Publications by authors named "Chien-Cheng Huang"

130 Publications

Analysis of COVID-19 pandemic impact on the presenting complaints of the emergency department visits.

Medicine (Baltimore) 2021 Dec;100(51):e28406

Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.

Abstract: The impact of coronavirus disease 2019 (COVID-19) on economic and medical systems is significant, especially in the emergency department (ED). The patterns of ED visits have also changed significantly and may play a crucial role in rearranging medical resources to the most needed departments during the pandemic.This was a retrospective study conducted in hospitals of the Cathay Health System. All patients presented to the EDs between January 21, 2020 to April 30, 2020 (pandemic stage) and January 21, 2019 to April 30, 2019 (before the pandemic stage). Basic demographics, including visit characteristics, disposition, and chief complaints, of the patients visiting the ED between these 2 periods of time will be compared and analyzed.A total of 71,739 patients were included in the study. A reduction in ED visits was noted in 15.1% (32,950 ED visits) during the pandemic stage. ED visiting patients with the chief complaints of upper respiratory infection and social problems increased by 14.23% and 1.86%, respectively, during the pandemic period. Critical chief complaints such as cardiac arrest, chest pain and altered mental status decreased to less than the ED visits difference (-15.1%) between the pandemic and prepandemic stages, for 0%, -7.67%, and -13.8% respectively.Rearrangement of the ED pediatric staff to the COVID-19 special units and recruiting more social workers to the ED should be performed to respond to the COVID-19 pandemic.
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http://dx.doi.org/10.1097/MD.0000000000028406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8701826PMC
December 2021

Epidemiologic Features, Survival, and Prognostic Factors Among Patients With Different Histologic Variants of Glioblastoma: Analysis of a Nationwide Database.

Front Neurol 2021 24;12:659921. Epub 2021 Nov 24.

Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Liouying, Tainan, Taiwan.

Glioblastoma (GBM) is the most common primary intracranial malignancy. Previous studies found incidence of GBM varies substantially by age, sex, race and ethnicity, and survival also varies by country, ethnicity, and treatment. Gliosarcoma (GSM) and giant cell glioblastoma (GC-GBM) are different histologic variants of GBM with distinct clinico-pathologic entities. We conducted a study to compare epidemiology, survival, and prognostic factors among the three. We identified GBM patients diagnosed between 2000 and 2016 using the Taiwan Cancer Registry and followed them using the death registry. Survival was compared among conventional GBM and two histologic variants. The potential confounding factors evaluated in this study included registered year, age, sex, and treatment modality (resection, radiotherapy, and chemotherapy). We enrolled 3,895 patients, including 3,732 (95.8%) with conventional GBM, 102 (2.6%) with GSM, and 61 (1.6%) with GC-GBM. GC-GBM patients had younger mean age at diagnosis (49.5 years) than conventional GBM patients (58.7 years) and GSM patients (61.3 years) ( < 0.01). The three groups had similar sex distributions ( = 0.29). GC-GBM had a longer median survival [18.5, 95% confidence interval (CI): 15.8-25.3 months] than conventional GBM (12.5, 95%CI: 12.0-13.0 months) and GSM (12.8, 95%CI: 9.2-16.2 months), and the differences in overall survival did not attain statistical significance ( = 0.08, log-rank test). In univariate analysis, GC-GBM had better survival than conventional GBM, but the hazard ratio (0.91) did not reach statistical significance (95%CI: 0.69-1.20) in the multivariate analysis. Young ages (≤ 40 years), female sex, resection, radiotherapy, and chemotherapy were factors associated with better survival in overall GBMs. In subtype analyses, these factors remained statistically significant for conventional GBM, as well as radiotherapy for GSM. Our analysis found conventional GBM and its variants shared similar poor survival. Factors with age ≤ 40 years, female sex, resection, radiotherapy, and chemotherapy were associated with better prognosis in conventional GBM patients.
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http://dx.doi.org/10.3389/fneur.2021.659921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651548PMC
November 2021

Chronic Pain Increases the Risk of Dementia: A Nationwide Population-Based Cohort Study.

Pain Physician 2021 09;24(6):E849-E856

Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Background: Chronic pain (CP) may increase the risk of cognitive impairment; however, the association between CP and dementia is still unclear.

Objectives: Therefore, we conducted this study to clarify the association between CP and dementia.

Study Design: Retrospective cohort study.

Settings: Nationwide population based.

Methods: This study recruited 27,792 patients (>= 50 years) with CP from the Taiwan National Health Insurance Research Database between January 1, 2000, and December 31, 2015, as the study cohort. The comparison cohort consists of patients without CP who were matched 1:1 for age, gender, and index date with the study cohort. A comparison of the risk of dementia between the two cohorts was performed by following up until 2015.

Results: The prevalence of CP was 13.4% in the population aged >= 50 years. Patients with CP had a higher risk of dementia than those without CP (adjusted hazard ratio [AHR]: 1.21; 95% confidence interval [CI]: 1.15-1.26). Compared with the other age subgroups, the 50-64 years age group with CP had the highest risk of dementia (AHR: 1.28; 95% CI: 1.14-1.43). The impact of CP on the increased risk of dementia was more prominent in the younger age subgroup and decreased with aging. The increased risk of dementia in patients with CP was persistent, even following up for more than 5 years (AHR: 1.19; 95% CI: 1.12-1.26).

Limitations: Using "analgesics use at least 3 months" as the surrogate criteria of CP may underestimate the diagnosis of CP.

Conclusions: CP was associated with a higher risk of dementia, especially in the 50-64 years age group. Early treatment of CP for the prevention of dementia is suggested.
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September 2021

Real-time interactive artificial intelligence of things-based prediction for adverse outcomes in adult patients with pneumonia in the emergency department.

Acad Emerg Med 2021 11 29;28(11):1277-1285. Epub 2021 Jul 29.

Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.

Background: Artificial intelligence of things (AIoT) may be a solution for predicting adverse outcomes in emergency department (ED) patients with pneumonia; however, this issue remains unclear. Therefore, we conducted this study to clarify it.

