Publications by authors named "Sherry Yueh-Hsia Chiu"

107 Publications

Imaging biomarkers of breast cancers originating from the major lactiferous ducts: Ductal adenocarcinoma of the breast, DAB.

Eur J Radiol 2022 Jun 4;154:110394. Epub 2022 Jun 4.

School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan.

Purpose: As we have previously demonstrated, breast cancers originating in the major lactiferous ducts and propagating through the process of neoductgenesis are a distinct subtype of invasive breast cancers, although by current practice they are placed within the group termed ductal carcinoma in situ (DCIS) and are consequently underdiagnosed and undertreated. Imaging biomarkers provide a reliable indication of the site of origin of this breast cancer subtype (Ductal Adenocarcinoma of the breast, DAB) and have excellent concordance with long-term patient outcome. In the present paper, the imaging biomarkers of DAB are described in detail to encourage and facilitate its recognition as a distinct, invasive breast cancer subtype.

Methods: Correlation of breast imaging biomarkers with the corresponding histopathological findings using large format technology, with additional evidence from subgross, thick section histopathology to demonstrate the complex three-dimensional structure of the newly formed duct-like structures, neoducts.

Results: There are six imaging biomarkers (mammographic tumour features) of DAB. Four subgroups have characteristic malignant-type calcifications on the mammogram. Two of these are characterized by intraluminal necrosis producing fragmented or dotted casting type calcifications on the mammogram; another two subgroups are characterized by intraductal fluid production which may eventually calcify, producing skipping stone-like or string of pearl-like calcifications. A fifth DAB subgroup presents with bloody or serous nipple discharge and is usually occult on mammography but is detectable with galactography and magnetic resonance imaging (MRI). The sixth subgroup presents as architectural distortion on the mammogram without associated calcifications.

Conclusions: Radiologists can use these well-defined imaging biomarkers to readily detect Ductal Adenocarcinoma of the Breast, DAB. Immunochemical biomarkers are generally not determined from the DAB itself, due to the erroneous assumption that DAB is non-invasive. MRI plays a crucial role in determining disease extent and guiding surgical management. The accumulating evidence that this disease subtype is, in fact, an invasive cancer, necessitates an urgent re-evaluation of the diagnostic and management criteria for this poorly understood malignancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2022.110394DOI Listing
June 2022

Significant association between serum Wisteria floribunda agglutinin-positive Mac-2-binding protein and prognosis of hepatocellular carcinoma after surgical treatment.

Am J Cancer Res 2022 15;12(2):601-614. Epub 2022 Feb 15.

Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital Kaohsiung 83301, Taiwan.

Serum Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA-M2BP) is a novel marker for evaluating fibrosis and predicting the development of hepatocellular carcinoma (HCC). However, the role of WFA-M2BP in the prognosis of HCC patients after curative surgery remains unknown. In this study, we aimed to evaluate the prognostic role of serum WFA-M2BP in HCC patients after curative resection and liver transplantation. We enrolled 460 HCC patients (357 resection and 103 transplantation) to analyze the risk factors for HCC recurrence and patient's survival. We employed time-to-event models using univariate and multivariable Cox proportional hazards regression analyses and calculated the hazard ratios (HRs) and adjusted HRs with their corresponding 95% confidence intervals (CIs). The levels of WFA-M2BP were 0.19-14.51 COI (median 1.08) in patients of hepatectomy and 0.47-19.90 COI (median 6.0) in transplant patients. The levels of WFA-M2BP in liver transplant patients is much higher than that of hepatectomy patients. Overall, liver fibrotic stage was positively correlated to WFA-M2BP levels (P<0.0001). This study demonstrated that elevated WFA-M2BP level (COI ≥0.75) was associated with a higher HCC recurrence rate in the resection group (P<0.001). Survival analysis showed that an elevated WFA-M2BP level (COI ≥1.43) is associated with a higher mortality risk after surgical resection (P=0.0088) in the univariate analysis only. In liver transplant patients, WFA-M2BP level (COI ≥3.81) did not predict HCC recurrence at all, but was associated poor survival after transplantation, with a borderline significance (P=0.0943). Serum WFA-M2BP is a reliable marker for liver fibrosis in the present study. It is also reliable marker to predict prognosis of HCC after surgical resection. However, the prognostic role of WFA-M2BP in HCC related transplants is equivocal, which is different from that of surgical resection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899980PMC
February 2022

Community-based multiple screening for metabolic syndrome by innovative theory: A longitudinal study.

Public Health Nurs 2022 01 4;39(1):303-312. Epub 2022 Jan 4.

School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.

The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check-ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease-free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/phn.13033DOI Listing
January 2022

Developing a Prediction Model for 7-Year and 10-Year All-Cause Mortality Risk in Type 2 Diabetes Using a Hospital-Based Prospective Cohort Study.

J Clin Med 2021 Oct 18;10(20). Epub 2021 Oct 18.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan.

Leveraging easily accessible data from hospitals to identify high-risk mortality rates for clinical diabetes care adjustment is a convenient method for the future of precision healthcare. We aimed to develop risk prediction models for all-cause mortality based on 7-year and 10-year follow-ups for type 2 diabetes. A total of Taiwanese subjects aged ≥18 with outpatient data were ascertained during 2007-2013 and followed up to the end of 2016 using a hospital-based prospective cohort. Both traditional model selection with stepwise approach and LASSO method were conducted for parsimonious models' selection and comparison. Multivariable Cox regression was performed for selected variables, and a time-dependent ROC curve with an integrated AUC and cumulative mortality by risk score levels was employed to evaluate the time-related predictive performance. The prediction model, which was composed of eight influential variables (age, sex, history of cancers, history of hypertension, antihyperlipidemic drug use, HbA1c level, creatinine level, and the LDL /HDL ratio), was the same for the 7-year and 10-year models. Harrell's C-statistic was 0.7955 and 0.7775, and the integrated AUCs were 0.8136 and 0.8045 for the 7-year and 10-year models, respectively. The predictive performance of the AUCs was consistent with time. Our study developed and validated all-cause mortality prediction models with 7-year and 10-year follow-ups that were composed of the same contributing factors, though the model with 10-year follow-up had slightly greater risk coefficients. Both prediction models were consistent with time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10204779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537078PMC
October 2021

Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients.

