vaccinations were also estimated. RESULTS Compared with the non-vaccinated cohort, the vaccinated cohort had a lower hospitalization rate (68.5 versus 80.2 per 100 person-years) with an adjusted hazard ratio (aHR) of 0.85 [95% confidence interval (CI) = 0.78-0.92]. Hazards of hospitalization were significantly reduced for sepsis (aHR = 0.79, 95% CI = 0.65-0.96), heart disease (aHR = 0.74, 95% CI = 0.63-0.89) and intensive care (aHR = 0.85, 95% CI = 0.73-0.99). In addition, hazards of peritonitis (aHR = 0.84, 95% CI = 0.73-0.97) and overall mortality (aHR = 0.66, 95% CI = 0.55-0.78) were also reduced. The aHR of mortality was reduced much further to 0.28 (95% CI = 0.22-0.35) for those with multiple-year vaccinations. CONCLUSIONS Seasonal influenza vaccination for PD patients is associated with significant reduction in morbidities and a 34% reduction in mortality. Multi-year vaccinations could reduce the death hazard further to 72%.
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Affiliation(s)
- I-Kuan Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan
| | - Po-Chang Lin
- Division of Infection, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Che-Yi Chou
- Division of Kidney Disease, 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
| | - Chiz-Tzung Chang
- Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Ching Huang
- Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Department of Health Services Administration, China Medical University, Taichung, Taiwan
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Abstract
Studies have suggested that statin use is related to cancer risk and prostate cancer mortality. We conducted a population-based cohort study to determine whether using statins in prostate cancer patients is associated with reduced all-cause mortality rates. Data were obtained from the Taiwan National Health Insurance Research Database. The study cohort comprised 5179 patients diagnosed with prostate cancer who used statins for at least 6 months between January 1, 1998 and December 31, 2010. To form a comparison group, each patient was randomly frequency-matched (according to age and index date) with a prostate cancer patient who did not use any type of statin-based drugs during the study period. The study endpoint was mortality. The hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox regression models. Among prostate cancer patients, statin use was associated with significantly decreased all-cause mortality (adjusted HR = 0.65; 95% CI = 0.60-0.71). This phenomenon was observed among various types of statin, age groups, and treatment methods. Analyzing the defined daily dose of statins indicated that both low- and high-dose groups exhibited significantly decreased death rates compared with nonusers, suggesting a dose-response relationship. The results of this population-based cohort study suggest that using statins reduces all-cause mortality among prostate cancer patients, and a dose-response relationship may exist.
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Affiliation(s)
- Li-Min Sun
- From the Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital (L-MS); Department of Nuclear Medicine, E-DA Hospital, I-Shou University, Kaohsiung (M-CL); Management Office for Health Data; China Medical University Hospital, (C-LL); Department of Medical Research, Taichung Veterans General Hospital (S-NC); Department of Radiation Oncology, China Medical University Hospital (J-AL); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung (J-AL, C-HK); Department of Family Medicine, Changhua Christian Hospital, Changhua (I-CL); School of Medicine, Chung Shan Medical University (I-CL); Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Hsu YT, Liao CC, Chang SN, Yang YW, Tsai CH, Chen TL, Sung FC. Increased Risk of Depression in Patients with Parkinson Disease: A Nationwide Cohort Study. Am J Geriatr Psychiatry 2015; 23:934-40. [PMID: 25529799 DOI: 10.1016/j.jagp.2014.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 10/20/2014] [Accepted: 10/30/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The association between Parkinson disease (PD) and depression remains unclear, particularly in the Asian population. The purpose of this study is to investigate the risk of depression in patients with PD using population-based data. METHODS Based on the National Health Insurance Research Database of Taiwan, we identified 1,698 patients with PD aged 40 years or older diagnosed in 2000-2003. With frequency matching procedure, we randomly selected 6,792 subjects without PD stratified by sex and age. Both cohorts were followed until the end of 2008 or diagnosis of depression. Risk of depression associated with PD was estimated in the multivariate Cox hazards regressions. Diabetes, hypertension, and hyperlipidemia were more prevalent at baseline in patients with PD. RESULTS Compared with the cohort without PD, the hazard ratio (HR) for depression in PD patients was 4.06 (95% CI: 3.15-5.23), which increased to 4.26 (95% CI: 3.29-5.51) after adjustment for age, sex, urbanization, income, and coexisting medical conditions. In the sex stratification, the HR of depression for men with PD was 4.42 (95% CI: 2.93-6.67) compared with men without PD. The HR for the association between PD and depression in women was 4.22 (95% CI: 3.02-5.88). CONCLUSION This study suggests that patients with PD are at an elevated risk of depression, particularly for men. Integrated care for early identification and treatment of depression are crucial for patients with PD.
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Affiliation(s)
- Yi-Ting Hsu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Chang Liao
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan; Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Ni Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Wan Yang
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan.
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Yang CC, Tai CJ, Chien SH, Lin CL, Chang SN, Sung FC, Chung CJ, Kao CH. Risk of Ear-Associated Diseases After Zygomaticomaxillary Complex Fracture. J Maxillofac Oral Surg 2015. [PMID: 26225057 DOI: 10.1007/s12663-015-0744-y] [Citation(s) in RCA: 3] [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: 11/26/2022] Open
Abstract
PURPOSE Investigate the risk of ear-associated diseases after zygomaticomaxillary complex (ZMC) fracture in a population-based retrospective cohort study. MATERIALS AND METHODS This is a retrospective cohort study using Taiwan's National Health Insurance Research Database of reimbursement claims. A total of 1,330 ZMC fracture patients and 5,320 non-ZMC fracture participants were included and newly developed ear-associated disease data were collected. A Poisson regression and multivariate Cox proportion hazard regression were used for data analysis. RESULTS The ZMC fracture cohort had a higher incidence of tinnitus than non-ZMC fracture cohort (IRR 1.64, 95 % CI 1.37-1.96), particularly in younger patients (≤34 years of age; IRR 4.05, 95 % CI 3.18-5.15) and male patients (IRR 2.08, 95 % CI 1.12-3.73). ZMC fracture patients also showed a significantly increased risk of having trigeminal neuralgia [IRR 4.06, 95 % CI 3.34-4.94, adjusted HR 4.07 (1.02-16.3)]. For sudden hearing loss and peripheral vertigo, the incidence densities were higher in the ZMC fracture cohort, but these relationships were not significant in the multivariate Cox proportional hazard regression analyses (HR 2.69, 95 % CI 0.76-9.53 for risk of sudden hearing loss; HR 1.36, 95 % CI 0.77-2.40 for risk of peripheral vertigo). CONCLUSIONS The findings of the study suggest an increased risk of ear-associated diseases among individuals with ZMC fractures, particularly within 2-years follow-ups after injury. We suggest performing detailed examinations for ear-associated diseases in patients with ZMC fractures for early diagnosis and adequate treatment.