Methods: We identified 52,626 adult ED patients with pneumonia from three hospitals between 2010 and 2019 for this study. Thirty-three feature variables from electronic medical records were used to construct an artificial intelligence (AI) model to predict sepsis or septic shock, respiratory failure, and mortality. After comparisons of the predictive accuracies among logistic regression, random forest, support-vector machine (SVM), light gradient boosting machine (LightGBM), multilayer perceptron (MLP), and eXtreme Gradient Boosting (XGBoost), we selected the best one to build the model. We further combined the AI model with the Internet of things as AIoT, added an interactive mode, and implemented it in the hospital information system to assist clinicians with decision making in real time. We also compared the AIoT-based model with the confusion-urea-respiratory rate-blood pressure-65 (CURB-65) and pneumonia severity index (PSI) for predicting mortality.

Results: The best AI algorithms were random forest for sepsis or septic shock (area under the curve [AUC] = 0.781), LightGBM for respiratory failure (AUC = 0.847), and mortality (AUC = 0.835). The AIoT-based model represented better performance than CURB-65 and PSI indicators for predicting mortality (0.835 vs. 0.681 and 0.835 vs. 0.728).

Conclusions: A real-time interactive AIoT-based model might be a better tool for predicting adverse outcomes in ED patients with pneumonia. Further validation in other populations is warranted.
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http://dx.doi.org/10.1111/acem.14339DOI Listing
November 2021

Selective brain cooling achieves peripheral organs protection in hemorrhagic shock resuscitation via preserving the integrity of the brain-gut axis.

Int J Med Sci 2021 4;18(13):2920-2929. Epub 2021 Jun 4.

Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.

Although whole-body cooling has been reported to improve the ischemic/reperfusion injury in hemorrhagic shock (HS) resuscitation, it is limited by its adverse reactions following therapeutic hypothermia. HS affects the experimental and clinical bowel disorders via activation of the brain-gut axis. It is unknown whether selective brain cooling achieves beneficial effects in HS resuscitation via preserving the integrity of the brain-gut axis. Male Sprague-Dawley rats were bled to hypovolemic HS and resuscitated with blood transfusion followed by retrograde jugular vein flush (RJVF) with 4 °C or 36 °C normal saline. The mean arterial blood pressure, cerebral blood flow, and brain and core temperature were measured. The integrity of intestinal tight junction proteins and permeability, blood pro-inflammatory cytokines, and multiple organs damage score were determined. Following blood transfusion resuscitation, HS rats displayed gut barrier disruption, increased blood levels of pro-inflammatory cytokines, and peripheral vital organ injuries. Intrajugular-based infusion cooled the brain robustly with a minimal effect on body temperature. This brain cooling significantly reduced the HS resuscitation-induced gut disruption, systemic inflammation, and peripheral vital organ injuries in rats. Resuscitation with selective brain cooling achieves peripheral vital organs protection in hemorrhagic shock resuscitation via preserving the integrity of the brain-gut axis.
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http://dx.doi.org/10.7150/ijms.61191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241763PMC
December 2021

The Critical Factors Affecting the Deployment and Scaling of Healthcare AI: Viewpoint from an Experienced Medical Center.

Healthcare (Basel) 2021 Jun 7;9(6). Epub 2021 Jun 7.

Department of Information Systems, Chi Mei Medical Center, Tainan 71004, Taiwan.

Healthcare Artificial Intelligence (AI) has the greatest opportunity for development. Since healthcare and technology are two of Taiwan's most competitive industries, the development of healthcare AI is an excellent chance for Taiwan to improve its health-related services. From the perspective of economic development, promoting healthcare AI must be a top priority. However, despite having many breakthroughs in research and pilot projects, healthcare AI is still considered rare and is broadly used in the healthcare setting. Based on a medical center in Taiwan that has introduced a variety of healthcare AI into practice, this study discussed and analyzed the issues and concerns in the development and scaling of medical AIs from the perspective of various stakeholders in the healthcare setting, including the government, healthcare institutions, users (healthcare workers), and AI providers. The present study also identified critical influential factors for the deployment and scaling of healthcare AI. It is hoped that this paper can serve as an important reference for the advancement of healthcare AI not only in Taiwan but also in other countries.
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http://dx.doi.org/10.3390/healthcare9060685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226916PMC
June 2021

Comparison of the Risk for Peripheral Vertigo between Physicians and the General Population.

Iran J Public Health 2021 Jan;50(1):180-187

Department of Occupational Medicine, Chi Mei Medical Center, Tainan, Taiwan.

Background: Because of the limited information available regarding peripheral vertigo (PV) in physicians, we conducted this study to clarify this issue.

Methods: We used Taiwan National Health Insurance Research Database to identify 26,309 physicians and an identical number of general population matched by age and sex. All the participants who had PV before 2007 and residents were excluded. By tracing their medical histories between 2007 and 2013, comparisons of PV risk between physicians and general population and among physicians were performed.

Results: Physicians had a significantly lower PV risk than the general population (adjusted odds ratio [AOR]: 0.811; 95% confidence interval [CI]: 0.662-0.994). In comparison among physicians, otolaryngologists had a significantly higher PV risk than other specialties. Physicians who were older or served in local hospitals or clinics had a significantly higher PV risk than physicians in medical centers.

Conclusion: Physicians had a significantly lower PV risk than the general population. Better medical knowledge in physicians than in the general population may explain the findings; however, further studies are warranted for elucidating the detailed mechanisms.
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http://dx.doi.org/10.18502/ijph.v50i1.5085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213624PMC
January 2021

Predicting outcomes in older ED patients with influenza in real time using a big data-driven and machine learning approach to the hospital information system.

BMC Geriatr 2021 04 27;21(1):280. Epub 2021 Apr 27.

Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.

Background: Predicting outcomes in older patients with influenza in the emergency department (ED) by machine learning (ML) has never been implemented. Therefore, we conducted this study to clarify the clinical utility of implementing ML.

Methods: We recruited 5508 older ED patients (≥65 years old) in three hospitals between 2009 and 2018. Patients were randomized into a 70%/30% split for model training and testing. Using 10 clinical variables from their electronic health records, a prediction model using the synthetic minority oversampling technique preprocessing algorithm was constructed to predict five outcomes.