Sci Rep 2021 07 27;11(1):15258. Epub 2021 Jul 27.

Department of Health Care Management, College of Management, and Healthy Aging Research Center, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.

Aspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96-3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41-0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1-2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-94757-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316573PMC
July 2021

Continental transmission of emerging COVID-19 on the 38° north latitude.

J Formos Med Assoc 2021 Jun 1;120 Suppl 1:S19-S25. Epub 2021 Jun 1.

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Emergency Department of Taipei City Hospital, Ren-Ai Branch, Taiwan. Electronic address:

Background: As COVID-19 has become a pandemic emerging infectious disease it is important to examine whether there was a spatiotemporal clustering phenomenon in the globe during the rapid spread after the first outbreak reported from southern China.

Materials And Methods: The open data on the number of COVID-19 cases reported at daily basis form the globe were used to assess the evolution of outbreaks with international air link on the same latitude and also including Taiwan. The dynamic Susceptible-Infected-Recovered model was used to evaluate continental transmission from December 2019 to March 2020 before the declaration of COVID-19 pandemic with basic reproductive number and effective reproductive number before and after containment measurements.

Results: For the initial COVID-19 outbreak in China, the estimated reproductive number was reduced from 2.84 during the overwhelming outbreaks in early January to 0.43 after the strict lockdown policy. It is very surprising to find there were three countries (including South Korea, Iran, and Italy) and the Washington state of the USA on the 38° North Latitude involved with large-scale community-acquired outbreaks since the first imported COVID-19 cases from China. The propagation of continental transmission was augmented from hotspot to hotspot with higher reproductive number immediately before the declaration of pandemic. By contrast, there was not any large community-acquired outbreak in Taiwan.

Conclusion: The propagated spatiotemporal transmission from China to other hotspots may explain the emerging pandemic that can only be exempted by timely border control and preparedness of containment measurements according to Taiwan experience.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jfma.2021.05.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166523PMC
June 2021

Gender difference in metabolic syndrome and incident colorectal adenoma: A prospective observational study (KCIS No.42).

Medicine (Baltimore) 2021 Jun;100(22):e26121

Department of Family Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.

Abstract: This community-based study aimed to elucidate whether there is a gender difference in the effect of metabolic syndrome (MetS) and its individual components on an elevated risk for incident colorectal adenoma.A prospective cohort study was conducted by enrolling 59,767 subjects aged 40 years or older between 2001 and 2009 in Keelung, Taiwan, to test this hypothesis, excluding those with a prior history of colorectal cancer and those with colorectal cancer diagnosed at the first screening. Cox proportional hazards regression models were used to assess the effect of MetS in terms of a dichotomous classification, each individual component and the number of components for males and females.Colorectal adenoma was present in 2.7% (n = 652) of male participants and 1.1% (n = 403) of female participants. The prevalence rate of MetS was 26.7% and 23.3% for males and females, respectively. The effect of MetS on colorectal adenoma was statistically significant and similar for the 2 genders, with an adjusted hazard ratio (aHR) of 1.33 (95% CI: 1.13-1.58) in males and 1.33 (95% CI: 1.06-1.66) in females after adjustment for confounders. However, MetS led to higher risk of advanced colorectal adenoma in men than in women. Regarding the effect of each component of MetS on colorectal adenoma, abnormal waist circumference and hypertriglyceridemia led to an elevated risk of colorectal adenoma in both genders. A rising risk of colorectal adenoma among females was noted in those with a moderately higher level of glycemia (100-125 mg/dL, aHR = 1.44, 95% CI: 1.12-1.85). Hypertriglyceridemia and high blood pressure were associated with an increased risk of advance colorectal adenoma in males.Both male and female subjects with MetS had a higher risk of colorectal adenoma. The contributions from individual components of MetS varied by gender. These findings suggest that the possible risk reduction of colorectal adenoma through metabolic syndrome-based lifestyle modifications may differ between genders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000026121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183717PMC
June 2021

Classification of community-acquired outbreaks for the global transmission of COVID-19: Machine learning and statistical model analysis.

J Formos Med Assoc 2021 Jun 16;120 Suppl 1:S26-S37. Epub 2021 May 16.

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Changhua Public Health Bureau, Changhua, Taiwan. Electronic address:

Background: As Coronavirus disease 2019 (COVID-19) pandemic led to the unprecedent large-scale repeated surges of epidemics worldwide since the end of 2019, data-driven analysis to look into the duration and case load of each episode of outbreak worldwide has been motivated.

Methods: Using open data repository with daily infected, recovered and death cases in the period between March 2020 and April 2021, a descriptive analysis was performed. The susceptible-exposed-infected-recovery model was used to estimate the effective productive number (R). The duration taken from R > 1 to R < 1 and case load were first modelled by using the compound Poisson method. Machine learning analysis using the K-means clustering method was further adopted to classify patterns of community-acquired outbreaks worldwide.

Results: The global estimated R declined after the first surge of COVID-19 pandemic but there were still two major surges of epidemics occurring in September 2020 and March 2021, respectively, and numerous episodes due to various extents of Nonpharmaceutical Interventions (NPIs). Unsupervised machine learning identified five patterns as "controlled epidemic", "mutant propagated epidemic", "propagated epidemic", "persistent epidemic" and "long persistent epidemic" with the corresponding duration and the logarithm of case load from the lowest (18.6 ± 11.7; 3.4 ± 1.8)) to the highest (258.2 ± 31.9; 11.9 ± 2.4). Countries like Taiwan outside five clusters were classified as no community-acquired outbreak.

Conclusion: Data-driven models for the new classification of community-acquired outbreaks are useful for global surveillance of uninterrupted COVID-19 pandemic and provide a timely decision support for the distribution of vaccine and the optimal NPIs from global to local community.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jfma.2021.05.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126178PMC
June 2021

Enhancing Prediction Performance by Add-On Combining Circulating Tumor Cell Count, CD45 EpCAM Cell Count on Colorectal Cancer, Advance, and Metastasis.

Cancers (Basel) 2021 May 21;13(11). Epub 2021 May 21.

Division of Hematology-Oncology, Department of Internal Medicine, New Taipei City Municipal TuCheng Hospital, New Taipei City 23652, Taiwan.

