Publications by authors named "Chung-Yi Li"

320 Publications

Erector Spinae Plane Block Similar to Paravertebral Block for Perioperative Pain Control in Breast Surgery: A Meta-Analysis Study.

Pain Physician 2021 May;24(3):203-213

Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan.

Background: Erector spinae plane block could be a potential alternative to paravertebral block or other analgesic techniques for breast surgery, but the current evidence on erector spinae plane block in breast surgery is conflicting.

Objective: To compare the analgesic effectiveness between erector spinae plane block, systemic analgesic, and paravertebral block for breast surgery.

Study Design: Meta-analysis.

Setting: The literature search was performed from 2016 to August 2020 using the MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov databases.

Methods: Clinical trials comparing erector spinae plane block to systemic analgesic and paravertebral block were included from the aforementioned databases. Primary outcomes were 24-hour postoperative opioid administration and postoperative pain score. Secondary outcomes were patient satisfaction levels, post-anesthesia care unit and hospital stay, block-related side effects, and opioid-related side effects. Systematic search, critical appraisal, and pooled analysis were performed according to the PRISMA statement.

Results: We analyzed 495 cases in 8 randomized controlled trials. Compared with a systemic analgesic, the use of erector spinae plane block resulted in a reduced 24-hour postoperative intravenous morphine equivalent dose by a mean difference of 7.59 mg (P < 0.00001). Compared with paravertebral block, no statistical difference was found in opioid administration. No differences were observed in pain score, opioid-related side effects, or analgesic technique-related complications. Between the trials, heterogeneity existed and could not be evaluated using meta-regression owing to inadequate reported data.

Limitations: Moderate heterogeneity among the included trials could not be assessed by potential covariates owing to the limited reported data in each trial.

Conclusion: Erector spinae plane block is superior to systemic analgesic within 24 hours after breast surgery and can serve as an alternative to paravertebral block with similar analgesic effects.
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May 2021

Single-Line Bidirectional Optical Add/Drop Multiplexer for Ring Topology Optical Fiber Networks.

Sensors (Basel) 2021 Apr 9;21(8). Epub 2021 Apr 9.

Department of Electrical Engineering, National Chiayi University, Chiayi 60004, Taiwan.

A new type of passive single-line bidirectional optical add/drop multiplexer (SBOADM) is proposed and experimentally demonstrated. When the proposed SBOADM is placed as a node of a ring topology optical fiber network, the special routing function of the SBOADM can always drop down the desired downstream signals whether the signals are injected into the SBOADM in either the clockwise (CW) or counterclockwise (CCW) direction and can upload and send back the upstream signals via the reversed optical pathway of the downstream signals. Once fiber link failure occurs in the optical network, the blocked network connections can be recovered immediately by sending out the downstream signals in both the CW and CCW directions of the fiber ring. As in all passive devices, the SBOADM needs no power supply or complicated network management to achieve the bidirectional function. Thus, the proposed device is an optimal solution to enhance the stability and reliability of rapidly developed optical fiber networks.
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http://dx.doi.org/10.3390/s21082641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069763PMC
April 2021

Associations of Physician Characteristics with Sex Difference in Ischemic Heart Disease Incidence among Patients Living with Type 2 Diabetes in Taiwan.

Healthcare (Basel) 2021 Apr 8;9(4). Epub 2021 Apr 8.

Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.

(1) Background: Certain non-biological factors are suspected to explain the reduced sex difference in cardiovascular risk after diabetes. This study aimed to assess whether physician characteristics may account for such reduced sex difference. (2) Methods: Totally 10,105 type 2 diabetes patients (including 4962 men and 5143 women) were selected from Taiwan's National Health Insurance claim data. The three-year period following the first day of clinical visit for type 2 diabetes in 2000 was set as the baseline period. The follow-up was made from the first day after baseline period to date of ischemic heart disease (IHD) incidence or censoring. Cox regression model was used to estimate hazard ratios (HRs) of IHD in relation to physician's characteristics. (3) Results: The incidence of IHD for men and women was estimated at 17.47 and 15.96 per 1000 person-years, respectively. After controlling for socio-demographic variables and co-morbidity, male patients experienced a significantly higher HR than females for IHD (1.16, 95% Confidence Interval (CI) 1.04 to 1.29). Further adjustment for treatment adherence/continuity and physician characteristics resulted in essentially the same results. (4) Conclusions: Our study provides little support for the notation that physician characteristics may contribute to the reduced sex difference in IHD incidence in patients with type 2 diabetes.
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http://dx.doi.org/10.3390/healthcare9040440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070518PMC
April 2021

Short-, Mid- and Long-Term Associations between PM2.5 and Stroke Incidence in Taiwan.

J Occup Environ Med 2021 Apr 12. Epub 2021 Apr 12.

Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan (Yang), Department of Medical Research, Kuang Tien General Hospital, Taichung, Taiwan (Yang, Lu, Yan), Institute of Biomedical Nutrition, Hung Kuang University, Taichung, Taiwan (Yang, Yan), Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (Li), Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan (Li), Department of Safety, Health, and Environmental Engineering, Hung Kuang University, Taichung, Taiwan (Huang), Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, Taiwan (Yu), Assistant Professor, Department of Healthcare Administration, Asia University (Yang), Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (Lang), Department of Endocrinology and Metabolism, Kuang Tien General Hospital, Taichung, Taiwan (Yan).

Objective: To investigate the association between the risk of stroke and exposure to particulate matter with an aerodynamic diameter < 2.5 μm (PM2.5) over various exposure periods.

Methods: This was a nationwide population-based case-control study in which 10,035 incident patients with a primary diagnosis of ischemic stroke each were matched with two randomly selected controls for sex, age, Charlson Comorbidity Index, year of stroke diagnosis, and level of urbanization. Multiple logistic models adjusted for potential confounders were used to assess the association of PM2.5 with ischemic stroke incidence.

Results: There were significant short-term, medium-term, and long-term relationships between PM2.5 exposure and ischemic stroke incidence.

Conclusions: This study supports existing evidence that PM2.5 should be considered a risk factor for ischemic stroke.
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http://dx.doi.org/10.1097/JOM.0000000000002222DOI Listing
April 2021

Association between trajectory of severe hypoglycemia and dementia in patients with type 2 diabetes: A population-based study.

J Epidemiol 2021 Mar 6. Epub 2021 Mar 6.