Results: The best areas under the curves of predicting outcomes were: random forest model for hospitalization (0.840), pneumonia (0.765), and sepsis or septic shock (0.857), XGBoost for intensive care unit admission (0.902), and logistic regression for in-hospital mortality (0.889) in the testing data. The predictive model was further applied in the hospital information system to assist physicians' decisions in real time.

Conclusions: ML is a promising way to assist physicians in predicting outcomes in older ED patients with influenza in real time. Evaluations of the effectiveness and impact are needed in the future.
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http://dx.doi.org/10.1186/s12877-021-02229-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077903PMC
April 2021

Increased Risk of Congestive Heart Failure Following Carbon Monoxide Poisoning.

Circ Heart Fail 2021 04 19;14(4):e007267. Epub 2021 Apr 19.

Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-C. Huang, T.-H.C., H.-R.G.).

Background: Carbon monoxide poisoning (COP) is an important public health issue around the world. It may increase the risk of myocardial injury, but the association between COP and congestive heart failure (CHF) remains unclear. We conducted a study incorporating data from epidemiological and animal studies to clarify this issue.

Methods: Using the National Health Insurance Database of Taiwan, we identified patients with COP diagnosed between 1999 and 2012 and compared them with patients without COP (non-COP cohort) matched by age and the index date at a 1:3 ratio. The comparison for the risk of CHF between the COP and non-COP cohorts was made using Cox proportional hazards regression. We also established a rat model to evaluate cardiac function using echocardiography and studied the pathological changes following COP.

Results: The 20 942 patients in the COP cohort had a higher risk for CHF than the 62 826 members in the non-COP cohort after adjusting for sex and underlying comorbidities (adjusted hazard ratio, 2.01 [95% CI, 1.74-2.32]). The increased risk of CHF persisted even after 2 years of follow-up (adjusted hazard ratio, 1.85 [95% CI, 1.55-2.21]). In the animal model, COP led to a decreased left ventricular ejection fraction on echocardiography and damage to cardiac cells with remarkable fibrotic changes.

Conclusions: Our epidemiological data showed an increased risk of CHF was associated with COP, which was supported by the animal study. We suggest close follow-up of cardiac function for patients with COP to facilitate early intervention and further studies to identify other long-term effects that have not been reported in the literature.
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.120.007267DOI Listing
April 2021

Comprehensive residency-based point-of-care ultrasound training program increases ultrasound utilization in the emergency department.

Medicine (Baltimore) 2021 Feb;100(5):e24644

Department of Emergency Medicine, Cathay General Hospital.

Abstract: Point-of-care ultrasonography (POCUS) is a prompt and simple tool for the urgent diagnosis and treatment of patients in the emergency department (ED). We developed a comprehensive residency-based POCUS training program for ED residents and determined its effect on ultrasound utilization in the ED.We conducted a retrospective cohort study in the ED of a university-affiliated medical center, to evaluate a centralized residency-based POCUS training course for ED residents, which included 12 core ultrasound applications, from July 2017 to June 2018. Each application comprised a combined lecture and hands-on practice session that lasted for 2 hours. Pre-tests and post-tests, including still image and video interpretation, were performed. The use of POCUS (number of ultrasound studies performed divided by the number of patients each resident saw in 1 year) among ED residents, before and after the POCUS training course (July 2016-June 2017 and July 2018-June 2019), was calculated and analyzed using the Wilcoxon signed-rank test.Sixteen residents participated and completed the entire training course. The post-test score was significantly better than the pre-test score, by a median of 12 points (P = .04). Utilization of POCUS among the ED residents increased significantly, from 0.15 ultrasound studies per patient per year to 0.41 ultrasound studies per patient per year (P < .01), after completion of the entire training course. Increased POCUS scanning percentages over the cardiac tissue, soft tissue, abdominal region, vascular system, procedural guidance, and ocular regions were also noted after providing the curriculum.Conducting a comprehensive POCUS education program may enhance POCUS utilization among residents in the ED.
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http://dx.doi.org/10.1097/MD.0000000000024644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870183PMC
February 2021

Carbon monoxide-triggered health effects: the important role of the inflammasome and its possible crosstalk with autophagy and exosomes.

Arch Toxicol 2021 04 8;95(4):1141-1159. Epub 2021 Feb 8.

Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan.

Carbon monoxide (CO) has long been known as a "silent killer" because of its ability to bind hemoglobin (Hb), leading to reduced oxygen carrying capacity of Hb, which is the main cause of CO poisoning (COP) in humans. Emerging studies suggest that mitochondria is a key target of CO action that can impact key biological processes, including apoptosis, cellular proliferation, inflammation, and autophagy. Despite its toxicity at high concentrations, CO also exhibits cyto- and tissue-protective effects at low concentrations in animal models of organ injury and disease. Specifically, CO modulates the production of pro- or anti-inflammatory cytokines and mediators by regulating the NLRP3 inflammasome. Given that human diseases are strongly associated with inflammation, a deep understanding of the exact mechanism is helpful for treatment. Autophagic factors and inflammasomes interact in various situations, including inflammatory disease, and exosomes might function as the bridge between the inflammasome and autophagy activation. Thus, the interplay among autophagy, mitochondrial dysfunction, exosomes, and the inflammasome may play pivotal roles in the health effects of CO. In this review, we summarize the latest research on the beneficial and toxic effects of CO and their underlying mechanisms, focusing on the important role of the inflammasome and its possible crosstalk with autophagy and exosomes. This knowledge may lead to the development of new therapies for inflammation-related diseases and is essential for the development of new therapeutic strategies and biomarkers of COP.
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http://dx.doi.org/10.1007/s00204-021-02976-7DOI Listing
April 2021

Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department.

BMC Infect Dis 2021 Jan 13;21(1):66. Epub 2021 Jan 13.

Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, 613, Taiwan.

Background: Early detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis (a potentially fatal condition caused by the body's response to an infection), may benefit a patient's outcome, since the mortality rate increases by 5-10% for each hour of delayed therapy. Unfortunately, GNB diagnosis is based on bacterial culture, which is time consuming. Therefore, an economic and effective GNB (defined as a positive blood, sputum, or urine culture) infection detection tool in the emergency department (ED) is warranted.