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Affiliation(s)
- Chao-Chih Yang
- Division of Plastic Surgery, Department of Surgery, Buddhist Taichung Tzu Chi General Hospital, Taichung, Taiwan
| | - Chih-Jaan Tai
- Department of Otolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Sou-Hsin Chien
- Division of Plastic Surgery, Department of Surgery, Buddhist Taichung Tzu Chi General Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Jung Chung
- Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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Affiliation(s)
- Pei-Ying Lin
- Taiwan International Graduate Program in Molecular Medicine, Academia Sinica and National Yang-Ming University, Taipei, Taiwan2Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan3Institute of Biochemistry and Molecular Biology, National Yang
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan6PhD Program for Cancer Biology and Drug Discovery, China Medical University, Taichung, Taiwan
| | - Tzu-Hung Hsiao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Bo-Tsang Huang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pan-Chyr Yang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
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Chen YM, Lin CH, Lan TH, Chen HH, Chang SN, Chen YH, Wang JS, Hung WT, Lan JL, Chen DY. Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study. Rheumatology (Oxford) 2015; 54:1244-1249. [DOI: 10.1093/rheumatology/keu451] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Objective. SLE is associated with increased risk of diabetes mellitus. Treatment for SLE requires high-dose glucocorticoids that may worsen glucose homoeostasis. HCQ can reduce diabetes risk in RA. This study aimed to investigate the association of HCQ use and diabetes mellitus risk in SLE patients.
Methods. This nationwide, population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. In the period 2001–10, 8628 newly diagnosed SLE patients were identified after excluding those with a previous diagnosis of RA, psoriasis or diabetes mellitus. Incidence of diabetes mellitus was identified as a new diagnostic code using a diabetes mellitus-specific medication.
Results. Two hundred and twenty-one newly diagnosed diabetes mellitus patients were identified among SLE patients (6795 had taken HCQ and 1833 had never taken HCQ), with an average follow-up period of 5.6 years. Compared with patients without HCQ treatment, the hazard ratio (HR) of diabetes mellitus in patients taking HCQ at a cumulative dose ≥129 g was reduced [HR 0.26 (95% CI 0.18, 0.37), P < 0.001]. Daily glucocorticoid ≥10 mg prednisolone-equivalent dose was associated with increased risk of developing diabetes mellitus [HR 2.47 (95% CI 1.44, 4.23), P = 0.001], which was minimized by concomitant HCQ use at a cumulative dose ≥129 g.
Conclusion. In SLE patients, the use of HCQ is associated with reduced risk of incident diabetes mellitus in a dose-dependent manner. High-dose glucocorticoids increase the risk of diabetes, which can be decreased by concomitant HCQ use.
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Affiliation(s)
- Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
| | - Ching-Heng Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
| | - Tsuo-Hung Lan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
| | - Hsin-Hua Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
| | - Shih-Ni Chang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
| | - Jun-Sing Wang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
| | - Wei-Ting Hung
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
| | - Joung-Liang Lan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
| | - Der-Yuan Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 2 Faculty of Medicine, School of Medicine, 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, 4 Department of Medical Research, 5 Department of Psychiatry, 6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Vetera
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Lin CH, Hsu KH, Chang SN, Tsou HK, Sheehan J, Sheu ML, Pan HC. Increased survival with the combination of stereotactic radiosurgery and gefitinib for non-small cell lung cancer brain metastasis patients: a nationwide study in Taiwan. Radiat Oncol 2015; 10:127. [PMID: 26048754 PMCID: PMC4490645 DOI: 10.1186/s13014-015-0431-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Whole brain irradiation (WBRT) either with or without resection has historically been the treatment for brain metastases from non-small cell lung cancer (NSCLC). The effect of gamma knife (GK) radiosurgery, chemotherapy, or the combination remains incompletely defined. In this study, we assessed the outcome of brain metastases from non-small cell lung cancer treated by WBRT followed by GK, gefitinib, or the combination of GK and gefitinib. MATERIAL AND METHODS We retrieved the records of NSCLC patients with brain metastases from the National Health Insurance Research Database (NHIRD) of Taiwan from 2004 to 2010. WBRT either with or without resection was the first line treatment for nearly all patients. The decision to add GK and/or gefitinib treatment was at the discretion of the treating physician and based upon a patient's medical records and imaging data. These patients were classified into four groups including WBRT, WBRT + gefitinib, WBRT + GK, WBRT + gefitinib + GK. These data was evaluated for difference in survival and factors that portended an extended survival from the time of brain metastasis diagnosis. RESULTS Of the 60194 patients with newly diagnosed NSCLC, 23874 (39.6 %) developed brain metastases. The distribution of patients for the groups was WBRT for 20241, WBRT + gefitinib for 3379, WBRT + GK for 155, and WBRT+ gefitinib + GK for 99 patients. The median survival for the time of brain metastasis diagnosis for WBRT, WBRT+ gefitinib, WBRT+ GK, WBRT+ gefitinib + GK groups was 0.53, 1.01, 1.46, and 2.25 years, respectively (p < 0.0001). The hazard ratio (95 % CI) for survival was 1, 0.56, 0.43, and 0.40, respectively (p < 0.001). The adjusted hazard ratio (95 % CI) by age, sex and Charlson comorbidity index (CCI) was 1, 0.73, 0.49, and 0.42, respectively (p < 0.001). CONCLUSION Patients with brain metastases from NSCLC receiving GK or gefitinib demonstrated extended survival. The improved survival seen with GK and gefitinib suggests a survival benefit in selected patients receiving the combined treatment. Further Phase II study should be conducted to assessment these influence.
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Affiliation(s)
- Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Kuo-Hsuan Hsu
- Department of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurosurgical Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec.4, 40705, Taichung, Taiwan.