School of Gerontology Health Management & Master Program in Long-Term Care, College of Nursing, Taipei Medical University.

Background: To investigate associations between exposure to various trajectories of severe hypoglycemic events and risk of dementia in patients with type 2 diabetes.

Methods: In 2002-2003, 677618 patients in Taiwan were newly diagnosed as having type 2 diabetes. Among them, 35720 (5.3%) experienced severe hypoglycemic events during the 3-year baseline period following diagnosis. All patients were followed from the first day after baseline period to the date of dementia diagnosis, death, or the end of 2011. A group-based trajectory model was used to classify individuals with severe hypoglycemic events during the baseline period. Cox proportional hazard models with the competing risk method were used to relate dementia risk to various severe hypoglycemia trajectories.

Results: After a median follow-up 6.70 and 6.10 years for patients with and without severe hypoglycemia at baseline, respectively, 1952 (5.5%) individuals with severe hypoglycemia and 23492 (3.7%) without developed dementia during follow-up, for incidence rates of 109.80 and 61.88 per 10000 person-years, respectively. Four groups of severe hypoglycemia trajectory were identified with a proportion of 18.06%, 33.19%, 43.25%, and 5.50%, respectively for Groups 1 to 4. Groups 3 (early manifestation but with later decrease) and 4 (early and sustained manifestation) were associated with a significantly increased risk of dementia diagnosis, with a covariate-adjusted subdistribution hazard ratio of 1.22 (95% confidence interval, 1.14-1.31) and 1.25 (95% confidence interval, 1.02-1.54), respectively.

Conclusions: Our analysis highlighted that early manifestation of severe hypoglycemic events may contribute more than does late manifestation to the risk of dementia among individuals newly diagnosed as having type 2 diabetes.
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http://dx.doi.org/10.2188/jea.JE20200518DOI Listing
March 2021

Social Determinants of Diabetes-Related Preventable Hospitalization in Taiwan: A Spatial Analysis.

Int J Environ Res Public Health 2021 02 22;18(4). Epub 2021 Feb 22.

Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan.

Diabetes-Related Preventable Hospitalization (DRPH) has been identified as an important indicator of efficiency and quality of the health system and can be modified by social determinants. However, the spatial disparities, clustering, and relationships between DRPH and social determinants have rarely been investigated. Accordingly, this study examined the association of DRPH with area deprivation, densities of certificated diabetes health-promoting clinics (DHPC) and hospitals (DHPH), and the presence of elderly social services (ESS) using both statistical and spatial analyses. Data were obtained from the 2010-2016 National Health Insurance Research Database (NHIRD) and government open data. Township-level ordinary least squares (OSL) and geographically weighted regression (GWR) were conducted. DRPH rates were found to be negatively associated with densities of DHPC (β = -66.36, = 0.029; 40.3% of all townships) and ESS (β = -1.85, = 0.027; 28.4% of all townships) but positively associated with area deprivation (β = 2.96, = 0.002; 25.6% of all townships) in both OLS and GWR models. Significant relationships were found in varying areas in the GWR model. DRPH rates are high in townships of Taiwan that have lower DHPC densities, lower ESS densities, and greater socioeconomic deprivation. Spatial analysis could identify areas of concern for potential intervention.
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http://dx.doi.org/10.3390/ijerph18042146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926970PMC
February 2021

Association between nucleos(t)ide analogue therapy for hepatitis B and Sjögren's syndrome: 15-year analysis of the national database of Taiwan.

J Viral Hepat 2021 May 14;28(5):809-816. Epub 2021 Feb 14.

School of Medicine, Tzu Chi University, Hualien, Taiwan.

Hepatitis B virus (HBV) infection has been proposed to play a role in the development of Sjögren's syndrome. However, to date, there are no reports on the risk of SS in HBV-infected patients following nucleos(t)ide analogue therapy. Due to Taiwan has higher prevalence of HBV infection and therapy was well recorded in the Taiwan's single-payer national health insurance database, we hypothesized that a long-term retrospective analysis of the risk of Sjögren's syndrome in HBV-infected patients following nucleotide therapy will increase our understanding of Sjögren's syndrome development following HBV infection. We identified 26,147 adults diagnosed with HBV infection between 1997 and 2012 in claims data. Finally, a total of 3268 HBV-infected patients who ever received nucleotide therapy (treated cohort) were frequency-matched on age and sex at 1:4 ratios to select a control group of 13,072 counterparts without therapy (untreated cohort). To identify Sjögren's syndrome risk, competing risk analysis adjusted for all covariates was performed. The risk was significantly lower in the treated cohort (15-year cumulative incidence, 2.4%; 95% confidence interval [CI], 1.4%-3.7%) than in the untreated cohort (7.1%; 95% CI, 2.5%-15.2%) (p = .015), and the adjusted HR was 0.6 (95% CI, 0.41-0.88; p = .009). Multivariable stratified analysis further verified the consistent associations between nucleoside therapy and risk reduction of Sjögren's syndrome across all strata. Our finding suggests that HBV infection treated with nucleotides is associated with lower risk of Sjögren's syndrome, implying a potential role of HBV infection in the development of Sjögren's syndrome.
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http://dx.doi.org/10.1111/jvh.13481DOI Listing
May 2021

Rosuvastatin Failed to Improve Arteriovenous Fistula Patency for Hemodialysis in Diabetic Patients - A Randomized Clinical Trial.

Acta Cardiol Sin 2021 Jan;37(1):18-29

Department of Anesthesiology, E-Da Hospital.

Background: Very limited therapeutic strategies exist to prevent the primary failure of arteriovenous (AV) fistulas in patients with diabetes.

Objectives: To investigate whether rosuvastatin could improve the primary patency of AV fistulas in diabetic patients with stage 5 chronic kidney disease (CKD).

Methods: This was a double-blind randomized clinical trial. From July 2012 to September 2018, patients aged between 18 and 65 years with type 2 diabetes and stage 5 CKD were randomized to receive placebo or rosuvastatin (5 mg/day) for 7 days prior to the creation of an AV fistula on the forearm until the 21 day after surgery. Patients were followed up for 180 days after the operation. The primary composite endpoint was the development of fistula immaturity or stenosis. The secondary endpoints were changes in inflammatory markers, oxidative stress, and occurrence of postoperative complications.