Methods: We conducted a retrospective cohort study in the ED of a university-affiliated medical center between January 01, 2014 and December 31, 2017. The inclusion criteria were as follows: (1) age ≥ 18; (2) clinical suspicion of bacterial infection; (3) bacterial culture from blood, sputum, or urine ordered and obtained in the ED. Descriptive statistics was performed on patient demographic characteristics, vital signs, laboratory data, infection sites, cultured microorganisms, and clinical outcomes. The accuracy of vital signs to predict GNB infection was identified via univariate logistic regression and receiver operating characteristic (ROC) curve analysis.

Results: A total of 797 patients were included in this study; the mean age was 71.8 years and 51.3% were male. The odds ratios of patients with body temperature ≥ 38.5 °C, heart rate ≥ 110 beats per minute, respiratory rate ≥ 20 breaths per minute, and Glasgow coma scale (GCS) < 14, in predicting GNB infection were found to be 2.3, 1.4, 1.9, and 1.6, respectively. The area under the curve values for ROC analysis of these measures were 0.70, 0.68, 0.69, and 0.67, respectively.

Conclusion: The four physiological parameters were rapid and reliable independent predictors for detection of GNB infection.
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http://dx.doi.org/10.1186/s12879-020-05758-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805130PMC
January 2021

Autoimmune Connective Tissue Disease Following Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study.

Clin Epidemiol 2020 20;12:1287-1298. Epub 2020 Nov 20.

Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Background: In addition to hypoxia, oxidative stress and inflammation due to carbon monoxide (CO) poisoning cause adverse health effects. These mechanisms are related to the occurrence of autoimmune connective tissue disease, but studies on the association between CO poisoning and autoimmune connective tissue disease are limited. We conducted a study to evaluate the occurrence of autoimmune connective tissue disease following CO poisoning.

Methods: We identified participants with CO poisoning diagnosed between 1999 and 2012 from the Nationwide Poisoning Database and selected participants without CO poisoning from the Taiwan National Health Insurance Research Database with matching age and index dates at a 1:3 ratio. Sex, underlying comorbidities, and monthly income were also included in the analyses. We followed up the participants until 2013 and made comparison of the risk of autoimmune connective tissue disease between participants with and without CO poisoning.

Results: The 23,877 participants with CO poisoning had a higher risk for autoimmune connective tissue disease than the 71,631 participants without CO poisoning (adjusted hazard ratio [AHR], 3.5; 95% confidence interval [CI], 3.1-3.9) after adjustment for sex, diabetes, Lyme disease, herpes zoster, infectious mononucleosis, hepatitis, HIV infection, liver disease, renal disease, non-CO poisoning or drug abuse, malignancy, hypertension, hyperlipidemia, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and monthly income. An increased risk was observed even after 4 years of follow-up (AHR, 3.6; 95% CI, 3.0-4.4).

Conclusion: The risk of autoimmune connective tissue disease increased following CO poisoning. Close follow-up of the patients with CO poisoning for the development of connective tissue disease is recommended, and further investigation of the detailed mechanisms is warranted.
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http://dx.doi.org/10.2147/CLEP.S266396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686473PMC
November 2020

Impact of carbon monoxide poisoning on the risk of breast cancer.

Sci Rep 2020 11 24;10(1):20450. Epub 2020 Nov 24.

Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, Tainan, 701, Taiwan.

Carbon monoxide (CO) is a toxic gas and an endogenous signaling molecule. Some studies involving cell lines have revealed the potential antibreast cancer effects of CO. Data on such effects in humans, however, are limited. Thus, we conducted a study on patients with CO poisoning (COP) to evaluate the effects of CO on the risk of breast cancer. We identified female patients who were diagnosed with COP over the period of 2002 and 2009 from the Nationwide Poisoning Database of Taiwan. For comparison, we selected females without COP from the National Health Insurance Research Database. Participants in the COP and comparison cohorts were matched on the index year, age, monthly income, and geographic region of residence at a 1:6 ratio. We followed up the two cohorts until the end of 2014 and compared their risks of developing breast cancer. We included 7053 participants with COP and 42,318 participants without COP. Participants with COP were at a lower risk of developing breast cancer than those without COP (0.7% vs. 1.0%, p < 0.001). Cox proportional hazard regression analyses revealed that COP was associated with a hazard ratio of 0.67 (95% confidence interval [95% CI] 0.50-0.90) for breast cancer after we adjusted for age, monthly income, geographic region, and comorbidities of hypertension, diabetes, and hyperlipidemia. Our result provides evidence for the potential protective effects of CO against breast cancer in humans. Further studies that directly evaluate the potential effects are warranted.
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http://dx.doi.org/10.1038/s41598-020-77371-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687884PMC
November 2020

Lung Herniation After Cardiopulmonary Resuscitation With Mechanical Chest Compression Device: First Case Report and Literature Review.

J Acute Med 2020 Jun;10(2):90-93

Chi Mei Medical Center Department of Emergency Medicine Tainan Taiwan.

We reported the first case of lung herniation after cardiopulmonary resuscitation (CPR) with a mechanical chest compression device and a literature review. Older age, long CPR duration, mechanical ventilation, and rib fracture were risk factors. Subcutaneous emphysema was the most common manifestation and indication for further computed tomography to make a definite diagnosis. Despite its rarity, physicians should keep a high awareness of this possible fetal complication. Further studies comparing mechanical and manual CPR for the risk of lung herniation are warranted.
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http://dx.doi.org/10.6705/j.jacme.202003_10(2).0005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517948PMC
June 2020

Real-time AI prediction for major adverse cardiac events in emergency department patients with chest pain.

Scand J Trauma Resusc Emerg Med 2020 Sep 11;28(1):93. Epub 2020 Sep 11.

Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.

Background: A big-data-driven and artificial intelligence (AI) with machine learning (ML) approach has never been integrated with the hospital information system (HIS) for predicting major adverse cardiac events (MACE) in patients with chest pain in the emergency department (ED). Therefore, we conducted the present study to clarify it.