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
| | - Meei-Ling Sheu
- Institute of Biomedical Sciences, National Chung-Hsing University, Taichung, Taiwan.
| | - Hung-Chuan Pan
- Functional Neurosurgery Division, Neurosurgical Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec.4, 40705, Taichung, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Wei CC, Chang CH, Lin CL, Chang SN, Li TC, Kao CH. Neonatal jaundice and increased risk of attention-deficit hyperactivity disorder: a population-based cohort study. J Child Psychol Psychiatry 2015; 56:460-7. [PMID: 25056274 DOI: 10.1111/jcpp.12303] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have posited conflicting results regarding the relationship between neonatal jaundice and the subsequent risk of attention-deficit hyperactivity disorder (ADHD). We therefore performed a large population study with a defined neonatal jaundice cohort to investigate the incidence and risk of physician-diagnosed ADHD in Taiwan. METHODS From 2000 to 2004, 24,950 neonatal jaundice cases and 69,964 matched nonjaundice controls were identified. At the end of 2008, the incidence rate and hazard ratios (HRs) of physician-diagnosed ADHD were calculated. RESULTS The incidence of ADHD was 2.48-fold greater in the jaundice cohort than in the nonjaundice cohort (3.84 vs. 1.51 per 100,000 person-years) in the study period. The HR of ADHD was substantially greater for male, preterm, and low-birth-weight infants with neonatal jaundice. The risk of developing ADHD in the jaundice cohort was greater after a diagnosis of neonatal jaundice for more than 6 years (HR: 2.64; 95% confidence interval: 2.13-3.28). The risk of ADHD increased for neonates with higher serum bilirubin levels requiring phototherapy and with longer admission days. CONCLUSION Neonates with jaundice are at high risk for developing physician-diagnosed ADHD during their growth period. A risk alert regarding neurologic consequences is urgently required after a neonatal jaundice diagnosis. Additional studies should be conducted to clarify the pathogenesis of these relationships.
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Affiliation(s)
- Chang-Ching Wei
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
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Chung WS, Chen YF, Lin CL, Chang SN, Hsu WH, Kao CH. Sleep disorders increase the risk of venous thromboembolism in individuals without sleep apnea: a nationwide population-based cohort study in Taiwan. Sleep Med 2015; 16:168-72. [DOI: 10.1016/j.sleep.2014.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/18/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
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Chen YC, Lin CH, Chang SN, Shi ZY. Epidemiology and clinical outcome of pyogenic liver abscess: an analysis from the National Health Insurance Research Database of Taiwan, 2000-2011. J Microbiol Immunol Infect 2014; 49:646-653. [PMID: 25442876 DOI: 10.1016/j.jmii.2014.08.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/29/2014] [Accepted: 08/31/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The epidemiology of pyogenic liver abscess continues to change and the issue of antimicrobial therapy is controversial. This study investigated the epidemiology and clinical outcomes of antimicrobial therapy. METHODS The annual incidence rates, demographic data, underlying diseases, complications, length of stay, mortality rates, and antimicrobial therapy were analyzed using the data retrieved from the Longitudinal Health Insurance Database 2000, Taiwan, from 2000 to 2011. RESULTS The annual incidence of pyogenic liver abscess for all age groups increased gradually in Taiwan from 10.83 per 100,000 person-years in 2000 to 15.45 per 100,000 person-years in 2011. Pyogenic liver abscess occurred more commonly in patients with male sex, of older age (>50 years), and lower family income. Among the 1522 adult patients with pyogenic liver abscess, 537 (35.3%) patients had diabetes mellitus, 165 (10.8%) patients had complications, 234 (15.4%) patients received mechanical ventilation, and 361 (23.7%) patients had a stay in intensive care; the mortality rate was 8.2% (125/1522). There were 426 (28%) patients treated with cefazolin and 158 (10.4%) patients treated with extended-spectrum cephalosporins. There were no statistically significant differences in the length of stay and mortality rates between these two groups (20.2 days vs. 23.1 days; and 7.5% vs. 10.1%, respectively). CONCLUSION The clinical outcomes of pyogenic liver abscess treated with cefazolin were comparable to those treated by extended-spectrum cephalosporins. Extended-spectrum cephalosporins should be used for severe complications, such as meningitis and endophthalmitis. Further surveillance of epidemiology and cohort analysis of antimicrobial therapy are important.
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Affiliation(s)
- Yung-Chun Chen
- Section of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Health Service Research Center (HSRC), Department of Medical Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Health Service Research Center (HSRC), Department of Medical Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Zhi-Yuan Shi
- Section of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Lee CF, Lin KY, Lin MC, Lin CL, Chang SN, Kao CH. Sleep disorders increase the risk of burning mouth syndrome: a retrospective population-based cohort study. Sleep Med 2014; 15:1405-10. [DOI: 10.1016/j.sleep.2014.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/22/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
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Su FH, Chang SN, Sung FC, Su CT, Shieh YH, Lin CC, Yeh CC. Hepatitis B virus infection and the risk of male infertility: a population-based analysis. Fertil Steril 2014; 102:1677-84. [PMID: 25439807 DOI: 10.1016/j.fertnstert.2014.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the risk of male infertility among patients with hepatitis B virus (HBV) infection. DESIGN A nationwide, population-based cohort study. SETTING Not applicable. PATIENT(S) Men infected with HBV (n = 5,138) and men without HBV infection (n = 25,690). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Male infertility, as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification. RESULT(S) The incidence of infertility was 1.59 times higher in patients with HBV infection than in those without HBV infection (2.21 vs. 1.39 per 1,000 person-years). The risk of developing infertility remained significant among patients with HBV infection (hazard ratio 1.52, 95% confidence interval 1.20-1.92) after adjusting for covariates in a multivariate Cox proportional hazards model. CONCLUSION(S) The data show an increased incidence and risk of infertility among men with HBV infection compared with men without HBV.
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Affiliation(s)
- Fu-Hsiung Su
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Family Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Ni Chang
- PhD Program for Cancer Biology and Drug Discovery, China Medical University, Taichung, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Management Office for Health Data, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chien-Tien Su
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan; School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Ying-Hua Shieh
- Department of Family Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Chieh Lin
- Division of Family Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Ching Yeh
- Department of Public Health, China Medical University, Taichung, Taiwan; School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
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Abstract
OBJECTIVE In this study, we aimed to investigate the effect of hypoglycemia on cardiovascular outcomes in a sample of patients with chronic kidney disease (CKD). METHODS Information about study participants was extracted from the National Health Insurance Research Database of Taiwan for the years 1998 through 2008. We conducted this retrospective cohort study of patients with CKD, with and without hypoglycemia, to evaluate the risk of overall mortality and cardiovascular complications including stroke, coronary heart disease, and congestive heart failure in both groups. RESULTS This study included 46,135 patients with CKD, of whom 2,117 (4.59%) were hospitalized and had hypoglycemia. Results of multivariate Cox proportional hazard regression analyses indicated that stroke (hazard ratio [HR] = 1.62, 95% confidence interval [CI] = 1.29-2.03), coronary heart disease (HR = 1.25, 95% CI = 1.00-1.57), congestive heart failure (HR = 1.49, 95% CI = 1.13-1.98), and death (HR = 2.53, 95% CI = 1.99-3.21) were associated with hypoglycemia in patients with CKD. Recurrent episodes of hypoglycemia were associated with a higher risk of death (HR = 33.0, 95% CI = 22.3-48.8 for >2 episodes, p for trend <0.0001), and a similar trend was observed for other multiple cardiovascular events. We observed an increased risk of stroke and overall mortality in patients with hypoglycemia compared to those without hypoglycemia, regardless of whether the patient had diabetes. CONCLUSIONS CKD was associated with a higher risk of stroke and mortality in patients with hypoglycemia. Recurrent hypoglycemia considerably increased the risk of stroke and overall mortality in patients with CKD regardless of whether they had diabetes. These results suggest that hypoglycemia has a crucial role in stroke and death in patients with CKD.