Results: A total of 60 patients were enrolled in the study. Rosuvastatin resulted in a 20% reduction in total cholesterol from postoperative day 0 to 28 (p = .0006). The overall rate of AV fistula failure (immaturity or stenosis) was 30%, with no significant difference between patients receiving rosuvastatin and those receiving the placebo (33.3% vs. 26.7%, p = .5731). Although not statistically significant, the administration of rosuvastatin might have increased the incidence of postoperative complications (2.99 vs. 2.39 event rate per 1000 patient-days; odds ratio, 1.33; p = .5986).

Conclusions: Rosuvastatin showed no significant beneficial effects on the primary patency of AV fistulas in diabetic patients with stage 5 CKD, but might have been associated with the risk of drug-related complications.
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http://dx.doi.org/10.6515/ACS.202101_37(1).20200703BDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814325PMC
January 2021

Rosuvastatin Failed to Improve Arteriovenous Fistula Patency for Hemodialysis in Diabetic Patients - A Randomized Clinical Trial.

Acta Cardiol Sin 2021 Jan;37(1):18-29

Department of Anesthesiology, E-Da Hospital.

Background: Very limited therapeutic strategies exist to prevent the primary failure of arteriovenous (AV) fistulas in patients with diabetes.

Objectives: To investigate whether rosuvastatin could improve the primary patency of AV fistulas in diabetic patients with stage 5 chronic kidney disease (CKD).

Methods: This was a double-blind randomized clinical trial. From July 2012 to September 2018, patients aged between 18 and 65 years with type 2 diabetes and stage 5 CKD were randomized to receive placebo or rosuvastatin (5 mg/day) for 7 days prior to the creation of an AV fistula on the forearm until the 21 day after surgery. Patients were followed up for 180 days after the operation. The primary composite endpoint was the development of fistula immaturity or stenosis. The secondary endpoints were changes in inflammatory markers, oxidative stress, and occurrence of postoperative complications.

Results: A total of 60 patients were enrolled in the study. Rosuvastatin resulted in a 20% reduction in total cholesterol from postoperative day 0 to 28 (p = .0006). The overall rate of AV fistula failure (immaturity or stenosis) was 30%, with no significant difference between patients receiving rosuvastatin and those receiving the placebo (33.3% vs. 26.7%, p = .5731). Although not statistically significant, the administration of rosuvastatin might have increased the incidence of postoperative complications (2.99 vs. 2.39 event rate per 1000 patient-days; odds ratio, 1.33; p = .5986).

Conclusions: Rosuvastatin showed no significant beneficial effects on the primary patency of AV fistulas in diabetic patients with stage 5 CKD, but might have been associated with the risk of drug-related complications.
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http://dx.doi.org/10.6515/ACS.202101_37(1).20200703BDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814325PMC
January 2021

White-lighting and WDM-VLC system using transmission gratings and an engineered diffuser.

Opt Lett 2020 Nov;45(22):6206-6209

A white-lighting and wavelength-division-multiplexing (WDM)-visible light communication (VLC) system with over 20 m of free-space distance and 3 m of lighting distance is demonstrated via a red/green/blue (R/G/B) triple-source polarization-multiplexing scheme, transmission gratings, and an engineered diffuser with a double-convex lens. Integrating four-level pulse amplitude modulation (PAM4) with a triple-source polarization-multiplexing scheme, the aggregate transmission rate is noticeably enhanced to 300 Gb/s [50/4/×3×2 (- and -polarizations)]. White-light is produced by multiplexing the R/G/B lights with two transmission gratings and separated by demultiplexing them using the other two transmission gratings. By adopting an engineered diffuser with a double-convex lens, the white-light is diffused over 3 m of free-space distance to provide general white-light illumination (>100). This demonstrated white-lighting and WDM-VLC system meets a high aggregate transmission rate with a qualified indoor lighting target. It opens up a new category for lighting and communication.
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http://dx.doi.org/10.1364/OL.409843DOI Listing
November 2020

Annealing-Dependent Breakdown Voltage and Capacitance of Gallium Oxide-Based Gallium Nitride MOSOM Varactors.

Materials (Basel) 2020 Nov 4;13(21). Epub 2020 Nov 4.

Graduate Institute of Electro-Optical Engineering, Chang Gung University, Guishan, Taoyuan 333, Taiwan.

Our laboratory has previously revealed the use of metal-semiconductor-metal (MSM) varactors against malicious pulses, as well as completed the related verification and measurements of such a circuit. To improve the reliability of this protection module further, in this study, we deposited a gallium oxide (GaO) thin film in between the Schottky contact electrode to manufacture a metal-oxide-semiconductor-oxide-metal (MOSOM) varactor. However, the thin-film quality and heterojunction interfaces will affect these fabricated varactors in various ways, such as the asymmetry threshold voltage to the variable capacitance characteristics. This study aims to address the issues associated with the inserted oxide thin film, as well as to determine how improvements could be obtained by using an oxygen furnace annealing process. As a result, the breakdown voltage of the MOSOM varactor was further promoted and a more robust anti-surge module was thus realized.
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http://dx.doi.org/10.3390/ma13214956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662979PMC
November 2020

Maternal survival of patients with pregnancy-associated cancers in Taiwan - A national population-based study.

Cancer Med 2020 12 25;9(24):9431-9444. Epub 2020 Oct 25.

Division of Hematology / Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Pregnancy-associated cancer (PAC), defined as cancers diagnosed during pregnancy or the first year after delivery, affects one to two in every 1000 pregnancies. Although PAC is expected to be a growing issue, information about PAC in the Asian population is still scarce. Women with cancer diagnosed at the age of 16-49 years between 2001 and 2015 were selected from the Taiwan Cancer Registry and linked with the National Birth Reporting Database to identify PAC patients. We compared the overall survival of patients with PAC to patients without pregnancy. Among 126,646 female cancer patients of childbearing age, 512 were diagnosed during pregnancy, and 2151 during the first postpartum year. Breast cancer was the most common PAC (N = 755, 28%). Compared with patients without pregnancy in the control group, patients with cancers diagnosed during pregnancy and the first postpartum year generally had more advanced stages (odds ratio 1.35 and 1.36, 95% confidence interval [CI] 1.02-1.77 and 1.18-1.57, respectively). For all cancer types combined and controlled for the stage, age, and year of diagnosis, patients with PAC had similar overall survival with those in the control group, with a hazard ratio (HR) of 1.07 (95% CI 0.80-1.41) for the pregnancy group and HR 1.02 (95% CI 0.88-1.18) for the postpartum group. The diagnosis of breast cancer during the first postpartum year was linked with shorter survival (HR 1.34, 95% CI 1.05-1.72). In contrast, patients with postpartum lymphoma (HR 0.11, 95% CI 0.02-0.79) and cervical cancer (HR 0.40, 95% CI 0.20-0.82) had better prognosis. In general, the diagnosis of cancer during pregnancy or the first postpartum year does not affect the survival of patients with most cancer types. Exceptions include the worse prognosis of postpartum breast cancer and the better outcome of postpartum lymphoma and cervical cancer.
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http://dx.doi.org/10.1002/cam4.3565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774740PMC
December 2020

Incidence of idiopathic cardiomyopathy in patients with type 2 diabetes in Taiwan: age, sex, and urbanization status-stratified analysis.