Methods: In total, 85,254 ED patients with chest pain in three hospitals between 2009 and 2018 were identified. We randomized the patients into a 70%/30% split for ML model training and testing. We used 14 clinical variables from their electronic health records to construct a random forest model with the synthetic minority oversampling technique preprocessing algorithm to predict acute myocardial infarction (AMI) < 1 month and all-cause mortality < 1 month. Comparisons of the predictive accuracies among random forest, logistic regression, support-vector clustering (SVC), and K-nearest neighbor (KNN) models were also performed.

Results: Predicting MACE using the random forest model produced areas under the curves (AUC) of 0.915 for AMI < 1 month and 0.999 for all-cause mortality < 1 month. The random forest model had better predictive accuracy than logistic regression, SVC, and KNN. We further integrated the AI prediction model with the HIS to assist physicians with decision-making in real time. Validation of the AI prediction model by new patients showed AUCs of 0.907 for AMI < 1 month and 0.888 for all-cause mortality < 1 month.

Conclusions: An AI real-time prediction model is a promising method for assisting physicians in predicting MACE in ED patients with chest pain. Further studies to evaluate the impact on clinical practice are warranted.
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http://dx.doi.org/10.1186/s13049-020-00786-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488862PMC
September 2020

Association between exercise and health-related quality of life and medical resource use in elderly people with diabetes: a cross-sectional population-based study.

BMC Geriatr 2020 09 7;20(1):331. Epub 2020 Sep 7.

Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan.

Background: Exercise improves glycemic control and functional capacity in elderly people with diabetes; however, its effect on health-related quality of life (HRQoL) and medical resource use remains unclear. This study aims to clarify the effect of exercise.

Methods: Using the data from National Health and Nutrition Examination Survey between 2007 and 2016, we identified 1572 elderly people with diabetes for this cross-sectional population-based study. Demographic characteristics, health conditions, comorbidities, HRQoL, and medical resource were compared among four groups (no exercise, low-intensity exercise, moderate-intensity exercise, and high-intensity exercise).

Results: The mean age of all participants was between 71.5 and 73.3 years. Male participants with higher education performed more exercise than their counterparts. The moderate- and high-intensity groups reported better general health condition than the no exercise group. Depression and worse health were more common in the no exercise group. Participants in the moderate-intensity exercise group had lower risk for depression than those in the no exercise group (adjusted odds ratio: 0.13, 95% confidence interval: 0.02-0.92) after adjusting for demographic characteristics, health conditions, and comorbidities, whereas participants in the low- and high-intensity exercise did not have a lower risk. The no exercise group had the highest proportions of emergency, hospitalization, and total healthcare visits.

Conclusions: Exercise is associated with better HRQoL, and lack of exercise is associated with higher medical resource use in elderly people with diabetes. Encouraging exercise is recommended in this population.
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http://dx.doi.org/10.1186/s12877-020-01750-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487942PMC
September 2020

Ischemia/reperfusion injured intestinal epithelial cells cause cortical neuron death by releasing exosomal microRNAs associated with apoptosis, necroptosis, and pyroptosis.

Sci Rep 2020 09 1;10(1):14409. Epub 2020 Sep 1.

Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.

To date, there is no good evidence that intestine epithelial cells (IEC) affected by ischemia/reperfusion (I/R) injury are able to cause cortical neuron injury directly. Additionally, it remains unclear whether the neuronal damage caused by I/R injured IEC can be affected by therapeutic hypothermia (TH, 32 °C). To address these questions, we performed an oxygen-glucose deprivation (OGD) affected IEC-6-primary cortical neuron coculture system under normothermia (37 °C) or TH (32 °C) conditions. It was found that OGD caused hyperpermeability in IEC-6 cell monolayers. OGD-preconditioned IEC-6 cells caused cortical neuronal death (e.g., decreased cell viability), synaptotoxicity, and neuronal apoptosis (evidenced by increased caspase-3 expression and the number of TUNEL-positive cells), necroptosis (evidenced by increased receptor-interacting serine/threonine-protein kinase-1 [RIPK1], RIPK3 and mixed lineage kinase domain-like pseudokinase [MLKL] expression), and pyroptosis (evidenced by an increase in caspase-1, gasdermin D [GSDMD], IL-1β, IL-18, the apoptosis-associated speck-like protein containing a caspase recruitment domain [ASC], and nucleotide oligomerization domain [NOD]-like receptor [NLRP]-1 expression). TH did not affect the intestinal epithelial hyperpermeability but did attenuate OGD-induced neuronal death and synaptotoxicity. We also performed quantitative real-time PCR to quantify the genes encoding 84 exosomal microRNAs in the medium of the control-IEC-6, the control-neuron, the OGD-IEC-6 at 37 °C, the OGD-IEC-6 at 32 °C, the neuron cocultured with OGD-IEC-6 at 37 °C, and the neurons cocultured with OGD-IEC-6 at 32 °C. We found that the control IEC-6 cell s or cortical neurons are able to secrete a basal level of exosomal miRNAs in their medium. OGD significantly up-regulated the basal level of each parameter for IEC-6 cells. As compared to those of the OGD-IEC-6 cells or the control neurons, the OGD-IEC-6 cocultured neurons had significantly higher levels of 19 exosomal miRNAs related to apoptosis, necroptosis, and/or pyroptosis events. Our results identify that I/R injured intestinal epithelium cells can induce cortical neuron death via releasing paracrine mediators such as exosomal miRNAs associated with apoptosis, necroptosis, and/or pyroptosis, which can be counteracted by TH.
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http://dx.doi.org/10.1038/s41598-020-71310-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462997PMC
September 2020

Risk of Dementia in Diabetic Patients with Hyperglycemic Crisis: A Nationwide Taiwanese Population-Based Cohort Study.

Neuroepidemiology 2020 25;54(5):419-426. Epub 2020 Aug 25.

Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan,

Background: A hyperglycemic crisis episode (HCE) signifies poor control of diabetes and may increase the risk of dementia via microvascular and macrovascular injuries.

Objectives: We conducted this study to clarify this issue, which remains unclear.