Conventional circulating tumor cell (CTC) enumeration could ignore the CTCs more relevant to cancer metastasis. Thus, negative selection CTC enumeration was proposed, by which information on two cellular biomarkers (numbers of CTCs and CD45 EpCAM cells) can be obtained. By combining this approach with the conventional biomarker carcinoembryonic antigen (CEA), this study aimed to explore whether any combination of these biomarkers could improve the predictive performance for colorectal cancer (CRC) or its status. In this work, these two cell populations in healthy donors and CRC patients were quantified. Results revealed that enumeration of these two cell populations was able to discriminate healthy donors from CRC patients, even patients with non-advanced CRC. Moreover, the combination of the two cell populations showed improved performance (AUROC: 0.893) for CRC prediction over the use of only one population. Compared with CEA alone, the combination of the three biomarkers increased the performance (AUROC) for advanced CRC prediction from 0.643 to 0.727. Compared with that of CEA alone for metastatic CRC prediction, the AUROC was increased from 0.780 to 0.837 when the CTC count was included. Overall, this study demonstrated that the combination of these two cellular biomarkers with CEA improved the predictive performance for CRC and its status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cancers13112521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196640PMC
May 2021

A novel evidence of serial changes of bone mineral density in chronic hepatitis B patients treated with entecavir.

Hepatol Int 2021 Apr 27;15(2):310-317. Epub 2021 Apr 27.

Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan.

Background And Aims: Tenofovir disoproxil fumarate (TDF) and Entecavir (ETV) are commonly used for patients with chronic hepatitis B (CHB), and renal or bone toxicity are possible concerns. This study is to evaluate the renal and bone effect of TDF compared with ETV in CHB patients.

Methods: This is a retrospective study at Kaohsiung Chung-Gung memorial hospital, Taiwan, from June 2013 to December 2018. Patients with CHB were prescribed with TDF or ETV for 3 years or above. Renal function was assessed at 12-week intervals. Dual-energy X-ray absorptiometry scans of the spine and femurs were performed at 48-week intervals. The propensity score analysis was conducted to balance the baseline characteristics of patients in both treatment groups.

Results: A total of 258 patients were included in this study: TDF (n = 135) and ETV (n = 123). The prevalence of osteopenia was much higher in the TDF group at week 48 and week 96. The TDF group showed significant mean percentage decrease from baseline in bone mineral density throughout the treatment course. Logistic regression analysis adjusted for the propensity score demonstrated that the use of TDF was the only predictive factor of significant bone density loss at week 144. The mean percentage decline of estimated glomerular filtration rate was significant in the TDF group at all time points. Renal threshold phosphate concentration was similar among both treatment groups.

Conclusions: This study suggested CHB patients treated with TDF may experience increased risks of bone loss and renal deficits compared to those treated with ETV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12072-021-10148-zDOI Listing
April 2021

Letter: tenofovir versus entecavir for hepatocellular carcinoma prevention in chronic hepatitis B-related compensated cirrhosis-authors' reply.

Aliment Pharmacol Ther 2021 05;53(9):1042-1043

Division of Hepato-Gastroenterology, Department of Internal Medicine, Linko Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apt.16339DOI Listing
May 2021

Validity of the Taiwan Triage and Acuity Scale in mainland China: a retrospective observational study.

Emerg Med J 2022 Aug 7;39(8):617-622. Epub 2021 Apr 7.

School of Nursing, Fujian Medical University, Fuzhou, Fujian, China

Objectives: The Taiwan Triage and Acuity Scale (TTAS), developed for use in EDs, has been shown to be an excellent tool for triaging patients with high predictive performance, with an area under the receiver operating curve (AUROC) of 0.75. TTAS has been widely used in hospitals in Taiwan since 2010, but its utility has not been studied outside of Taiwan. Thus, the aim of this study was to evaluate the validity of using the TTAS in the ED of a tertiary hospital in mainland China to predict patient outcomes.

Methods: A retrospective observational study was performed on patients 14 years of age or older attending the ED of a tertiary hospital in mainland China between 1 January 2016 and 31 March 2016. The validity of the TTAS in predicting hospital admission, intensive care unit (ICU) admission, death, ED length of stay (LOS) and ED resource utilisation was evaluated by determining the correlation of these outcomes with the TTAS, AUROC and test characteristics.

Results: A total of 7843 patients were included in this study. There were significant differences between the TTAS categories in disposition, ED LOS and ED resource utilisation (p<0.0001). The TTAS was significantly correlated with patient disposition at discharge, hospital admission, ICU admission and death in the ED (Kendall rank correlations were 0.254, -0.254, -0.079 and -0.071, respectively; p=0.001). The AUROCs for the prediction of hospital admissions, ICU admissions and deaths in the ED were 0.749 (95% CI 0.732 to 0.765), 0.869 (95% CI 0.797 to 0.942) and 0.998 (95% CI 0.995 to 1.000), respectively. Our results demonstrated better performance using the TTAS for predictions of ICU admission and death.

Conclusions: The TTAS had good validity in predicting patient outcomes and ED resource utilisation in a tertiary hospital in mainland China. Compared with the performance of the TTAS in Taiwan, our results suggest that the TTAS can usefully be applied outside of Taiwan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/emermed-2019-208732DOI Listing
August 2022

Pregnancy weight gain may affect perinatal outcomes, quality of life during pregnancy, and child-bearing expenses: an observational cohort study.

Arch Gynecol Obstet 2021 09 4;304(3):599-608. Epub 2021 Mar 4.

Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan.

Purpose: We aimed to examine the effect of gestational weight gain (GWG) on perinatal outcomes, quality of life (QoL) during pregnancy, and medical costs of childbirth.

Methods: The observational cohort comprised 2210 pregnant women who were classified into three groups based on their pre-pregnancy body mass index (BMI) and GWG in relation to the 2020 Institute of Medicine (IOM) recommendations. The data were collected on perinatal outcomes, urinary incontinence (UI) during pregnancy, changes in sexual function, and medical costs of hospitalization for delivery. Univariate and multivariable logistic regression models were employed to explore those associations.