Cardiovasc Diabetol 2020 10 14;19(1):177. Epub 2020 Oct 14.

Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Background: The epidemiology of diabetes and idiopathic cardiomyopathy have limited data. We investigated the overall and the age-, sex-, and urbanization-specific incidence and relative hazard of idiopathic cardiomyopathy in association with type 2 diabetes and various anti-diabetic medications used in Taiwan.

Methods: A total of 474,268 patients with type 2 diabetes were identified from ambulatory care and inpatient claims in 2007-2009 from Taiwan's National Health Insurance (NHI) database. We randomly selected 474,266 age-, sex-, and diagnosis date-matched controls from the registry of NHI beneficiaries. All study subjects were linked to ambulatory care and inpatient claims (up to the end of 2016) to identify the possible diagnosis of idiopathic cardiomyopathy. The person-year approach with Poisson assumption was used to estimate the incidence, and Cox proportional hazard regression model with Fine and Gray's method was used to estimate the relative hazards of idiopathic cardiomyopathy in relation to type 2 diabetes.

Results: The overall incidence of idiopathic cardiomyopathy for men and women patients, respectively, was 3.83 and 2.94 per 10,000 person-years, which were higher than the corresponding men and women controls (2.00 and 1.34 per 10,000 person-years). Compared with the control group, patients with type 2 diabetes were significantly associated with an increased hazard of idiopathic cardiomyopathy (adjusted hazard ratio [aHR]: 1.60, 95% confidence interval [CI]: 1.45-1.77] in all age and sex stratifications except in those men aged > 64 years. Patients with type 2 diabetes aged < 45 years confronted the greatest increase in the hazard of idiopathic cardiomyopathy, with an aHR of 3.35 (95% CI 2.21-5.06) and 3.48 (95% CI 1.60-7.56) for men and women, respectively. The usage of some anti-diabetic medications revealed lower risks of idiopathic cardiomyopathy.

Conclusions: In Taiwan, diabetes increased the risk of idiopathic cardiomyopathy in both sexes and in all age groups, except in men aged > 64 years. Younger patients were vulnerable to have higher HRs of idiopathic cardiomyopathy. Some anti-diabetic medications may reduce the risks of cardiomyopathy.
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http://dx.doi.org/10.1186/s12933-020-01144-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558694PMC
October 2020

Hepatic and cardiovascular safety of acarbose among type 2 diabetes patients with end-stage renal disease: A nationwide population-based longitudinal study.

Diabetes Res Clin Pract 2021 Feb 6;172:108489. Epub 2020 Oct 6.

Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address:

Aim: To assess the relationship between acarbose and hepatotoxicity, cardiovascular disease (CVD), and mortality among type 2 diabetes (T2D) patients with end-stage renal disease (ESRD).

Methods: 32,531 T2D patients with ESRD were identified from Taiwan's National Health Insurance Research Database in 2000~∼2012 and followed up until 2013. 19.3% of subjects were newly initiated with acarbose during the follow-up. The use of acarbose was quantified as the numbers of the 30-day drug's supplies and dosages (measured by defined daily doses; DDDs), respectively. Time-varying Cox models were applied to evaluate the association of acarbose use with hepatic, cardiovascular and mortality outcomes, with adjustment for patients' demographics, comorbidities, diabetes severity, and co-medications.

Results: For each 30-day supply increase in acarbose exposure, the risks of hepatic injury, composite CVD events, and all-cause mortality were significantly lowered by 9% (95% confidence interval: 6-12%), 7% (6-7%) and 7% (7-8%), respectively, while for each 30-day DDD increase in acarbose exposure, the risks for three aforementioned outcomes were significantly reduced by 45% (33-54%), 33% (29-36%) and 35% (32-39%), respectively. In subgroup analyses, the favorable study outcomes of acarbose use were more apparent among patients with more severe diabetes, a longer diabetes duration, or absence of established CVD at baseline.

Conclusion: Acarbose used in real-world T2D patients with ESRD may have hepatic and cardiovascular safety.
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http://dx.doi.org/10.1016/j.diabres.2020.108489DOI Listing
February 2021

Seasonality of gestational diabetes mellitus and maternal blood glucose levels: Evidence from Taiwan.

Medicine (Baltimore) 2020 Oct;99(41):e22684

Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, Taiwan.

Previous studies have indicated that the prevalence of gestational diabetes mellitus (GDM) was related to the season. However, there was no relevant information in Asia. The aim of this study was to determine whether there was seasonality of GDM and maternal blood glucose level in Taiwanese women.A total of 6396 pregnancies were enrolled between 2012 and 2014 in this retrospective study. A 2-step approach according to the Carpenter-Coustan criteria was used for GDM diagnosis. A generalized linear mixed model was used to estimate the effect of season on GDM diagnosis by adjusting for age, prepregnancy body mass index, parity, history of GDM, fetal sex, and the rate of weight gain.During the study period, 418 (6.5%) pregnancies were diagnosed as GDM. The model demonstrated an increased prevalence of GDM in spring and summer (odds ratio: 1.59, 95% confidence interval: 1.13-2.24; odds ratio: 1.59, 95% confidence interval: 1.14-2.23, respectively) compared to winter. For the glucose level variation, the model demonstrated an increase of 2.56 mg/dL glucose in the 50-g glucose challenge test in summer compared to winter. In glucose challenge test-positive pregnancies, the season also had an effect on the results of the 100-g 1-h, 2-h, and 3-h oral glucose tolerance tests, but no effect on the 100-g fasting oral glucose tolerance tests.GDM prevalence in Taiwan presents seasonal variation, with the highest risk during spring and summer due to post-glucose load level variations. These findings could serve as reference data for countries in Southeast Asia or areas with a similar climate.
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http://dx.doi.org/10.1097/MD.0000000000022684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544315PMC
October 2020

Impact of 23-valent pneumococcal polysaccharide vaccination on the frequency of pneumonia-related hospitalization and survival in elderly patients with prostate cancer: A seven-year nationwide matched cohort study.