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Affiliation(s)
- Tung-Min Yu
- From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- From the Graduate Institute of Clinical Medical Science (T.-M.Y., C.-H. K.) and Department of Public Health (C.-L.L., S.-N.C., F.-C. S.), China Medical University, Taichung; Division of Nephrology (T.-M.Y.), Taichung Veteran General Hospital; and Management Office for Health Data (C.-L.L., S.-N.C., F.-C.S.) and Department of Radiation Oncology and Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung, Taiwan.
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Chao TH, Fu PK, Chang CH, Chang SN, Chiahung Mao F, Lin CH. Prescription patterns of Chinese herbal products for post-surgery colon cancer patients in Taiwan. J Ethnopharmacol 2014; 155:702-708. [PMID: 24945402 DOI: 10.1016/j.jep.2014.06.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [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: 01/22/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 06/03/2023]
Abstract
ETHNO-PHARMACOLOGICAL RELEVANCE Traditional Chinese medicine (TCM) is commonly provided to cancer patients, however, the patterns of prescriptions for this type of medicine in Taiwan are unclear. This study aimed to evaluate the use of traditional Chinese medicine products in colon cancer patients post-surgery in Taiwan and to research patterns of TCM. MATERIAL AND METHODS This was a cross-sectional study of newly diagnosed colon cancer patients who received surgery between 2004 and 2008 identified from the National Health Insurance Research Database of Taiwan. The prescription patterns and reasons for the use of TCM for colon cancer were analyzed. RESULTS The results showed that "symptoms, signs and ill-defined conditions" (23.3%) and diseases of the digestive system (16.9%) were the most common reasons for using Chinese herbal medicine. Xiang-sha-liu-jun-zi-tang (7.1%), Bu-zhong-yi-qi-tang (4.3%), Jia-wei-xiao-yao-san (4.1%), Shen-Ling-Bai-Zhu-San (3.7%), Ban-Xia-Xie-Xin-Tang (3.4%), Gui-pi-tang (2.4%), Ping-Wei-San (2.4%), Gan-Lu-Yin (2.0%), Bao-He-Wan (1.9%), and Zhen-Ren-Huo-Ming-Yin (1.8%) were the most commonly prescribed single Chinese herbal formulae (CHF) for colon cancer patients post-surgery. Hedyotis diffusa Willd (Bai Hua She She Cao) (5.1%) and Scutellaria barbata (Ban Zhi Lian )(4.8%) were the most commonly prescribed single Chinese herbs. CONCLUSIONS This study identified patterns of TCM use in colon cancer patients post-surgery in Taiwan. The herbal ingredients were most commonly used for stimulate ghrelin secretion to increase food intake and had potential anti-tumor effect. However, further research is required to evaluate any beneficial effects which could identify leads for the development of new treatment strategies using TCM.
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Affiliation(s)
- Te-Hsin Chao
- Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan, ROC; Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Pin-Kuei Fu
- Division of Critical Care & Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan, ROC; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan, ROC
| | - Chiung-Hung Chang
- School of Chinese Medicine, China Medical University, Taichung 404, Taiwan, ROC; Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan, ROC
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, #160, Section 3, Chung-Kang Rd., Taichung, Taichung 407, Taiwan, ROC
| | - Frank Chiahung Mao
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, #160, Section 3, Chung-Kang Rd., Taichung, Taichung 407, Taiwan, ROC.
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Yen CM, Kuo CL, Lin MC, Lee CF, Lin KY, Lin CL, Chang SN, Sung FC, Kao CH. Sleep disorders increase the risk of osteoporosis: a nationwide population-based cohort study. Sleep Med 2014; 15:1339-44. [PMID: 25224072 DOI: 10.1016/j.sleep.2014.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/23/2014] [Accepted: 07/03/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study evaluated the relationship between sleep disorders (SDs) and osteoporosis risk in Taiwan. METHODS From the Taiwan National Health Insurance data, we identified 44,690 newly diagnosed SD patients (846 with apnea and 43,844 without) from 1998 to 2001 and 89,380 comparisons without SD in the same period frequency matched by sex, age and diagnosis year. Incident osteoporosis was measured by the end of 2010. RESULT Patients with apnea-SD and nonapnea SD exhibited a higher osteoporosis incidence rate than did the comparisons (9.97 and 13.3 vs. 6.77 per 1000 person-years, respectively). The Cox method estimated adjusted hazard ratio (HR) of osteoporosis was 2.98 (95% confidence interval [CI] = 2.36-3.74) in apnea-SD patients, compared with 2.76 (95% CI = 2.64-2.88) in nonapnea-SD patients after controlling for sex, age, comorbidities, and treatment. Greater HRs of osteoporosis were observed for female patients (4.00, 95% CI = 3.72-4.29) and those aged >64 years (42.0, 95% CI = 33.5-52.7) in the apnea SD sub-cohort. Apnea SD was associated with the highest risk of osteoporosis without fracture compared with both the nonapnea SD sub-cohort and comparisons. CONCLUSION Patients with sleep disorders have an elevated risk of osteoporosis, especially for women and the elderly.