Results: Only 42.1% of women met the 2020 IOM guidelines. After adjustments for potential confounding factors, women with above-normal GWG had adverse pregnancy outcomes, including a large fetal head circumference and macrosomia, and women with below-normal GWG were more likely to deliver low-birthweight fetuses preterm than women with normal GWG. Only 16.8% of women reported sexual activity during pregnancy. There were not significant differences in sexual activity and satisfaction, or QoL among the three GWG groups. Child-bearing expenses were higher for women with above-normal GWG than for women with normal GWG. Although the child-bearing expenses were higher for the above-normal GWG, the proportion of women with expenses above the median increased according to pre-pregnancy BMI.

Conclusion: Our results show that inappropriate GWG is associated with a greater risk of adverse perinatal outcomes and increased medical expenses for delivery. Healthcare providers are advised to counsel women to maintain their GWG following the 2020 IOM recommendations throughout pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-021-05983-2DOI Listing
September 2021

Beneficial Effect of Consecutive Screening Mammography Examinations on Mortality from Breast Cancer: A Prospective Study.

Radiology 2021 06 2;299(3):541-547. Epub 2021 Mar 2.

From the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, England (S.W.D., R.M.); Department of Mammography, Falun Central Hospital, Falun, Sweden (L.T.); School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan (A.M.F.Y., S.L.S.C.); Department of Diagnostic Radiology, University of Turku, Turku, Finland (P.B.D.); Department of Cancer Control Sciences, American Cancer Society, Atlanta, Ga (R.A.S.); Regional Cancer Center, Umeå University, Umeå, Sweden (H.J.); Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (S.T.); Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan (S.Y.H.C.); Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (S.Y.H.C.); Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan (S.Y.H.C., G.H.H.J., M.M.S.K., C.Y.H., T.H.H.C.); Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden (J.A.); Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, England (L.H.); and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (L.H.).

Background Previously, the risk of death from breast cancer was analyzed for women participating versus those not participating in the last screening examination before breast cancer diagnosis. Consecutive attendance patterns may further refine estimates. Purpose To estimate the effect of participation in successive mammographic screening examinations on breast cancer mortality. Materials and Methods Participation data for Swedish women eligible for screening mammography in nine counties from 1992 to 2016 were linked with data from registries and regional cancer centers for breast cancer diagnosis, cause, and date of death (Uppsala University ethics committee registration number: 2017/147). Incidence-based breast cancer mortality was calculated by whether the women had participated in the most recent screening examination prior to diagnosis only (intermittent participants), the penultimate screening examination only (lapsed participants), both examinations (serial participants), or neither examination (serial nonparticipants). Rates were analyzed with Poisson regression. We also analyzed incidence of breast cancers proving fatal within 10 years. Results Data were available for a total average population of 549 091 women (average age, 58.9 years ± 6.7 [standard deviation]). The numbers of participants in the four groups were as follows: serial participants, 392 135; intermittent participants, 41 746; lapsed participants, 30 945; and serial nonparticipants, 84 265. Serial participants had a 49% lower risk of breast cancer mortality (relative risk [RR], 0.51; 95% CI: 0.48, 0.55; < .001) and a 50% lower risk of death from breast cancer within 10 years of diagnosis (RR, 0.50; 95% CI: 0.46, 0.55; < .001) than serial nonparticipants. Lapsed and intermittent participants had a smaller reduction. Serial participants had significantly lower risk of both outcomes than lapsed or intermittent participants. Analyses correcting for potential biases made little difference to the results. Conclusion Women participating in the last two breast cancer screening examinations prior to breast cancer diagnosis had the largest reduction in breast cancer death. Missing either one of the last two examinations conferred a significantly higher risk. Published under a CC BY 4.0 license. See also the editorial by Stephen A. Feig in this issue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2021203935DOI Listing
June 2021

Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers.

Gut 2021 12 25;70(12):2321-2329. Epub 2021 Jan 25.

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

Objective: To measure the effects of faecal immunochemical test (FIT) for colorectal cancer (CRC) screening on overall and site-specific long-term effectiveness of population-based organised service screening.

Design: A prospective cohort study of Taiwanese nationwide biennial FIT screening was performed. A total of 5 417 699 eligible subjects were invited to attend screening from 2004 through 2009 and were followed up until 2014. We estimated the adjusted relative rates (aRRs) on the effectiveness of reducing advanced-stage CRC (stage II+) and CRC death by Bayesian Poisson regression models with the full adjustment for a cascade of self-selection factors (including the screening rate and the colonoscopy rate) and the completeness of colonoscopy together with demographic features.

Results: FIT screening (exposed vs unexposed) reduced the incidence of advanced-stage CRC (48.4 vs 75.7 per 100 000) and mortality (20.3 vs 41.3 per 100 000). Statistically significant reductions of both incidence of advanced-stage CRCs (aRR=0.66, 95% CI 0.63 to 0.70) and deaths from CRC (aRR=0.60, 95% CI 0.57 to 0.64) were noted. FIT screening was more effective in reducing distal advanced-stage CRCs (aRR=0.61, 95% CI 0.58 to 0.64) and CRC mortality (aRR=0.56, 95% CI 0.53 to 0.69) than proximal advanced CRCs (aRR=0.84, 95% CI 0.77 to 0.92) and CRC mortality (aRR=0.72, 95% CI 0.66 to 0.80).

Conclusion: A large-scale population-based biennial FIT screening demonstrates 34% significant reduction of advanced-stage CRCs and 40% reduction of death from CRC with larger long-term effectiveness in the distal colon than the proximal colon. Our findings provide a strong and consistent evidence-based policy for supporting a sustainable population-based FIT organised service screening worldwide. The disparity of site-specific long-term effectiveness also provides an insight into the remedy for lower effectiveness of FIT screening in the proximal colon.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/gutjnl-2020-322545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8588305PMC
December 2021

Classifying interval cancers as false negatives or newly occurring in fecal immunochemical testing.

J Med Screen 2021 09 18;28(3):286-294. Epub 2021 Jan 18.

Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.

Objective: To classify interval colorectal cancers as false negatives or newly occurring cases in a biennial Fecal immunochemical test (FIT) screening program and by various interscreening intervals.

Setting: Data from the Taiwanese biennial colorectal cancer screening program involving FIT from 2004 to 2014 were used to estimate the incidence rate of asymptomatic colorectal cancer and the rate of its subsequent progression to clinical mode.