Cancer 2020 Jan 30;127(1):124-136. Epub 2020 Sep 30.

Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.

Background: The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is indicated for adults who have a high risk of pneumonia; however, its effectiveness in patients with prostate cancer who are at a risk of pneumonia because of age and cancer treatments, including androgen-deprivation therapy, is unknown.

Methods: Between 2000 and 2010, 38,735 patients with prostate cancer were diagnosed in Taiwan. After exclusions and exact matching for age, previous pneumonia, and influenza vaccination, 2188 vaccinated patients and 2188 unvaccinated patients were recruited. The incidence density of all-cause bacterial pneumonia hospitalizations was analyzed.

Results: Over 7 years of follow-up, patients who received the PPSV23 had a significantly lower incidence density, with 142.8 per 1000 person-years versus 162.0 per 1000 person-years for unvaccinated patients. More patients in the vaccinated cohort were never hospitalized for pneumonia compared with those in the unvaccinated cohort (64.2% vs 62.2%, respectively). After adjusting for the Charlson comorbidity index, cancer treatment modalities, and socioeconomic levels, the risk of pneumonia-related hospitalization in the PPSV23 vaccination cohort was 0.48 times lower than that in the unvaccinated cohort (adjusted incidence rate ratio, 0.48; P = .046). For patients who received the influenza vaccination, subgroup analysis demonstrated that PPSV23 vaccination significantly decreased the risk (adjusted incidence rate ratio, 0.45; P < .001). Compared with unvaccinated controls, PPSV23-vaccinated patients had a lower cumulative incidence for the first occurrence of pneumonia-related hospitalization (34.49% vs 36.36%; P = .178) and higher overall survival (47.5% and 42.3%, respectively; P < .001).

Conclusions: Vaccination of elderly patients who have prostate cancer with the relatively common and inexpensive PPSV23 can decrease the risk of pneumonia and prolong survival.
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http://dx.doi.org/10.1002/cncr.33203DOI Listing
January 2020

Trends and Contributing Factors to Contraceptive Use in Kenya: A Large Population-Based Survey 1989 to 2014.

Int J Environ Res Public Health 2020 09 27;17(19). Epub 2020 Sep 27.

Department and Graduate Institute of Public Health, National Cheng Kung University, Tainan 701, Taiwan.

Kenya is among the leading nations in family planning in Africa, having the first official nationwide family planning program in sub-Saharan Africa. However, Kenya is still one of the most highly populated countries in Africa with a population of more than 52 million. The objective of this study was to assess the trends and contributing factors of contraceptive use. We conducted a multi-wave cross-sectional study using both the demographic health survey (DHS) and family planning effort index (FPE) datasets, analyzing five-year waves from 1989 to 2014. This study indicates that contraceptive use increased from 24.0% to 42.6%, with a change % of 77.5%. Despite changes in women's characteristics, these characteristics posed little on the time trend of contraceptive use in Kenya. In addition, the policy component of FPE scores had a positive association with contraceptive use with negligible change after adjusting for social and demographic factors 1.055 (1.046-1.065). There was a fluctuating trend of the additional FPE components throughout the years. Women with lower education, those married to husbands with lower education, unmarried, and rural women remain behind in family planning service utilization. Targeted programs are still needed for these special groups. Policy adherence is vital for continued progress.
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http://dx.doi.org/10.3390/ijerph17197065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579622PMC
September 2020

Prevalence and determinants of depressive symptoms among adults in Indonesia: A cross-sectional population-based national survey.

Nurs Forum 2021 Jan 22;56(1):37-44. Epub 2020 Sep 22.

Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia.

Aims: To analyze the association between personal health conditions (self-rated health, physical function, and chronic conditions) and symptoms of depression in Indonesia.

Methods: Data were collected from the Indonesian family life survey 5. This study used a cross-sectional study design with a sample size of 17,734 respondents. We included depressive symptoms, self-rated health, physical function, chronic conditions, demographics and socioeconomic variables. The center for epidemiologic studies depression scale was used to measure symptoms of depression. Multivariate logistic regression analysis was used to analyze the data.

Results: The results showed that 23.47% of respondents had depressive symptoms, 20.04% had poor self-rated health, 55.93% had a poor physical function, and 32.37% had at least one chronic disease. Respondents who had poor self-rated health, had poor physical function, or had a chronic condition were all had a significantly higher odds of experiencing symptoms of depression after controlling for demographic variables (age, sex, married, and education level), social-economic, and smoking status.

Conclusion: Depressive symptoms were significantly associated with personal health conditions including self-rated health, physical functioning, and chronic conditions among community residents. Strategies that can improve personal health conditions needed to be studied at the community level to improve the level of mental health.
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http://dx.doi.org/10.1111/nuf.12508DOI Listing
January 2021

A population-based case-control study on the association of exposure with risk of breast cancer.

J Tradit Complement Med 2020 Sep 23;10(5):454-459. Epub 2019 Oct 23.

Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, East District, Tainan, Taiwan.

Background: Due to a lack of evidence from large-scale epidemiological studies by far on this issue, whether there is a link between exposure and breast cancer risk remained inconclusive.

Methods: We conducted a population-based case-control study using Taiwan's National Health Insurance claim data, in which all breast cancer patients newly diagnosed between 2005 and 2008 were employed as the case group ( = 34,262) and a random sample of non-breast cancer individuals selected from 1-million beneficiaries registered in 2005 was served as the control group. For fair comparability, we employed the time density sampling method to select controls who were matched to case on date of breast cancer diagnosis and age with a case/control ratio of 1/3 ( = 102,786).

Results: We found that the use of presents a weakly but significantly protective effect on breast cancer (adjusted odds ratio (aOR) 0.95, 95% confidence interval (CI) 0.93-0.98), with a significant dose-gradient relationship. We also noted a stronger association with breast cancer with initial use of at a longer time before breast cancer diagnosis, and found that the seemingly protective effect of was more obvious among women who had initial use at 47-55 years (aOR 0.93, 95% CI 0.88-0.98).