Methods: Using the Taiwan National Health Insurance Database, we identified 9,466 diabetic patients with HCE and the identical number of diabetic patients without HCE who were matched by age and sex for this nationwide population-based cohort study. The risk of dementia was compared between the 2 cohorts by following up until 2014. Investigation of independent predictors of dementia was also done.

Results: In the overall analysis, the risk of dementia between the 2 cohorts was not different. However, stratified analyses showed that patients with HCE had a higher risk of subsequent dementia in the age subgroup of 45-54 and 55-64 years (adjusted odds ratio [AOR]: 2.4, 95% confidence interval [CI]: 1.6-3.6, and AOR: 1.2, 95% CI: 1.0-1.5, respectively). In the overall analysis, older age, female sex, ≥3 HCEs, hypertension, hyperlipidemia, depression, cerebrovascular disease, Parkinson's disease, and head injury were independent predictors.

Conclusions: HCE increased the risk of dementia in diabetic patients aged 45-64 years. Dementia was predicted by ≥3 HCEs. Prevention of recurrent HCE, control of comorbidities, and close follow-up of cognitive decline and dementia are suggested in patients with HCE.
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http://dx.doi.org/10.1159/000509754DOI Listing
September 2021

Prevalence of Geriatric Syndromes and the Need for Hospice Care in Older Patients of the Emergency Department: A Study in an Asian Medical Center.

Emerg Med Int 2020 17;2020:7174695. Epub 2020 Jul 17.

Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan.

Background: The prevalence of geriatric syndromes and the need for hospice care in the emergency department (ED) in Asian populations remain unclear. This study was conducted to fill the data gap.

Methods: Using a newly developed emergency geriatric assessment (EGA), we investigated the prevalence of geriatric syndromes and the need for hospice care in older ED patients of a tertiary medical center between September 1, 2016, and January 31, 2017.

Results: We recruited a total of 693 patients with a mean age of 78.0 years (standard deviation 8.2 years), comprising 46.6% of females. According to age subgroups, 37.4% of patients were aged 65-74 years, 37.4% were aged 75-84 years, and 25.2% were aged ≥85 years. The prevalence rates of geriatric syndromes were as follows: delirium (11.4%), depression (23.4%), dementia (43.1%), deterioration of activities of daily living (ADL) for <1 year (29.4%), vision impairment (22.2%), hearing impairment (23.8%), sleep disturbance (13.1%), any fall in <1 year (21.8%), polypharmacy (28.7%), pain (35.1%), pressure ulcer (5.6%), incontinence or retention (29.6%), indwelling device or physical restrain (21.6%), nutrition problem (35.7%), frequent use of medical resources (50.1%), lack of advance care planning (84.0%), caregiver problem (4.6%), socioeconomic problem (5.5%), and need for family meeting (6.2%). The need for hospice care was 11.9%. Most geriatric syndromes increased with advancing age except depression, sleep disturbance, polypharmacy, pain, nutrition problem, lack of advance care planning, caregiver problem, and socioeconomic problem.

Conclusion: Geriatric syndromes and the need for hospice care were common in the older ED patients. Further studies about subsequent intervention for improving geriatric care are needed.
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http://dx.doi.org/10.1155/2020/7174695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382720PMC
July 2020

Clinical Frailty Scale in Predicting Postoperative Outcomes in Older Patients Undergoing Curative Surgery for Urologic Malignancies: A Prospective Observational Cohort Study.

Urology 2020 10 23;144:38-45. Epub 2020 Jul 23.

Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address:

Objective: To examine the utility of the Clinical Frailty Scale (CFS) in predicting outcomes in older adults with urologic malignancies undergoing curative surgeries.

Methods: This prospective observational cohort study was conducted in a university-based tertiary medical center. Patients aged 75 years or older who were scheduled to undergo curative surgery for a urologic malignancy from January 2017 to December 2017 were recruited. Patients were grouped according to the CFS scores. The primary postoperative outcome measures were a major complication within 30 days and a decline in the activities of daily living (ADL) within 30 days and 90 days. Multivariable analyses and the area under the receiver operating characteristic curve were performed to investigate the association between the CFS and postoperative outcomes.

Results: A total of 82 patients, 50% women, were enrolled with mean age 81.6 years. The CFS was significantly associated with postoperative outcomes in a dose-response relationship. When compared with those with a CFS <5, patients with CFS scores ≥5 had a 10.3-times higher risk for a major complication, 8.5-times and 21.4-times higher risk for a decline in ADL within 30 days and 90 days. The area under the receiver operating characteristic curves for the CFS to predict a major complication, the 30-day decline in ADL and the 90-day decline in ADL were 0.60, 0.73, and 0.79.

Conclusion: A higher CFS score predicted a higher risk of poor outcomes in this population. It is recommended that patients with higher CFS scores, especially above 5, are needed to receive further multidisciplinary perioperative care.
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http://dx.doi.org/10.1016/j.urology.2020.06.069DOI Listing
October 2020

Validation of shock index for predicting mortality in older patients with dengue fever.

Aging Clin Exp Res 2021 Mar 12;33(3):635-640. Epub 2020 May 12.

Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.

Background: Older adults have a higher mortality for dengue fever (DF). However, the best method for predicting mortality is still unclear.

Aims: We conducted this study to evaluate the shock index (SI) for this issue.

Methods: A retrospective case-control study was conducted by recruiting older patients (≥ 65 years old) with DF who visited the study hospital in southern Taiwan during the 2015 DF outbreak. Demographic data, vital signs, past histories, decision groups, complications, and mortality were included in the analyses. We evaluated the accuracy of SI ≥ 1 for predicting 30-day mortality in this population.

Results: A total of 626 patients with a mean age of 74.1 years and nearly equal sex distribution were recruited. The mean of SI (± standard deviation [SD]) was 0.6 (± 0.2) and patients with a SI ≥ 1 accounted for 3.5% of the total patients. Logistic regression showed that patients with SI ≥ 1 had a higher mortality than those with SI < 1 (odds ratio: 8.49; 95% confidence interval: 1.76-17.92). The area under the receiver-operating characteristic was 0.76, and the Hosmer-Lemeshow goodness of fit test was 0.48. The SI ≥ 1 had a sensitivity, specificity, positive predictive value, and negative predictive value of 14.8%, 97.0%, 18.2%, and 96.2% for predicting mortality.