Methods: The sensitivity of detecting asymptomatic colorectal cancers excluding newly developed colorectal cancers was compared to the conventional estimate of sensitivity, the complementary FIT interval cancer rate as a percentage of the expected incidence rate ((1-I/E)%). The relative contribution of newly developed or false-negative cases to FIT interval colorectal cancers was estimated by age and interscreening intervals.

Results: The Taiwanese biennial fecal immunochemical test screening program had a conventional sensitivity estimate of 70.2%. After newly developed colorectal cancers were separated from FIT interval cancers, the ability to detect asymptomatic colorectal cancers increased to 75.5%. FIT interval colorectal cancers from the biennial program mainly resulted from newly developed colorectal cancers (68.8%). The corresponding figures decreased to 61.1% for the annual program but increased to 74.7% for the triennial program. The preponderance of newly developed colorectal cancers among FIT interval cancers was more prominent in screenees aged 50-59  than in those aged 60-69.

Conclusions: Newly developed colorectal cancers showed a predominance among the FIT interval colorectal cancers in particular in the younger population screened. It is desirable to identify high-risk individuals to offer them a short interscreening interval or advanced detection methods to reduce their odds of developing interval cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0969141320986830DOI Listing
September 2021

Clinical and novel application of FibroScan, FIB-4 and aspartate aminotransferase-to-platelet ratio index in liver fibrosis evaluation in patients with hepatocellular carcinoma and their roles in oesophageal variceal prediction.

Int J Clin Pract 2021 Apr 19;75(4):e13945. Epub 2021 Jan 19.

Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.

Background: Non-invasive techniques for liver fibrosis diagnosis are very important for clinician especially in high-risk patients for liver biopsy. We further explored the diagnostic accuracy of FibroScan, FIB-4 and aminotransferase-to-platelet ratio index (APRI) in identifying liver fibrosis and assess their predictive role for oesophageal varices in patients with hepatocellular carcinoma (HCC).

Methods: In total, 380 patients who underwent surgery for HCC were included based on retrospective study design. Liver fibrosis was pathologically diagnosed using the Ishak scoring system. Liver stiffness parameters were measured using FibroScan. APRI and FIB-4 were calculated. Among those, 121 patients who received oesophagogastroduodenoscopic examination underwent variceal evaluation.

Results: For liver cirrhosis diagnosis with FibroScan, the optimal cut-off values for the patients with HCC overall, left HCC and right HCC were 8.85, 11.75 and 8.70 kPa (the accuracy were 78.7%, 78.4% and 79.2%, respectively). They had high areas under the receiver operating characteristic curve of 0.84, 0.84 and 0.85. The combined FibroScan, APRI and FIB-4 had very high specificity (more than 92%) for cirrhosis diagnosis. The optimal cut-off liver stiffness values for the diagnosis of varices were all 11.2 kPa. For predicting varices, the optimal cut-off values of FIB-4 and APRI were 2.64 and 0.71, their accuracy were 64.3%-78.4%, 69.4% and 72.7%, respectively.

Conclusions: FibroScan, FIB-4 and APRI have moderate accuracy for liver fibrosis diagnosis and oesophageal varices prediction in patients with hepatoma. This is a study of these non-invasive techniques applied in specific hepatoma patients and with inevitable limitations and need future more studies for validation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijcp.13945DOI Listing
April 2021

The Association between Metabolic Syndrome and Related Factors among the Community-Dwelling Indigenous Population in Taiwan.

Int J Environ Res Public Health 2020 12 2;17(23). Epub 2020 Dec 2.

College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan.

The aim of this study was to conduct a community-based study with a view to construct a detailed analysis about metabolic syndrome and the related risk factors of the indigenous population. This was an observational, population-based and cross-sectional study that was conducted in remote villages of an indigenous community in northern Taiwan between 2010 and 2013. A total of 586 participants, 275 men and 311 women, were eligible for analysis. The participants underwent a questionnaire survey that included demographic and health behavior issues. An anthropometric assessment and measurements of blood pressure were carried out including serum biochemical variables. Metabolic syndrome (MetS) was defined by following the criteria provided by the modified Adult Treatment Panel III (ATP III) criteria of the National Cholesterol Education Program (NCEP). Univariate and multiple logistic regressions were used to identify the risk factors for metabolic syndrome. The standardized prevalence rates of substance use (cigarette smoking, alcohol drinking and betel nut chewing) were significantly higher than the general population regardless of whether it was northern, central or southern Taiwan and this was especially the case with betel nut chewing in women. The prevalence rate of metabolic syndrome was 42.9% in the indigenous population with 41.3% in men and 44.4% in women, which was higher than for urban Taiwanese. In the multiple logistic regression models, we found that the significant associated factors for metabolic syndrome were older age, lower education level, high levels of uric acid, alanine transaminase (ALT), gamma-glutamyl transferase (γ-GT) and creatinine. A higher prevalence rate of metabolic syndrome and substance use were observed in the indigenous population compared with urban Taiwanese, especially in women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17238958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730304PMC
December 2020

Impact of prepregnancy body mass index on pregnancy outcomes, incidence of urinary incontinence and quality of life during pregnancy - An observational cohort study.

Biomed J 2020 12 24;43(6):476-483. Epub 2020 Nov 24.

Department of Health Care Management and Healthy Aging Research Center, College of Management, Chang Gung University, Taoyuan, Taiwan; Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Electronic address:

Background: To evaluate the effects of prepregnancy body mass index (BMI) on pregnancy outcomes, prevalence of urinary incontinence, and quality of life.

Methods: The observational cohort included 2210 pregnant women who were divided into 4 groups according to their prepregnancy BMI: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), and obese (≥30). Data were analyzed for pregnancy outcomes, prevalence of urinary incontinence during pregnancy, scores of the Short Form 12 health survey (SF-12) and changes in sexual function.

Results: Compared with normal weight, overweight and obesity were associated with advanced maternal age, low education level, multiparity, preterm delivery, cesarean section, gestational weight gain above the Institute of Medicine (IOM) guidelines, preeclampsia, gestational diabetes, macrosomia and large fetal head circumference. After adjusting for confounding factors, women with overweight and obesity were more likely to have adverse maternal outcomes (gestational weight gain above the IOM guidelines, preeclampsia and gestational diabetes) and fetal outcomes (large fetal head circumference and macrosomia) compared to normal weight women. Overweight and obese women (BMI ≥ 25) were more likely to have urinary incontinence than normal weight and underweight women. There were no significant differences in SF-12 scores among the 4 BMI groups, but more than 90% of pregnant women had reduced or no sexual activities regardless of BMI.