Conclusion: This population-based case-control study revealed that exposure to showed a weakly but significantly protective effect on breast cancer risk, which could ease people's concern over the potential carcinogenic effect from exposure to .
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http://dx.doi.org/10.1016/j.jtcme.2019.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484959PMC
September 2020

High sleep-related breathing disorders among HIV-infected patients with sleep complaints.

Sleep Med 2020 11 20;75:218-224. Epub 2020 Jul 20.

Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan City, 70403, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 70101, Taiwan. Electronic address:

Background: Sleep-related breathing disorders (SRBD) not only adversely impact cardiovascular and pulmonary functions but also reduce the quality of life. This study attempted to investigate the severity and related factors of SRBD among human immunodeficiency virus (HIV)-infected people with sleep complaints.

Methods: A cross-sectional study was conducted among HIV-infected people with Pittsburgh Sleep Quality Index (PSQI) values above 5 points. SRBDs were defined as Apnea-Hypopnea Index (AHI) over 5 events/hour by full channel home-based polysomnography (PSG). An AHI greater than 30 was categorized as moderate to severe apnea. All of the participants were asked to rate the severity of their snoring, complete a snore outcomes survey (SOS) and complete the PSQI. Multiple logistic regression analysis was conducted to examine the associated factors of severity of SRBD among HIV-infected people.

Results: Of 54 male HIV-positive patients with sleep complaints, 34 subjects (62.96%) were diagnosed with SRBDs, and 29.63% were categorized as having moderate to severe SRBD. SOS score was significantly associated with HIV patients with moderate to severe SRBD (adjusted odds ratio = 0.93, 95% CI: 0.87-1.00, p = 0.045).

Conclusions: SRBDs is highly prevalent in male HIV-infected people with sleep complaints. Intensive snoring was one of the indicators associated with the occurrence of moderate to severe SRBDs among HIV-infected people. Healthcare professionals should include snoring screening in the regular course of clinical HIV care.
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http://dx.doi.org/10.1016/j.sleep.2020.07.005DOI Listing
November 2020

The use of activated vitamin D and risks of hospitalization for infection and amputation in incident hemodialysis patients in Taiwan: a nationwide population-based cohort study.

BMC Nephrol 2020 08 6;21(1):331. Epub 2020 Aug 6.

Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 70101, Taiwan.

Background: Hemodialysis patients have a high risk of mortality. The most common causes of death are cardiovascular disease and infection. The potential hazard or benefit associated with vitamin D use and cardiovascular or infection outcome is poorly characterized.

Methods: We conducted a retrospective observational cohort study by recruiting 52,757 patients older than 20 years from Taiwan National Health Insurance Research Database (NHIRD) who initiated maintenance hemodialysis between 2001 and 2009. Patients who were prescribed activated vitamin D before the 360th day from hemodialysis initiation were defined as vitamin D users. The primary outcome of interest includes occurrence of acute myocardial infarction (AMI), ischemic stroke, lower limb amputation, and hospitalization for infection, respectively, while death events are treated as competing events. We conducted competing risk analysis using subdistribution hazard regression model to estimate subdistribution hazard ratios (SHRs) in relation to various outcomes.

Results: During the median follow-up of 1019 days, the vitamin D users had a lower crude mortality rate, lower incidences of AMI, ischemic stroke, amputation, and hospitalization for infection compared with non-users. Taking into consideration competing events of death, vitamin D users were associated with a lower hazard of lower limb amputation (SHR 0.84 [95% CI, 0.74-0.96]) and hospitalization for infection (SHR 0.90 [95% CI, 0.87-0.94]), but not AMI or ischemic stroke, after adjustment for potential confounders. Subgroup analyses and dose response evaluation both showed a consistent association of activated vitamin D treatment with decreased risk of amputation and infection.

Conclusion: The findings suggest that therapeutic activated vitamin D use in hemodialysis patients may be beneficial for decreasing infection events and amputation, of which the latter is a complication of peripheral vascular disease, rather than reducing major atherosclerotic cardiovascular events such as AMI or ischemic stroke.
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http://dx.doi.org/10.1186/s12882-020-01988-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409709PMC
August 2020

Overall and cause-specific mortality in patients with type 1 diabetes mellitus: Population-based cohort study in Taiwan between 1998 and 2014.

J Epidemiol 2020 Aug 1. Epub 2020 Aug 1.

Department of Public Health, College of Medicine, National Cheng Kung University.

Background: To investigate all-cause and cause-specific mortality in Taiwanese patients with type 1 diabetes.

Methods: A cohort of 17,203 patients with type 1 diabetes were identified from Taiwan's National Health Insurance claims in the period of 1998-2014. Person-years (pys) were accumulated for each individual from date of type 1 diabetes registration to date of death or the last day of 2014. Age, sex, and calendar year standardized mortality ratios (SMRs) were calculated with reference to the general population.

Results: In up to 17 years of follow-up, 4,916 patients died from 182,523 person-years. Diabetes (30.15%), cancer (20.48%), circulatory diseases (13.14%), and renal diseases (11.45%) were the leading underlying causes of death. Mortality rate (26.93 per 1000 pys) from type 1 diabetes in Taiwan was high, the cause of death with the highest mortality rate was diabetes (8.12 per 1000 pys), followed by cancer (5.52 per 1000 pys), and circulatory diseases (3.54 per 1000 pys). The all-cause SMR was significantly elevated at 4.16 (95% CI, 4.04- 4.28), with a greater all-cause SMR noted in females than in males (4.62 vs. 3.79). The cause-specific SMR was highly elevated for diabetes (SMR=16.45), followed by renal disease (SMR =14.48), chronic hepatitis and liver cirrhosis (SMR=4.91) and infection (SMR=4.59). All-cause SMRs were also significantly increased for all ages, with the greatest figure noted for 15-24 years (SMR=8.46).

Conclusions: Type 1 diabetes in both genders and all ages was associated with significantly elevated SMRs for all-cause and mostly for diabetes per se and renal disease.
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http://dx.doi.org/10.2188/jea.JE20200026DOI Listing
August 2020

Increased repeat syphilis among HIV-infected patients: A nationwide population-based cohort study in Taiwan.