Conclusions: The SI ≥ 1 is an easy tool that can be potentially used to predict 30-day mortality in older DF patients, especially in DF outbreak. It has a high specificity and negative predictive value for excluding patients with high-risk mortality.
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http://dx.doi.org/10.1007/s40520-020-01563-7DOI Listing
March 2021

Chronic pain and use of analgesics in the elderly: a nationwide population-based study.

Arch Med Sci 2020 11;16(3):627-634. Epub 2020 Feb 11.

Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.

Introduction: Chronic pain may cause many comorbidities in the elderly; however, nationwide data about this issue remain insufficient. We conducted this study to address the data gap.

Material And Methods: We identified geriatric participants (≥ 65 years) with chronic pain between 2000 and 2013 from the Taiwan National Health Insurance Research Database. The causes of chronic pain and use of analgesics between two sexes and among three age subgroups were compared.

Results: A total of 21,018 participants were identified with the mean age (standard deviation) of 72.7 years (5.6) and the female percentage of 50.8%. The prevalence of chronic pain in the elderly was 21.5%, and it was higher in the females than males. The proportions of each age subgroup were 65-74 (66.8%), 75-84 (29.4%), and ≥ 85 years (3.8%). Common causes of chronic pain were osteoarthritis (21.9%), spinal disorders (19.0%), peripheral vascular diseases (12.4%), and osteoporosis (11.4%). Non-steroidal anti-inflammatory drugs were the most common medication, followed by acetaminophen and opioids. The most commonly used opioid was morphine. The use of opioids increased with age.

Conclusions: This study delineated the causes of chronic pain and use of analgesics in a geriatric population, which may help further studies about this issue in the future.
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http://dx.doi.org/10.5114/aoms.2020.92894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212229PMC
February 2020

Chronic Pain Increases the Risk for Major Adverse Cardiac and Cerebrovascular Events: A Nationwide Population-Based Study in Asia.

Pain Med 2020 09;21(9):1985-1990

Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.

Objective: Chronic pain (CP) may increase the risk for major adverse cardiac and cerebrovascular events (MACCEs); however, this issue is still unclear in the Asian population. We conducted this study to delineate it.

Design: From the Taiwan National Health Insurance Research Database, we identified 17,614 participants (<65 years) with CP and matched them by age and sex at a 1:2 ratio to participants without CP, who made up the comparison cohort. Several causes of CP and its underlying comorbidities were also analyzed.

Outcome Measure: A comparison of MACCE occurring in the two cohorts was performed via follow-up until 2015.

Results: The mean age (SD) was 50.2 (11.5) years and 50.4 (11.7) years in participants with and without CP, respectively. In both cohorts, the percentage of female participants was 55.5%. Common causes of CP were spinal disorders (23.9%), osteoarthritis (12.4%), headaches (11.0%), gout (10.2%), malignancy (6.2%), and osteoporosis (4.5%). After adjusting for hypertension, diabetes, chronic obstructive pulmonary disease, renal diseases, hyperlipidemia, liver diseases, dementia, and depression, participants with CP had a higher risk for MACCE than those without CP (adjusted hazard ratio [AHR] = 1.3, 95% confidence interval [CI] = 1.3 - 1.4). After conducting subgroup analyses, an increased risk was also found for all-cause mortality (AHR = 1.4, 95% CI = 1.1 - 1.8), acute myocardial infarction (AHR = 1.2, 95% CI = 1.0 - 1.4), and stroke (AHR = 1.3, 95% CI = 1.3 - 1.4).

Conclusions: CP is associated with increased occurrence of MACCE. Early detection and interventions for CP are suggested.
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http://dx.doi.org/10.1093/pm/pnaa107DOI Listing
September 2020

Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury.

Sci Rep 2020 02 7;10(1):2095. Epub 2020 Feb 7.

Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.

The reverse shock index (rSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), is used to identify prognosis in trauma patients. Multiplying rSI by Glasgow Coma Scale (rSIG) can possibly predict better in-hospital mortality in patients with trauma. However, rSIG has never been used to evaluate the mortality risk in adult severe trauma patients (Injury Severity Score [ISS] ≥ 16) with head injury (head Abbreviated Injury Scale [AIS] ≥ 2) in the emergency department (ED). This retrospective case control study recruited adult severe trauma patients (ISS ≥ 16) with head injury (head AIS ≥ 2) who presented to the ED of two major trauma centers between January 01, 2014 and May 31, 2017. Demographic data, vital signs, ISS scores, injury mechanisms, laboratory data, managements, and outcomes were included for the analysis. Logistic regression and receiver operating characteristic analysis were used to evaluate the accuracy of rSIG score in predicting in-hospital mortality. In total, 438 patients (mean age: 56.48 years; 68.5% were males) were included in this study. In-hospital mortality occurred in 24.7% patients. The median (interquartile range) ISS score was 20 (17-26). Patients with rSIG ≤ 14 had seven-fold increased risks of mortality than those without rSIG ≤ 14 (odds ratio: 7.64; 95% confidence interval: 4.69-12.42). Hosmer-Lemeshow goodness-of-fit test and area under the curve values for rSIG score were 0.29 and 0.76, respectively. The sensitivity, specificity, positive predictive value, and negative predictive values of rSIG ≤ 14 were 0.71, 0.75, 0.49, and 0.89, respectively. The rSIG score is a prompt and simple tool to predict in-hospital mortality among adult severe trauma patients with head injury.
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http://dx.doi.org/10.1038/s41598-020-59044-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005840PMC
February 2020

Effects of Hyperbaric Oxygen Therapy on Acute Myocardial Infarction Following Carbon Monoxide Poisoning.

Cardiovasc Toxicol 2020 06;20(3):291-300

Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, East District, Tainan, 701, Taiwan.