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Affiliation(s)
- Chia-Ming Yen
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - Chi-Ling Kuo
- Department of Nuclear Medicine, New Taipei City Hospital, Sanchong Branch, Taipei, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Chun-Feng Lee
- Department of Oral and Maxillofacial Surgery, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - Kuan-Yu Lin
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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Yu TM, Lin CL, Chang SN, Sung FC, Huang ST, Kao CH. Osteoporosis and fractures after solid organ transplantation: a nationwide population-based cohort study. Mayo Clin Proc 2014; 89:888-95. [PMID: 24809760 DOI: 10.1016/j.mayocp.2014.02.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 01/08/2014] [Revised: 02/11/2014] [Accepted: 02/17/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the incidence of bone disorders after solid organ transplantation (SOT). PARTICIPANTS AND METHODS We used Taiwan's National Health Insurance Research Database to identify 9428 recipients of SOT and 38,140 sex- and age- matched control subjects between January 1, 1997, and December 31, 2010, to compare the incidence and risk of bone disorders between groups. RESULTS Recipients of SOT had a significantly higher incidence of osteoporosis and related fractures compared with the non-SOT group. The overall hazard ratio (HR) of osteoporosis after SOT was 5.14 (95% CI, 3.13-8.43), and the HR of related fractures was 5.76 (95% CI, 3.80-8.74). The highest HRs were observed in male patients (HR, 7.09; 95% CI, 3.09-16.3) and in those aged 50 years or younger (HR, 7.38; 95% CI, 2.46-22.1). In addition, SOT patients without any comorbidities had a 9.03-fold higher risk of osteoporosis than non-SOT participants (HR, 9.03; 95% CI, 5.29-15.4). To compare the risk of osteoporosis and related fractures in different recipients of SOT, the highest risk of osteoporosis and fractures was noted in patients receiving lung transplantation, followed by other types of SOT. CONCLUSION We report high rates of metabolic bone disorders after SOT in chronic transplant patients over a long follow-up. Both underlying bone disorders before transplantation and use of immunosuppressant agents may contribute to bone disorders after transplantation.
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Affiliation(s)
- Tung-Min Yu
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Taichung Veteran General Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ting Huang
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Taichung Veteran General Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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Chou CH, Lin CL, Chang SN, Lin MC, Kao CH, Huang YJ. A nationwide population-based retrospective cohort study: Increased risk of acute myocardial infarction in systemic lupus erythematous patients. Int J Cardiol 2014; 174:751-3. [DOI: 10.1016/j.ijcard.2014.04.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
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Tsai MS, Lin CL, Chang SN, Lee PH, Kao CH. Diabetes mellitus and increased postoperative risk of acute renal failure after hepatectomy for hepatocellular carcinoma: a nationwide population-based study. Ann Surg Oncol 2014; 21:3810-6. [PMID: 24841349 DOI: 10.1245/s10434-014-3777-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to determine the effects of diabetes mellitus (DM) on the risk of surgical mortality and morbidity in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). METHODS We identified 2,962 DM patients who underwent a hepatectomy for HCC from 2000 to 2010. The non-DM control cohort consisted of 2,962 patients who also received a hepatectomy during the same period. Age, sex, comorbidities, and year of admission were all matched between the 2 cohorts. RESULTS The prevalence of preoperative coexisting medical conditions was comparable between the DM and non-DM cohorts, except the percentage of patients undergoing major hepatectomy (lobectomy; 18.1 % in the DM cohort vs. 20.4 % in the non-DM cohort; p = 0.02).The hazard ratio (HR) of 30-day postoperative mortality in the DM patients after hepatectomy was 1.17 [95 % confidence interval (CI) 0.75-1.84] after adjustment. The DM cohort exhibited a significantly higher risk of postoperative septicemia (adjusted hazard ratio, 1.45; 95 % CI 1.06-2.00) and acute renal failure (adjusted hazard ratio, 1.70; 95 % CI 1.01-2.84) compared with that of the non-DM cohort, but this higher risk was not associated with the increased risk of other major morbidities, including pneumonia, stroke, and myocardial infarction. Further analysis showed that major hepatectomy (lobectomy) in DM patients carried higher risks of septicemia and acute renal failure. In multiple regression models, preoperative diabetes-related comorbidities were not significantly associated with 30-day postoperative mortality. CONCLUSIONS DM is associated with a significantly high risk of septicemia and acute renal failure, but not with other major complications or mortality, after hepatectomy for HCC.
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Affiliation(s)
- Ming-Shian Tsai
- Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
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Huang WS, Muo CH, Chang SN, Chang YJ, Tsai CH, Kao CH. Benzodiazepine use and risk of stroke: a retrospective population-based cohort study. Psychiatry Clin Neurosci 2014; 68:255-62. [PMID: 24829937 DOI: 10.1111/pcn.12117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to investigate the possible association between benzodiazepine (BZD) use and risk of incident stroke by utilizing data from 2000 to 2003 from the National Health Insurance system of Taiwan. METHODS Study subjects consisted of 38,671 patients with new BZD use and 38,663 people without BZD use who were frequency-matched for age, sex and baseline comorbidity with BZD users. All subjects had no history of stroke. Each study patient's case was followed until a new diagnosis of stroke was made or until the patient was censored by loss to follow up, death, or termination of insurance. The study lasted until the end of 2009. A Cox proportional hazards regression model was used to estimate the incidences and hazard ratios (HR) of stroke. RESULTS The HR of hemorrhagic stroke was significantly lower in the BZD group when compared with the non-BZD group. For patients aged 20-39 years, the HR of ischemic stroke was significantly higher in the BZD group when compared with the non-BZD group. Compared to the non-BZD group, patients with a lower annual dosage (<1 g) or duration (<30 days) of BZD use had a lower risk of stroke in the elder group (P < 0.0001) and patients with a higher annual dosage (≥ 4 g) or duration (≥ 95 days) of BZD use had a higher risk of stroke in all age groups (P < 0.0001). CONCLUSIONS Our findings may suggest neuroprotection under lower-dosage BZD use and neurotoxicity under higher-dosage BZD use.