Medicine (Baltimore) 2020 Jul;99(28):e21132

Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.

Among human immunodeficiency virus (HIV)-infected individuals, syphilis is an important sexually transmitted infection (STI), and repeat infections are common. Identifying risk factors for delineating the trends in repeat syphilis are essential for STI and HIV prevention.This study is to investigate the dynamic of the syphilis epidemic among HIV-infected patients and to identify the risk factors associated with repeat syphilis.A population-based cohort design was used to analyze claim data between January 2000 and December 2010 using the Taiwan National Health Insurance Research Database. The Poisson regression test was used to identify risk factors for repeat syphilis.Of 13,239 HIV-infected patients, annual syphilis screen tests have been performed in 4,907 (37.1%) of these patients. Syphilis has been diagnosed in 956 (19.5%) patients, and 524 (10.7%) had repeat syphilis. The annual trend in repeat syphilis showed a significant increase in the study period (β = 0.23, P < .001). Younger age (adjusted incidence rate ratio [aIRR] 1.43; 95% CI 1.11-1.86), male gender (aIRR 11.14, 95% CI 4.16-29.79), a history of STIs (aIRR 1.39, 95% CI 1.21-1.59) were independently associated with repeat syphilis. The retention in HIV care and adherence to antiretroviral therapy ≥85% ([aIRR] 0.77, 95% CI 0.61-0.98; P < .001) were associated with a reduced risk of repeat syphilis.The incidence of repeat syphilis increased during 11 years of follow-up. The screening of syphilis for early diagnosis and retention in HIV care with medication adherence should be encouraged to minimize the risk of repeat syphilis in the targeted population.
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http://dx.doi.org/10.1097/MD.0000000000021132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360277PMC
July 2020

Risk of Injury and Mortality among Driver Victims Involved in Single-Vehicle Crashes in Taiwan: Comparisons between Vehicle Types.

Int J Environ Res Public Health 2020 06 29;17(13). Epub 2020 Jun 29.

Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei 110, Taiwan.

Vehicle-type specific injury severity has rarely been investigated mainly because of a lack of such information in hospital-based studies that normally exclude those who are severely injured and die on the scene. No study has been conducted either on driver characteristics in single vehicle crashes in Taiwan according to vehicle type. This was the first population-based study aiming to describe demographic characteristics in association with vehicle-specific rates of injury and fatality among driver victims involved in single-vehicle crashes in Taiwan. We presented sex and age-specific number and proportion of driver victims according to vehicle type. We calculated sex and age-specific rates of injury and fatality. Injury and fatality rates were also graphically presented. Bicycle and motorcycle rider victims generally had higher injury rates but lower fatality rates. However, older (45+) bicycle rider victims had greater fatality risk. By contrast, truck and car driver victims were generally associated with lower injury rates but with higher fatality rates. Elderly (65+ years) truck driver victims suffered from higher rates of injury and fatality. Male victims were found to have a higher fatality rate than female victims regardless of vehicle type. The vehicle-type-specific analyses of injury and fatality are considered useful in identifying single-vehicle crash victims at greater risks of injury and fatality.
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http://dx.doi.org/10.3390/ijerph17134687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370069PMC
June 2020

Effects of physical and social environments on the risk of dementia among Taiwanese older adults: a population-based case-control study.

BMC Geriatr 2020 06 26;20(1):226. Epub 2020 Jun 26.

Healthy Cities Research Center, Research and Services Headquarters, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.

Background: Physical and social environments may influence cognition health in older adults. However, evidence regarding physical and social environments linked to dementia is lacking, especially in Asia. This study aims to explore the influence of physical and social environments on the incidence of dementia through a population-based case-control design in Taiwan.

Methods: We identified 26,206 incident cases with dementia aged≧65 years in 2010, with the same no. of controls from National Health Insurance claims. Environmental measures were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CI) of the association between dementia incidence and the environmental measures at the township level.

Results: We observed a significant reduction of 12% in the odds ratios of dementia in areas with higher availability of playgrounds and sport venues (OR 0.88, 95% CI 0.81-0.95), after controlling for individual and other environmental characteristics. Community center availability was also significantly associated with an 8% decreased odds for dementia (OR 0.92, 95% CI 0.87-0.99), but the association was not significant after further consideration of individual-level characteristics. Although higher odds of dementia were found in areas with high median annual family income (OR 1.14, 95% CI 1.04-1.25), such a significant relationship did not appear in the full model.

Conclusions: Our study suggests that specific physical and social environmental features have different influences on the risk of dementia. Public health interventions may consider these environmental aspects for preventing dementia incidence.
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http://dx.doi.org/10.1186/s12877-020-01624-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318767PMC
June 2020

A comparison of the risk of acute myocardial infarction in patients receiving hemodialysis and peritoneal dialysis: A population-based, propensity score-matched cohort study.

Atherosclerosis 2020 08 29;307:130-138. Epub 2020 May 29.

Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address:

Background And Aims: Acute myocardial infarction (AMI) remains the major cause of morbidity and mortality in the dialysis population. Traditional cardiovascular (CV) risk factors are unable to fully account for the high incidence of AMI in the dialysis population. In this study, we investigated whether dialysis modalities could be one of the uremia-specific risk factors for AMI.

Methods: Using the National Health Insurance Research Database, we recruited all incident dialysis patients from the period January 1, 1998 to December 31, 2010. The propensity score matching method was applied to form the matched pairs of hemodialysis (HD) and peritoneal dialysis (PD) patients. Incidence rate (IR), cumulative incidence rate (CIR) and multivariable subdistribution hazards models were employed to compare the risk of AMI in the HD and PD groups.

Results: Of the 86,215 incident dialysis patients, 5,513 matched pairs of HD and PD patients were identified. The HD patients had a higher IR of AMI than the PD patients (9.71 vs. 8.35 per 1000 patient-years, respectively, p = 0.01). The CIR was also higher in the HD patients than in the PD patients (0.09 vs. 0.05), especially 4 years after dialysis therapy was initiated (p = 0.04). In the subdistribution hazards models, HD was still significantly associated with a higher risk of developing AMI (adjusted hazard ratio:1.30, 95% confidence interval:1.02-1.65). The results remained unchanged in various stratifications as well as in the analysis of the unmatched cohorts.