Carbon monoxide poisoning (COP) may increase the risk of myocardial infarction. We conducted a study to investigate the effects of hyperbaric oxygen therapy (HBOT) on the risk. We used the Nationwide Poisoning Database in Taiwan to identify COP patients diagnosed between 1999 and 2012. We compared the risk for myocardial infarction between patients with and without HBOT by following up through 2013 and identified the independent predictors of myocardial infarction. The risk of myocardial infarction in the 7278 patients with HBOT was lower than in the 18,459 patients without HBOT, but this difference did not reach statistical significance [adjusted hazard ratio (AHR): 0.69; 95% confidence interval (CI) 0.45-1.07]. Stratified analyses showed that the reductions in the risk associated with HBOT for myocardial infarction reached statistical significance in male patients (AHR: 0.45; 95% CI 0.24-0.83) and during the first 2 weeks of follow-up (AHR: 0.22; 95% CI 0.05-0.96). In patients without HBOT, independent predictors of myocardial infarction were old age, male sex, and the underlying comorbidities of hypertension, diabetes, coronary artery disease, and congestive heart failure. In patients with HBOT, however, old age, male sex, and the underlying comorbidities of diabetes, coronary artery disease, and congestive heart failure were not independent predictors. HBOT was associated with a reduced risk of myocardial infarction in male patients and within 2 weeks following COP. These results may provide important reference for using HBOT in treating COP.
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http://dx.doi.org/10.1007/s12012-019-09552-7DOI Listing
June 2020

Increased risk for hypothyroidism associated with carbon monoxide poisoning: a nationwide population-based cohort study.

Sci Rep 2019 11 11;9(1):16512. Epub 2019 Nov 11.

Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Carbon monoxide poisoning (COP) may cause injuries to the central nervous and endocrine systems, which might increase the risk of developing hypothyroidism. We wanted to evaluate the association between COP and the risk of developing hypothyroidism because epidemiological data on this potential association are limited. We conducted a nationwide population-based cohort study using the Nationwide Poisoning Database and identified 24,328 COP subjects diagnosed between 1999 and 2012. By matching the index date and age, we selected 72,984 non-COP subjects for comparison. Subjects with thyroid diseases and malignancy before 1999 were excluded. We followed up the two groups of subjects until 2013 and compared the risk of developing hypothyroidism. COP subjects had a significantly higher risk for hypothyroidism than non-COP subjects (adjusted hazard ratio [AHR]: 3.8; 95% confidence interval [CI]: 3.2-4.7) after adjusting for age, sex, underlying comorbidities, and monthly income, and the AHR was particular higher in subjects with diabetes mellitus, hyperlipidemia, and mental disorder. The increased risk was highest in the first month after COP (AHR: 41.0; 95% CI: 5.4-310.6), and the impact remained significant even after 4 years. In conclusion, COP was associated with an increased risk for hypothyroidism. Further studies regarding the underlying mechanisms are warranted.
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http://dx.doi.org/10.1038/s41598-019-52844-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848088PMC
November 2019

Long-term mortality in older adults with chronic pain: a nationwide population-based study in Taiwan.

Eur Geriatr Med 2019 Oct 29;10(5):777-784. Epub 2019 Aug 29.

Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan.

Purpose: This study was conducted to clarify the long-term mortality in the older population with chronic pain (CP), which is still unclear.

Methods: We identified 17,568 older participants (aged ≥ 65 years) with CP and an identical number of comparison cohort without CP matched 1:1 by age and sex between 1996 and 2000 from the Taiwan National Health Insurance Research Database. Causes of CP, underlying comorbidities, living areas, and mortality were collected for analyses. The long-term mortality and the causes of mortality were compared between the two cohorts through follow-up since 2000 until 2015.

Results: The mean age (± standard deviation) was 73.5 ± 5.7 years, and female participants comprised 55.1% in both cohorts. The most common causes of CP were osteoarthritis (24.2%), spinal disorders (22.4%), peripheral vascular diseases (14.0%), and osteoporosis (9.5%). Older participants with CP had an increased rate of long-term mortality compared to that among their counterparts without CP after adjusting for the underlying comorbidities and the causes of CP (adjusted hazard ratio [AHR]: 1.18; 95% confidence interval [CI] 1.14-1.21). The increased mortality rate was observed even after the follow-up of 6 years (AHR 1.15; 95% CI 1.10-1.20). No significant difference was observed in the causes of mortality between the two cohorts. The most common cause of mortality was malignancy, followed by cardiovascular and cerebrovascular diseases.

Conclusions: Chronic pain was associated with an increased rate of long-term mortality in the older population. Early detection and intervention for treating CP are suggested for this population.
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http://dx.doi.org/10.1007/s41999-019-00228-7DOI Listing
October 2019

Plantar fasciitis in physicians and nurses: a nationwide population-based study.

Ind Health 2020 Apr 20;58(2):153-160. Epub 2019 Sep 20.

Department of Emergency Medicine, Chi-Mei Medical Center, Taiwan.

Physicians and nurses in Taiwan have heavy workload and long working hours, which may contribute to plantar fasciitis. However, this issue is unclear, and therefore, we conducted this study to delineate it. We conducted a nationwide population-based study by identifying 26,024 physicians and 127,455 nurses and an identical number of subjects for comparison (general population) via the National Health Insurance Research Database. The risk of plantar fasciitis between 2006 and 2012 was compared between physicians and general population, between nurses and general population, and between physicians and nurses. We also compared the risk of plantar fasciitis among physician subgroups. Physicians and nurses had a period prevalence of plantar fasciitis of 8.14% and 13.11% during the 7-yr period, respectively. The risk of plantar fasciitis was lower among physicians (odds ratio [OR]: 0.660; 95% confidence interval [CI]: 0.622-0.699) but higher among nurses (OR: 1.035; 95% CI: 1.011-1.059) compared with that in the general population. Nurses also had a higher risk than the physicians after adjusting for age and sex (adjusted odds ratio [AOR]: 1.541; 95% CI: 1.399-1.701). Physician subspecialties of orthopedics and physical medicine and rehabilitation showed a higher risk. Female physicians had a higher risk of plantar fasciitis than male physicians. This study showed that nurses, physician specialties of orthopedics and physical medicine and rehabilitation, and female physicians had a higher risk of plantar fasciitis. Improvement of the occupational environment and health promotion are suggested for these populations.
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http://dx.doi.org/10.2486/indhealth.2019-0069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118066PMC
April 2020
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