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Affiliation(s)
- Wei-Shih Huang
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
| | | | | | - Yen-Jung Chang
- Management Office for Health Data; Taichung Taiwan
- Department of Health Promotion and Health Education; National Taiwan Normal University; Taipei Taiwan
| | - Chon-Haw Tsai
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; School of Medicine; College of Medicine; China Medical University; Taichung Taiwan
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Yen CM, Muo CH, Lin MC, Chang SN, Chang YJ, Kao CH. A nationwide population cohort study: irritable bowel syndrome is a risk factor of osteoporosis. Eur J Intern Med 2014; 25:87-91. [PMID: 24183216 DOI: 10.1016/j.ejim.2013.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/14/2013] [Accepted: 10/17/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND The goal of the study is to determine the relationship between irritable bowel syndrome (IBS) and osteoporosis in Taiwan. MATERIALS AND METHODS We collected data from the National Health Insurance (NHI) program in Taiwan. The sample in this study consisted of 31,892 patients enrolled from 2000 to 2009 and diagnosed by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). We divided the sample into 2 cohorts based on whether they had IBS, and formed subgroups based on age, sex, enrolment year, and enrolment month. RESULTS Age and gender did not differ statistically among the 2 cohorts. Results show that IBS is more correlated with urbanization and the occupation of business. The IBS cohort had a higher incidence of osteoporosis than the non-IBS cohort (6.90 vs 4.15 per 1000 person-years; HR=1.65, 955 CI=1.54-1.77). Female patients aged 40-59years had the highest risk of developing osteoporosis (HR=4.42, 95% CI=3.37-5.79 in the IBS cohort; HR=4.41, 95% CI=3.67-5.29 in the non-IBS cohort, respectively). In IBS patients less than 40years of age, female patients had a significant 2.18-fold greater risk of developing osteoporosis than male patients (HR=2.18, 95% CI=1.09-4.38). CONCLUSIONS IBS is a risk factor for osteoporosis in Taiwan.
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Affiliation(s)
- Chia-Ming Yen
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Shih-Ni Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Jung Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine PET Center, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
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Yen YS, Sun LM, Lin CL, Chang SN, Sung FC, Kao CH. Higher risk for meningioma in women with uterine myoma: a nationwide population-based retrospective cohort study. J Neurosurg 2013; 120:655-61. [PMID: 24313608 DOI: 10.3171/2013.10.jns131357] [Citation(s) in RCA: 6] [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] [Indexed: 11/06/2022]
Abstract
OBJECT Evidence suggests that hormones play a role in modifying both uterine myoma (UM) and meningioma. A number of studies have observed the positive association between these diseases. The aim of the current population-based study was to determine if women with UM are at a higher risk for meningioma. METHODS The authors used data from the National Health Insurance system of Taiwan for the study. The UM cohort contained 281,244 women. Each woman was randomly frequency-matched with 4 women without UM, based on age, index year of diagnosis, occupation, urbanization (urbanization level was categorized by the population density of the residential area into 4 levels, with Level 1 as the most urbanized and Level 4 as the least urbanized), and comorbidity, to form the control cohort. Cox's proportional hazard regression analysis was conducted to estimate the influence of UM on the meningioma risk. RESULTS Among women with UM, the risk of developing meningioma was significantly higher (45%) than among women without UM (95% CI 1.23-1.70). The same phenomenon was observed among most age groups, but a significant difference was only seen in the middle-age range. For women with UM, further analysis did not show a significant change after myomectomy. The cumulative incidence of meningioma between groups with and without UM differed over time. CONCLUSIONS The nationwide population-based cohort study found that Taiwanese women with UM are at higher risk for developing meningioma.
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Affiliation(s)
- Yu-Shu Yen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei
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Sun LM, Lin MC, Liang JA, Chang YJ, Chang SN, Sung FC, Muo CH, Kao CH. Does use of tetracyclic antidepressant-mirtazapine reduce cancer risk in depression patients? Pharmacoepidemiol Drug Saf 2013; 22:1292-7. [PMID: 24115340 DOI: 10.1002/pds.3523] [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: 09/19/2012] [Revised: 07/09/2013] [Accepted: 08/25/2013] [Indexed: 11/12/2022]
Abstract
PURPOSE We conducted a nested case-control study to evaluate the association between risk of cancer and mirtazapine use in depression patients in Taiwan. METHODS We obtained data from the Taiwan National Health Insurance Research Database to conduct a population-based nested case-control study. The study cohort included 16 897 patients diagnosed with depression between January 1, 2000 and December 31, 2008. We identified 530 cancer patients as the study group and matched 4 non-cancer subjects with each cancer patient by incident density, age, and sex. Odds ratios and 95% confidence intervals were estimated using multivariate conditional logistic regression analysis. RESULTS Use of mirtazapine for depression did not have significant effect on overall cancer incidence (odds ratio: 1.03, 95% confidence interval: 0.72-1.48). Further analysis of annual mirtazapine dosages and the duration of mirtazapine use revealed no significant effect on cancer risk. CONCLUSION The findings of this population-based nested case-control study suggest that mirtazapine use may not provide a tumor suppression effect in humans such as that seen in the animal model. Future large-scale and in-depth investigations in this area are warranted.
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Affiliation(s)
- Li-Min Sun
- Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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Lai HC, Chang SN, Lin CC, Chen CC, Chou JW, Peng CY, Lai SW, Sung FC, Li YF. Does diabetes mellitus with or without gallstones increase the risk of gallbladder cancer? Results from a population-based cohort study. J Gastroenterol 2013; 48:856-65. [PMID: 23065035 DOI: 10.1007/s00535-012-0683-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 01/28/2012] [Accepted: 09/07/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Previous studies have suggested that diabetes mellitus (DM) is a risk factor for gallbladder cancer; however, it remains unclear whether DM with or without gallstones increases the risk of gallbladder cancer. The aim of this study was to evaluate the risk factors for gallbladder cancer, including sex, hypertension, hyperlipidemia, gallstones, and DM. METHODS The study cohort consisted of 214,179 subjects newly diagnosed with diabetes (cases) collected from the claims data of the Health Insurance Program of Taiwan from 2000 to 2001 who were retrospectively enrolled. The control group consisted of 206,860 subjects without diabetes, matched with the cases for sex, age, and index year. The subjects were followed up until the end of 2008. The effects of the risk factors on the incidence of gallbladder cancer were evaluated with Cox's proportional hazard regression models. RESULTS The risk of gallbladder cancer was higher in the DM group than in the non-DM group, with a hazard ratio (HR) of 1.53 [95 % confidence interval (CI) 1.22-1.90]. Gallstones were also a risk factor for gallbladder cancer, with an HR of 2.52 (95 % CI 1.11-5.73). DM and gallstones were synergistic risk factors for gallbladder cancer (p < 0.0001), with an HR of 5.37 (95 % CI 3.17-9.10) for subjects with both diseases in relation to those with neither of these conditions. CONCLUSIONS In the present long-term cohort study, DM with or without gallstones increased the risk of gallbladder cancer. Gallstones were independently related to gallbladder cancer, and DM and gallstones were synergistic risk factors for gallbladder cancer.