Conclusions: Maternal prepregnancy overweight and obesity are associated with greater risks of preeclampsia, gestational diabetes, macrosomia and urinary incontinence. Health care providers should inform women to start their pregnancy at a BMI in the normal weight category.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bj.2019.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804172PMC
December 2020

The effect of intravesical hyaluronic acid therapy on urodynamic and clinical outcomes among women with interstitial cystitis/bladder pain syndrome.

Taiwan J Obstet Gynecol 2020 Nov;59(6):922-926

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address:

Objective: Treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) is often delayed because of a lack of objective data during diagnosis. This study was conducted to determine the clinical validity of using urodynamic studies to investigate the effect of intravesical hyaluronic acid (HA) treatment among women with IC/BPS.

Materials And Methods: Thirty patients with IC/BPS undergoing 6-month intravesical instillation of HA were recruited. Pretreatment evaluation involved a urinalysis and urinary culture, urinary cytology, a 3-day voiding diary, and cystoscopy with hydrodistention of the bladder. Urodynamic study was performed before and after HA treatment. Symptomatic changes were assessed using a questionnaire covering lower urinary tract symptoms, the O'Leary-Sant symptom index and problem indexes (ICSI and ICPI), and the visual analog scale for pain and urgency. Patient demographics, urinary symptoms, ICSI/ICPI scores, pain and urgency scores, and urodynamic results before and after HA treatment were compared.

Results: Urinary frequency, nocturia, urgency, pelvic pain, bladder capacity, ICSI, and ICPI were significantly improved after HA treatment. Comparing urodynamic parameters, the volumes at first desire to void (FDV) and maximum cystometric capacity were significantly increased after HA treatment. Before HA treatment, a negative correlation existed between the ICSI and ICPI and urodynamic parameters, including maximum flow rate and bladder capacity, but there were no significant correlations after treatment. Before HA treatment, a negative correlation was discovered between nocturia and FDV. However, after HA treatment, there were no significant correlations between urinary symptoms and urodynamic parameters.

Conclusions: Our results indicate that the improvement of urinary symptoms of IC/BPS after HA treatment is associated with increased FDV and maximum cystometric capacity. The value of FDV and the frequency of nocturia after treatment may become useful objective indicators for prognosis of IC/BPS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tjog.2020.09.021DOI Listing
November 2020

Five-year comparative risk of hepatocellular carcinoma development under entecavir or tenofovir treatment-naïve patients with chronic hepatitis B-related compensated cirrhosis in Taiwan.

Aliment Pharmacol Ther 2020 12 27;52(11-12):1695-1706. Epub 2020 Oct 27.

Division of Hepato-Gastroenterology, Department of Internal Medicine, Linko Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.

Background: Comparative long-term efficacy of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) for prevention of disease progression to hepatocellular carcinoma (HCC) among high-risk patients with chronic hepatitis B (CHB)-related compensated cirrhosis is controversial.

Aims: To compare the long-term efficacy of ETV and TDF in HCC prevention in patients with CHB-related cirrhosis, and to evaluate predictive risk factors for HCC development.

Methods: From January 2008 to March 2018, 894 treatment-naïve patients with CHB-related compensated cirrhosis on ETV or TDF were enrolled based on the longitudinal cohort study. Data were originally collected for 7.3 years of follow-up or after the launch of TDF in 2011. Only the 5-year cumulative incidence and risk factors of HCC were assessed.

Result: Total 678 and 216 patients received ETV and TDF, respectively. The cumulative risk of HCC at 1, 3 and 5 years of follow-up was 1.6%, 11.3% and 18.7%, respectively, in the ETV group; and 0.9%, 6.7% and 10.7%, respectively, in the TDF group (P = 0.0305). Univariate and adjusted-multivariable models revealed that platelet count, alpha-fetoprotein (AFP) levels and upper gastrointestinal (UGI) varices were independent risk factors for HCC development. TDF resulted in risk of HCC development compared to ETV with adjusted hazard ratios (aHRs) of 0.66 (95% confidence interval [CI]:0.40, 1.08; P = 0.0971), 0.69 (95% CI: 0.42, 1.14; P = 0.1488) and 0.66 (95% CI: 0.38, 1.14; P = 0.1407) under stepwise selection, propensity score adjustment, and propensity score matching multivariable models, respectively.

Conclusions: For treatment-naïve patients with CHB-related compensated cirrhosis with 5-year follow-up, after variable adjustments, propensity score approaches and subgroup analyses, TDF showed a lower rate of HCC development that did not reach statistical significance, compared to the ETV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apt.16116DOI Listing
December 2020

Impact of treatment delay on survival of oral/oropharyngeal cancers: Results of a nationwide screening program.

Head Neck 2021 02 13;43(2):473-484. Epub 2020 Oct 13.

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

Background: To assess the impact of treatment delay on survival of oral/oropharyngeal cancer (OSCC).

Methods: We followed 5743 OSCCs between 2004 and 2009 from a population-based screening program and ascertained death until the end of 2012.

Results: The hazard ratios (HRs) of mortality from OSCC were 1.46 (1.30-1.65) and 1.18 (1.04-1.33) in univariable and multivariable analyses, respectively, for treatment delay longer than 6 weeks compared with that shorter than 3 weeks. The corresponding figures were 1.12 (1.01-1.24) and 1.00 (0.91-1.11) for treatment delay between 3 and 6 weeks. Advancing age (1.01), higher stage (stage II: 1.84, stage III: 2.97, stage IV: 6.33), cancer in tongue (1.37), or hard palate (1.63) had higher HR of mortality (P < .05). However, treatment at medical center had a lower mortality (0.83, 0.75-0.91) than local/regional hospital.

Conclusions: Treatment delay longer than 6 weeks for OSCCs detected via a population-based screening program had unfavorable survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.26504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820997PMC
February 2021

Design and Usability Evaluation of Mobile Voice-Added Food Reporting for Elderly People: Randomized Controlled Trial.