Conclusions: Compared to PD, HD was significantly associated with higher risk of developing AMI, especially after 4 years since dialysis was initiated. Prevention and routine surveillance programs for AMI should be individualized according to dialysis modalities and vintage.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.05.010DOI Listing
August 2020

Risk of 30-day mortality and its association with alcohol concentration level among driver victims of motor vehicle crashes: comparison of population- and hospital-based designs.

J Epidemiol Community Health 2020 10 16;74(10):815-823. Epub 2020 Jun 16.

Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Background: Although blood alcohol concentration (BAC) is undoubtedly associated with increased risk of injury among driver victims involved in motor vehicle crashes (MVCs), some studies noted that high BAC was associated with reduced risk of mortality after injury. In addition, most of the previous studies included only injured patients admitted, which may lead to potential selection bias arising from exclusion of those with minor injury and those who died at the accident scene of MVC.

Method: The population-based design included 2586 driver victims with BAC equivalent >0 and 10 307 matched controls (BAC equivalent =0) selected from the Police-reported Traffic Accident Registry from 1 July to 31 December 2016 in Taiwan. The hospital-based design comprised a subset sample, which included 517 driver victims with BAC equivalent >0 and 662 with BAC equivalent =0 hospitalised on the same day the MVCs occurred. Conditional logistic regression models with adjustment for potential confounders were used to estimate the ORs and 95% CIs of 30-day mortality associated with BAC equivalent level.

Results: In the population-based design, a positive dose-gradient relationship was observed between BAC equivalent level and 30-day mortality, with a covariate-adjusted OR of 3.77 (95% CI 1.84 to 7.72), 6.19 (95% CI 3.13 to 12.26) and 7.75 (95% CI 4.51 to 13.32) for low, moderate and high BAC equivalent levels, respectively. By contrast, the hospital-based design revealed no significant association between 30-day mortality and alcohol concentration regardless of the BAC equivalent level.

Conclusion: The association between BAC equivalent level and short-term mortality could have been overlooked in hospital-based studies that excluded MVC-related deaths outside hospital settings.
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http://dx.doi.org/10.1136/jech-2020-213953DOI Listing
October 2020

Spina bifida and pediatric cancers.

Pediatr Hematol Oncol 2020 Oct 4;37(7):630-636. Epub 2020 May 4.

Danish Cancer Society Research Center, Copenhagen, Denmark.

Spina bifida has been reported to co-occur with pediatric cancer, but comprehensive evaluations remained elusive. We investigated this co-occurrence in two large, population-based studies in Taiwan (N = 1900 cancer cases, 2,077,137 controls) and Denmark (N = 5508 cases, 137,700 controls). Analyses in Denmark were restricted to the period before prenatal diagnostics became available (2004) and pregnancy terminations of fetuses with birth defects became more common. Using national patient and cancer registries, we linked spina bifida and cancer diagnoses among cases and non-cases. The risk of spina bifida among all cancer cases was increased and similar in Denmark [odds ratio (OR)=8.4, 95% confidence interval (CI) 5.1-13.8] and Taiwan (OR = 8.5, 95% CI 4.0-17.8), particularly for central nervous system (CNS) tumors (Denmark: OR = 16.3, 95% CI 8.1-33.0; Taiwan: OR = 26.6, 95% CI 8.5, 83.1), including benign CNS tumors (Denmark: OR = 41.5, 95% CI 21.2, 81.4). These findings suggest the need for comprehensive investigation of shared risk factors in the link between spina bifida and pediatric cancer.
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http://dx.doi.org/10.1080/08880018.2020.1760409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577564PMC
October 2020

and Gene Mutations and Lung Cancer Sisk: A Meta-Analysis.

Medicina (Kaunas) 2020 Apr 27;56(5). Epub 2020 Apr 27.

College of Intelligence, National Taichung University of Science and Technology, Taichung 404, Taiwan.

and are associated with many cancer types in addition to hereditary breast and ovarian cancers. However, their relation to lung cancer remains to be explored. Observation studies were systematically reviewed to explore the association of or with lung cancer. PubMed, MEDLINE [EBSCOhost], and relevant articles published up to 7 January 2020 were searched. Odd ratio (OR), standardized morbidity rate (SMR), and cancer-specific standardized incidence ratios (SIRs) were pooled together as relative risk (RR) estimates (95% confidence interval [CI], 0.66-1.40). Thirteen studies were included for analysis. Results showed that the RR of is 0.76 (95% CI, 0.48-1.19), the overall RR is 0.96 (95% CI, 0.66-1.40), and that of is 0.66 (95% CI, 0.41-1.05), indicating that it was not associated with lung cancer. With the limitation of the retrospective study design and severe heterogeneity, these results inform clinicians and relevant families that and mutation carriers have no increased risk of lung cancer.
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http://dx.doi.org/10.3390/medicina56050212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279251PMC
April 2020

Association of Dysfunction of Vascular Access for Hemodialysis With Major Adverse Cardiovascular Events - A Group-Based Trajectory Model Analysis.

Circ J 2020 05 22;84(6):1004-1011. Epub 2020 Apr 22.

Department of Public Health, College of Medicine, National Cheng Kung University.

Background: An unconventional risk factor, "dysfunction of hemodialysis vascular access", was demonstrated to be associated with subsequent major adverse cardiovascular events (MACE) in our previous study. However, applying this suggestion in a clinical scenario may be not intuitive. A group-based trajectory model was applied to further recognize those patients with the highest risks for MACE.Methods and Results:In a cohort of patients who received hemodialysis from 2001 to 2010, we identified 9,711 cases that developed MACE in the stage of stable maintenance dialysis, and 19,422 randomly selected controls matched to cases on age, gender and duration of dialysis. Events of vascular access dysfunction in the 6-month period before MACE for cases and index dates for controls were evaluated. By group-based trajectory modeling, patients according to their counts of vascular access dysfunction in each month over the 6-month period prior to MACE or index dates were categorized. There were 26,744 patients in group 1 (no dysfunction), 650 in group 2 (escalating dysfunction) and 1,739 in group 3 (persistent dysfunction). Logistic regression analysis indicated that patients in group 3 had the highest chance of subsequent MACE (odds ratio 2.47, in comparison with group 1) after controlling for all the available potential confounders.

Conclusions: Uninterrupted clusters of vascular access dysfunction are associated with a higher risk of subsequent MACE.
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http://dx.doi.org/10.1253/circj.CJ-19-1036DOI Listing
May 2020