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Affiliation(s)
- Hsueh-Chou Lai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
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Tsai JD, Chang SN, Mou CH, Sung FC, Lue KH. Association between atopic diseases and attention-deficit/hyperactivity disorder in childhood: a population-based case-control study. Ann Epidemiol 2013; 23:185-8. [PMID: 23375343 DOI: 10.1016/j.annepidem.2012.12.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 12/17/2012] [Accepted: 12/24/2012] [Indexed: 12/29/2022]
Abstract
PURPOSE Both atopic diseases (AD) and attention-deficit/hyperactivity disorders (ADHD) are common pediatric disorders that may lead to mental and physical complications. This population-based, case-control design is to correlate the risk of ADHD with AD among a pediatric population. METHODS By using a Longitudinal Health Insurance Database ranged from 2002 to 2009, 4692 children with ADHD and 18,768 randomly selected controls were enrolled. Odds ratios (OR) of ADHD were calculated for the association with AD. RESULTS The children with ADHD had a higher rate of AD than controls, particularly allergic rhinitis and allergic conjunctivitis. The corresponding ORs were 1.81 (95% confidence interval [CI], 1.69-1.93) and 1.69 (95% CI, 1.58-1.81), respectively. Despite the lower prevalence, children with atopic dermatitis and asthma were also at higher risk of ADHD, with ORs of 1.80 (95% CI, 1.58-2.05) and 1.48 (95% CI, 1.24-1.78). Logistic regression analysis estimated ORs showed ADHD risk was higher for those living in urban areas. The risk of ADHD increased with numbers of AD and age. CONCLUSIONS Most of the children with ADHD had a strong association with AD, especially allergic rhinitis. Awareness of these comorbidities may help clinicians to provide better comprehensive management and reduce the burden of disease.
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Affiliation(s)
- Jeng-Dau Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Lee WY, Sun LM, Lin MC, Liang JA, Chang SN, Sung FC, Muo CH, Kao CH. A higher dosage of oral alendronate will increase the subsequent cancer risk of osteoporosis patients in Taiwan: a population-based cohort study. PLoS One 2012; 7:e53032. [PMID: 23300854 PMCID: PMC3534103 DOI: 10.1371/journal.pone.0053032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/22/2012] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Controversy still exists regarding whether alendronate (ALN) use increases the risk of esophageal cancer or breast cancer. METHODS This paper explores the possible association between the use of oral ALN in osteoporosis patients and subsequent cancer risk using the National Health Insurance (NHI) system database of Taiwan with a Cox proportional-hazard regression analysis. The exposure cohort contained 5,624 osteoporosis patients used ALN and randomly frequency-matched by age and gender of 3 osteoporosis patients without any kind of anti-osteoporosis drugs in the same period. RESULTS For a dose ≥ 1.0 g/year, the risk of developing overall cancer was significantly higher (hazard ratio: 1.69, 95% confidence ratio: 1.39-2.04) than in osteoporosis patients without any anti-osteoporosis drugs. The risks for developing liver, lung, and prostate cancers and lymphoma were also significantly higher than in the control group. CONCLUSIONS This population-based retrospective cohort study did not find a relationship between ALN use and either esophageal or breast cancer, but unexpectedly discovered that use of ALN with dose ≥ 1.0 g/year significantly increased risks of overall cancer incidence, as well as liver, lung, and prostate cancers and lymphoma. Further large population-based unbiased studies to enforce our findings are required before any confirmatory conclusion can be made.
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Affiliation(s)
- Wen-Yuan Lee
- China Medical University Hospital Taipei Branch, Taipei, Taiwan
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Li-Min Sun
- Department of Radiation Oncology, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Ji-An Liang
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Ph.D. Program for Cancer Biology and Drug Discovery, China Medical University, Taichung, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Institute of Environmental Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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Yeh CC, Liao CC, Muo CH, Chang SN, Hsieh CH, Chen FN, Lane HY, Sung FC. Mental disorder as a risk factor for dog bites and post-bite cellulitis. Injury 2012; 43:1903-7. [PMID: 21529803 DOI: 10.1016/j.injury.2011.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 09/03/2010] [Revised: 01/31/2011] [Accepted: 03/14/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Patients with mental disorders are at an increased risk for sustaining traumatic injury. No study has evaluated the association between mental disorders and the injury of dog bite. We conducted case-control studies to investigate whether people with mental disorders are at elevated risks of dog bite and post-bite cellulitis. METHODS Using insurance data of 2000-2007, we compared 4660 patients with dog bites and 18,640 controls without the events for the association with mental disorders and other covariates. Amongst those with dog bites, a nested case-control study was performed to compare 286 patients with post-bite cellulites and rest of 4374 patients for factors associated with the infection. RESULTS Young children, the older adults, and people with low socioeconomic status were at an elevated risk of sustaining the dog bite. In separate logistic regression models adjusting for socio-demographic variables, the results showed that patients with concomitant psychotic and non-psychotic mental disorders were associated with increased risks of dog bites (adjusted odds ratio [OR]=1.51, 95% confidence interval [CI]: 1.32-1.74) and of post-bite cellulitis (OR=2.13, 95% CI 1.46-3.10). CONCLUSIONS Individuals with mental disorders are likely at an elevated risk for serious dog bites and post-bite cellulitis.
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Affiliation(s)
- Chun-Chieh Yeh
- Trauma and Emergency Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
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Su FH, Chang SN, Chen PC, Sung FC, Huang SF, Chiou HY, Su CT, Lin CC, Yeh CC. Positive association between hepatitis C infection and oral cavity cancer: a nationwide population-based cohort study in Taiwan. PLoS One 2012; 7:e48109. [PMID: 23133554 PMCID: PMC3485043 DOI: 10.1371/journal.pone.0048109] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 09/19/2012] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The association between viral hepatitis (B and C) and oral cavity cancer has been widely debated. This nationwide, population-based cohort study assessed the subsequent risk of oral cavity cancer among patients with chronic viral hepatitis infection. MATERIALS AND METHODS Data were retrieved from insurance claims data of 1,000,000 randomly sampled individuals covered under the Taiwan National Health Insurance system. We identified a total of 21,199 adults with chronic viral hepatitis infection (12,369 with HBV alone, 5,311 with HCV alone, and 3,519 with HBV/HCV dual infections) from 2000-2005. Comparison group comprised 84,796 sex- and age-matched subjects without viral hepatitis during the same study period. Incidence and risk of subsequent oral cavity cancer were measured until 2008. RESULTS The incidence of oral cavity cancers was 2.28-fold higher among patients with HCV alone than non-viral hepatitis group (6.15 versus 2.69 per 10,000 person-years). After adjusting for sociodemographic covariates, HCV alone was significantly associated with an increased risk for oral cavity cancer (hazard ratio (HR) = 1.90, 95% confidence interval (CI) = 1.20-3.02). This positive association was highest among individuals in the 40-49-year age group (HR = 2.57, 95% CI = 1.21-5.46). However, there were no significant associations between HBV alone or HBV/HCV dual infections and risk for oral cavity cancer. CONCLUSION Our data suggest that HCV but not HBV infection is a risk factor for oral cavity cancer. In addition, subjects with HCV infection tend to be at early onset risk for oral cavity cancer. This finding needs to be replicated in further studies.