JMIR Mhealth Uhealth 2020 09 28;8(9):e20317. Epub 2020 Sep 28.

Department of Health Care Management and Healthy Aging Research Center, College of Management, Chang Gung University, Taoyuan, Taiwan.

Background: Advances in voice technology have raised new possibilities for apps related to daily health maintenance. However, the usability of such technologies for older users remains unclear and requires further investigation.

Objective: We designed and evaluated two innovative mobile voice-added apps for food intake reporting, namely voice-only reporting (VOR) and voice-button reporting (VBR). Each app features a unique interactive procedure for reporting food intake. With VOR, users verbally report the main contents of each dish, while VBR provides both voice and existing touch screen inputs for food intake reporting. The relative usability of the two apps was assessed through the metrics of accuracy, efficiency, and user perception.

Methods: The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. A group of 57 adults aged 60-90 years (12 male and 45 female participants) was recruited from a retirement community and randomized into two experimental groups, that is, VOR (n=30) and VBR (n=27) groups. Both groups were tested using the same set of 17 food items including dishes and beverages selected and allocated to present distinct breakfast, lunch, and dinner meals. All participants used a 7-inch tablet computer for the test. The resulting data were analyzed to evaluate reporting accuracy and time efficiency, and the system usability scale (SUS) was used to measure user perception.

Results: For eight error types identified in the experiment, the VBR group participants were significantly (P<.001) more error prone owing to the required use of button-tapping actions. The highest error rates in the VOR group were related to incomprehensible reporting speech (28/420, 6.7%), while the highest error rates in the VBR group were related to failure to make required button taps (39/378, 10.3%). The VOR group required significantly (P<.001) less time to complete food reporting. The overall subjective reactions of the two groups based on the SUS surpassed the benchmark and were not significantly different (P=.20).

Conclusions: Experimental results showed that VOR outperformed VBR, suggesting that voice-only food input reporting is preferable for elderly users. Voice-added apps offer a potential mechanism for the self-management of dietary intake by elderly users. Our study contributes an evidence-based evaluation of prototype design and selection under a user-centered design model. The results provide a useful reference for selecting optimal user interaction design.

Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN17335889; http://www.isrctn.com/ISRCTN17335889.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/20317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551114PMC
September 2020

Mass eradication of to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands.

Gut 2021 02 13;70(2):243-250. Epub 2020 Aug 13.

Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

Objective: Although mass eradication of has been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear.

Design: Mass eradication of infection was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalent infection. Test positives for the C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively.

Results: After six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates of fell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI -14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate of .

Conclusion: Population-based eradication of has significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period.

Trial Registration Number: NCT00155389.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/gutjnl-2020-322200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815911PMC
February 2021

Novel Toilet Paper-Based Point-Of-Care Test for the Rapid Detection of Fecal Occult Blood: Instrument Validation Study.

J Med Internet Res 2020 08 7;22(8):e20261. Epub 2020 Aug 7.

PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan City, Taiwan.

Background: Colorectal cancer screening by fecal occult blood testing has been an important public health test and shown to reduce colorectal cancer-related mortality. However, the low participation rate in colorectal cancer screening by the general public remains a problematic public health issue. This fact could be attributed to the complex and unpleasant operation of the screening tool.

Objective: This study aimed to validate a novel toilet paper-based point-of-care test (ie, JustWipe) as a public health instrument to detect fecal occult blood and provide detailed results from the evaluation of the analytic characteristics in the clinical validation.

Methods: The mechanism of fecal specimen collection by the toilet-paper device was verified with repeatability and reproducibility tests. We also evaluated the analytical characteristics of the test reagents. For clinical validation, we conducted comparisons between JustWipe and other fecal occult blood tests. The first comparison was between JustWipe and typical fecal occult blood testing in a central laboratory setting with 70 fecal specimens from the hospital. For the second comparison, a total of 58 volunteers were recruited, and JustWipe was compared with the commercially available Hemoccult SENSA in a point-of-care setting.

Results: Adequate amounts of fecal specimens were collected using the toilet-paper device with small day-to-day and person-to-person variations. The limit of detection of the test reagent was evaluated to be 3.75 µg of hemoglobin per milliliter of reagent. Moreover, the test reagent also showed high repeatability (100%) on different days and high reproducibility (>96%) among different users. The overall agreement between JustWipe and a typical fecal occult blood test in a central laboratory setting was 82.9%. In the setting of point-of-care tests, the overall agreement between JustWipe and Hemoccult SENSA was 89.7%. Moreover, the usability questionnaire showed that the novel test tool had high scores in operation friendliness (87.3/100), ease of reading results (97.4/100), and information usefulness (96.1/100).

Conclusions: We developed and validated a toilet paper-based fecal occult blood test for use as a point-of-care test for the rapid (in 60 seconds) and easy testing of fecal occult blood. These favorable characteristics render it a promising tool for colorectal cancer screening as a public health instrument.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/20261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472847PMC
August 2020

Risk stratification for gastric cancer after Helicobacter pylori eradication: A population-based study on Matsu Islands.

J Gastroenterol Hepatol 2021 Mar 24;36(3):671-679. Epub 2020 Jul 24.

Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

Background And Aim: The reliable method to stratify the gastric cancer risk after Helicobacter pylori eradication remains an elusive goal.

Methods: Mass eradication of H. pylori began in 2004 in a high-risk population. After eradication, a screening program involving first-stage serological tests (pepsinogen-I, pepsinogen-II, H. pylori immunoglobin G, and gastrin-17) and second-stage endoscopic examination was launched in 2015-2018. Index lesions included gastric cancer or extensive premalignant lesions. We evaluated the performance of the serological tests to "rule in" and "rule out" the risk based on positive and negative likelihood ratios, respectively. The methylation levels of microRNA-124a-3 in the stomach were measured to indicate genetic damage.

Results: Among 6512 invited subjects, 3895 (59.6%) participated. Both gastrin-17 and pepsinogen tests were normal in 3560 (91.4%) subjects; 206 (5.3%) gastrin-17 and 129 (3.3%) pepsinogen tests were abnormal. Years after eradication, the severity of gastritis had fallen greatly, and extensive premalignant lesions or gastric cancer frequently occurred in newly non-atrophic-appearing mucosa. Pepsinogen testing could moderately predict atrophic gastritis (positive likelihood ratio: 4.11 [95% confidence interval: 2.92-5.77]; negative likelihood ratio: 0.14 [0.10-0.19]). Gastrin-17 was not useful (0.66 and 1.20, respectively). However, pepsinogen testing poorly predicted the index lesions (2.04 [1.21-3.42] and 0.57 [0.34-0.95]). DNA methylation levels in the post-eradication mucosa were more discriminative for predicting index lesions (3.89 [2.32-6.54] and 0.25 [0.15-0.42]).

Conclusions: After eradication, pepsinogen false-negative results become more frequent because histology is improved but genetic damage may persist. Direct testing for genetic damage offers better discrimination.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jgh.15187DOI Listing
March 2021

Precision Science on Incidence and Progression of Early-Detected Small Breast Invasive Cancers by Mammographic Features.

Cancers (Basel) 2020 Jul 10;12(7). Epub 2020 Jul 10.

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City 100, Taiwan.

The aim was to evaluate how the inter-screening interval affected the performance of screening by mammographic appearances. This was a Swedish retrospective screening cohort study with information on screening history and mammography features in two periods (1977-1985 and 1996-2010). The pre-clinical incidence and the mean sojourn time (MST) for small breast cancer allowing for sensitivity by mammographic appearances were estimated. The percentage of interval cancer against background incidence (I/E ratio) was used to assess the performance of mammography screening by different inter-screening intervals. The sensitivity-adjusted MSTs (in years) were heterogeneous with mammographic features, being longer for powdery and crushed stone-like calcifications (4.26, (95% CI, 3.50-5.26)) and stellate masses (3.76, (95% CI, 3.15-4.53)) but shorter for circular masses (2.65, (95% CI, 2.06-3.55)) in 1996-2010. The similar trends, albeit longer MSTs, were also noted in 1977-1985. The I/E ratios for the stellate type were 23% and 32% for biennial and triennial screening, respectively. The corresponding figures were 32% and 43% for the circular type and 21% and 29% for powdery and crushed stone-like calcifications, respectively. Mammography-featured progressions of small invasive breast cancer provides a new insight into personalized quality assurance, surveillance, treatment and therapy of early-detected breast cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cancers12071855DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408735PMC
July 2020

Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women.

Cancer 2020 07 11;126(13):2971-2979. Epub 2020 May 11.

Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.

Background: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death.

Methods: Among 549,091 women, covering approximately 30% of the Swedish screening-eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression.

Results: Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51-0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66-0.84 [P < .001]).

Conclusions: Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/cncr.32859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318598PMC
July 2020

Early detection of breast cancer rectifies inequality of breast cancer outcomes.

J Med Screen 2021 03 5;28(1):34-38. Epub 2020 May 5.

Regional Cancer Center Stockholm Gotland, Stockholm, Sweden.

Objectives: To explain apparent differences among mammography screening services in Sweden using individual data on participation in screening and with breast cancer-specific survival as an outcome.

Methods: We analysed breast cancer survival data from the Swedish Cancer Register on breast cancer cases from nine Swedish counties diagnosed in women eligible for screening. Data were available on 38,278 breast cancers diagnosed and 4312 breast cancer deaths. Survival to death from breast cancer was estimated using the Kaplan-Meier estimate, for all cases in each county, and separately for cases of women participating and not participating in their last invitation to screening. Formal statistical comparisons of survival were made using proportional hazards regression.

Results: All counties showed a reduction in the hazard of breast cancer death with participation in screening, but the reductions for individual counties varied substantially, ranging from 51% (95% confidence interval 46-55%) to 81% (95% confidence interval 74-85%). Survival rates in nonparticipating women ranged from 53% (95% confidence interval 40-65%) to 74% (95% confidence interval 72-77%), while the corresponding survival in women participating in screening varied from 80% (95% confidence interval 77-84%) to 86% (95% confidence interval 83-88%), a considerably narrower range.

Conclusions: Differences among counties in the effect of screening on breast cancer outcomes were mainly due to variation in survival in women not participating in screening. Screening conferred similarly high survival rates in all counties. This indicates that the performance of screening services was similar across counties and that detection and treatment of breast cancer in early-stage reduces inequalities in breast cancer outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0969141320921210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905745PMC
March 2021

Cost-Effectiveness Analysis of Deep Brain Stimulation for Parkinson Disease in Taiwan.

World Neurosurg 2020 06 5;138:e459-e468. Epub 2020 Mar 5.

Department of Neurology, National Taiwan University Yunlin Branch, Yunlin, Taiwan; Department of Neurology and Pharmacology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address:

Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective therapy for Parkinson disease (PD). However, cost-effectiveness analysis is required because most patients are older adults and decision makers must therefore consider whether the long-term effectiveness outweighs the initial cost.

Methods: A Markov decision model was constructed on the basis of a societal perspective. The Hoehn and Yahr scale and Unified PD Rating Scale motor score were used in the polytomous logistic regression model. Markov Chain Monte Carlo simulation was used to initiate the probabilistic cost-effectiveness analysis.

Results: The life-year gained (LYG) in the STN-DBS group and medication group was, respectively, 2.937 and 2.632 years at the 3-year follow-up and 7.417 and 5.971 years at the 10-year follow-up. The quality-adjusted life-year (QALY) gained in the STN-DBS and medication groups was, respectively, 1.739 and 1.220 at the 3-year follow-up and 4.189 and 2.88 at the 10-year follow-up. The incremental cost-effectiveness ratio of STN-DBS compared with medication was $147,065 per LYG and $123,436 per QALY gained at the 3-year follow-up and $36,833 and $69,033 at the 10-year follow-up, respectively. STN-DBS is an optimal strategy when the willingness to pay is $150,000 per LYG and over $90,000 per QALY gained in 3 years and when the willingness to pay is over $38,000 per LYG and over $41,000 per QALY gained in 10 years.

Conclusions: This study provided data comparing STN-DBS and medical treatment for PD with respect to LYG and QALY gained. STN-DBS was more cost-effective in terms of LYG and QALY gained according to the current gross domestic product of Taiwan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2020.02.150DOI Listing
June 2020
-->