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Affiliation(s)
- Fu-Hsiung Su
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shih-Ni Chang
- The Ph.D. Program for Cancer Biology and Drug Discovery, China Medical University, Taichung, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Chun Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
- Center of Excellence for Cancer Research, Taipei Medical University, Taipei, Taiwan
| | - Chien-Tien Su
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Chih-Ching Yeh
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- * E-mail:
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Liang JA, Sun LM, Lin MC, Chang SN, Sung FC, Muo CH, Kao CH. A population-based nested case-control study in taiwan: use of 5α-reductase inhibitors did not decrease prostate cancer risk in patients with benign prostate hyperplasia. Oncologist 2012; 17:986-91. [PMID: 22723508 DOI: 10.1634/theoncologist.2011-0464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND 5α-Reductase inhibitors (5ARIs) are commonly used to treat benign prostate hyperplasia (BPH) by blocking the conversion of testosterone into the more potent dihydrotestosterone. This study explored a possible association between the use of the 5ARIs finasteride and dutasteride and the subsequent risk of prostate cancer or other cancers. METHODS We analyzed data from the Taiwanese National Health Insurance system. In a BPH cohort, we identified 1,489 patients with cancer and included them in our study group. For the control group, 3 patients without cancer were frequency matched with each BPH case for age, BPH diagnosis year, index year, and month. Information regarding past 5ARI use was obtained from the Taiwanese National Health Insurance Research Database (NHIRD). Multivariate logistic regression analysis was conducted, and odds ratio (OR) and 95% confidence interval (CI) were estimated. RESULTS Finasteride use marginally increased the incidence of prostate and overall cancer at a level of statistical significance (prostate cancer: OR = 1.90; 95% CI: 1.00-3.59; overall cancer: OR = 1.51; 95% CI: 1.00-2.28). Dutasteride use significantly increased kidney cancer risk (OR = 9.68, 95% CI: 1.17-80.0). Dosage analysis showed that lower doses of finasteride were associated with higher overall and prostate cancer risks. The major limitation is the lack of important data in the NHIRD, such as prostate cancer histologic grades, smoking habits, alcohol consumption, body mass index, socioeconomic status, and family history of cancer. CONCLUSIONS This population-based nested case-control study suggested that finasteride use may increase prostate and overall cancer risks for patients with BPH. The effects were more prominent for patients using lower doses of finasteride.
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Affiliation(s)
- Ji-An Liang
- Institute of Clinical Medicine Science, China Medical University, Taichung, Taiwan
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Lo SF, Chang SN, Muo CH, Chen SY, Liao FY, Dee SW, Chen PC, Sung FC. Modest increase in risk of specific types of cancer types in type 2 diabetes mellitus patients. Int J Cancer 2012; 132:182-8. [PMID: 22510866 DOI: 10.1002/ijc.27597] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/22/2012] [Indexed: 12/13/2022]
Abstract
Most studies associated diabetes mellitus (DM) with risk of cancer have focused on the Caucasian population and only a few types of cancer. Therefore, a large and comprehensive nationwide retrospective cohort study involving an Asian population was conducted to evaluate the risk of several major types of cancer among Type 2 DM patients. The study analyzed the nationwide population-based database from 1996 to 2009 released by the National Health Research Institute in Taiwan. Incidence and hazard ratios (HRs) were calculated for specific types of cancer. The overall risk of cancers was significantly greater in the DM cohort [N = 895,434; HR = 1.19, 95% confidence interval (CI) = 1.17-1.20], compared with non-DM controls (N = 895,434). Several organs in the digestive and urogenital systems showed increased risk of cancer. The three highest HRs were obtained from cancers of the liver (HR = 1.78, 95% CI = 1.73-1.84), pancreatic (HR = 1.52, 95% CI = 1.40-1.65), and uterus and corpus (HR = 1.38, 95% CI = 1.22-1.55). The risk increased with age, and men with DM aged ≥ 75 years exhibited the highest risk (HR = 7.76, 95% CI = 7.39-8.15). Subjects with DM in this population have a modest increased risk of cancer, similar to the Caucasian population for several specific types of cancer. Old men with DM have the highest risk of cancer. Careful screening for cancer in DM patients is important for early diagnosis and effective treatment.
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Affiliation(s)
- Sui-Foon Lo
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
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Su FH, Su CT, Chang SN, Chen PC, Sung FC, Lin CC, Yeh CC. Association of hepatitis C virus infection with risk of ESRD: a population-based study. Am J Kidney Dis 2012; 60:553-60. [PMID: 22554802 DOI: 10.1053/j.ajkd.2012.04.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 04/05/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND The association between chronic hepatitis C virus (HCV) infection and end-stage renal disease (ESRD) has been widely debated. STUDY DESIGN National population-based cohort study. SETTING & PARTICIPANTS Insurance claims data from the Taiwan National Health Insurance Research Database in 2000-2005. PREDICTOR Chronic HCV infection as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification. OUTCOMES ESRD as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification. RESULTS We identified 6,291 adults with chronic HCV infection. The control group included 31,455 sex- and age-matched individuals without evidence of chronic hepatitis. The incidence of ESRD was 2.14-fold higher in patients with chronic HCV infection (HR, 1.53; 95% CI, 1.17-2.01; P = 0.002) than in patients without HCV infection. Age stratification analysis showed that patients aged 50-59 years with chronic HCV infection (HR, 7.77; 95% CI, 4.23-14.3; P < 0.001) had the highest risk of developing ESRD relative to patients aged 20-49 years without chronic HCV infection (interaction P < 0.001). LIMITATIONS Lack of clinical data. CONCLUSIONS Patients with chronic HCV infection are at greater risk of developing ESRD than individuals without chronic HCV infection. In addition, the risk of developing ESRD is highest in younger patients with HCV infection. Early renal screening programs should be initiated for this high-risk group of young individuals with chronic HCV infection.
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Affiliation(s)
- Fu-Hsiung Su
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taiwan
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