Publications by authors named "Yi-Wei Kao"

35 Publications

Association of Tooth Scaling with Acute Myocardial Infarction and Analysis of the Corresponding Medical Expenditure: A Nationwide Population-Based Study.

Int J Environ Res Public Health 2021 Jul 17;18(14). Epub 2021 Jul 17.

Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242, Taiwan.

Accumulating evidence has shown a significant correlation between periodontal diseases and systemic diseases. In this study, we investigated the association between the frequency of tooth scaling and acute myocardial infarction (AMI). Here, a group of 7164 participants who underwent tooth scaling was compared with another group of 7164 participants without tooth scaling through propensity score matching to assess AMI risk by Cox's proportional hazard regression. The results show that the hazard ratio of AMI from the tooth scaling group was 0.543 (0.441, 0.670) and the average expenses of AMI in the follow up period was USD 265.76, while the average expenses of AMI in follow up period for control group was USD 292.47. The tooth scaling group was further divided into two subgroups, namely A and B, to check the influence of tooth scaling frequency on AMI risk. We observed that (1) the incidence rate of AMI in the group without any tooth scaling was 3.5%, which is significantly higher than the incidence of 1.9% in the group with tooth scaling; (2) the tooth scaling group had lower total medical expenditures than those of the other group because of the high medical expenditure associated with AMI; and (3) participants who underwent tooth scaling had a lower AMI risk than those who never underwent tooth scaling had. Therefore, the results of this study demonstrate the importance of preventive medicine.
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http://dx.doi.org/10.3390/ijerph18147613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305378PMC
July 2021

Risk of early-onset dementia among persons with tinnitus: a retrospective case-control study.

Sci Rep 2021 Jun 28;11(1):13399. Epub 2021 Jun 28.

School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St., Taipei, 110, Taiwan.

Higher rates of poor cognitive performance are known to prevail among persons with tinnitus in all age groups. However, no study has explored the association between tinnitus and early-onset dementia. We hypothesize that tinnitus may precede or occur concurrently with subclinical or early onset dementia in adults younger than 65 years of age. This case-control study used data from the Taiwan National Health Insurance Research Database, identifying 1308 patients with early-onset dementia (dementia diagnosed before 65 years of age) and 1308 matched controls. We used multivariable logistic regressions to estimate odds ratios (ORs) for prior tinnitus among patients with dementia versus controls. Among total 2616 sample participants, the prevalence of prior tinnitus was 18%, 21.5% among cases and 14.5% among controls (p < 0.001). Multivariable logistic regression showed and adjusted OR for prior tinnitus of 1.6 for cases versus controls (95% CI: 1.3 ~ 2.0). After adjusting for sociodemographic characteristics and medical co-morbidities, patients with early-onset dementia had a 67% higher likelihood of having prior tinnitus (OR = 1.628; 95% CI = 1.321-2.006). Our findings showed that pre-existing tinnitus was associated with a 68% increased risk of developing early-onset dementia among young and middle-aged adults. The results call for greater awareness of tinnitus as a potential harbinger of future dementia in this population.
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http://dx.doi.org/10.1038/s41598-021-92802-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238939PMC
June 2021

The impact of rotavirus vaccination in the prevalence of gastroenteritis and comorbidities among children after suboptimal rotavirus vaccines implementation in Taiwan: A population-based study.

Medicine (Baltimore) 2021 Jun;100(25):e25925

Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Abstract: In Taiwan, rotavirus vaccination was implemented in 2006 in the private sector. The population-based impact of rotavirus vaccination on gastroenteritis and comorbidities of children remains under-investigated.We analyzed the annual prevalence of rotavirus-related disease, including gastroenteritis, convulsions, epilepsy, type I diabetes mellitus, intussusception, and biliary atresia among children under 5 years of age. Data were collected from Taiwan's National Health Insurance Research Database, a nationwide population-based database. A 16-year retrospective cohort study was conducted between 2000 and 2015.Among children <5 years of age, the prevalence of gastroenteritis decreased after 2012 (44,259.69 per 100 thousands) and remained lower through 2015 (39,931.11per 100 thousands, P < .001). The prevalence of convulsions rose steadily and significantly from 2007 (775.90 per 100 thousands) to 2015 (962.17 per 100 thousands, P < .001). The prevalence of epilepsy decreased significantly until reaching a nadir in 2013 (from 501.56 to 293.53 per 100 thousands, P < .001). The prevalence of biliary atresia tended upward, and surged suddenly in 2007 with a peak in 2013 (18.74 per 100 thousands). Among infants (<1 year of age) from 2000 to 2015, the prevalence of gastroenteritis declined steadily, and more rapidly after 2007 (22,513 to 17,285 per 100 thousands).In Taiwan, after introducing rotavirus vaccination, gastroenteritis in young children decreased, especially in infancy. However, gastroenteritis is still common in children, given other emerging pathogens. Our results highlight the impact of rotavirus vaccines on children's health in Taiwan and provide indications for future preventive medicine and healthcare strategies in children.
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http://dx.doi.org/10.1097/MD.0000000000025925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238267PMC
June 2021

Feasibility of Upper Gastrointestinal Examination in Home Care Setting with a Magnetically Assisted Capsule Endoscopy System: A Retrospective Study.

Healthcare (Basel) 2021 May 13;9(5). Epub 2021 May 13.

Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei 242, Taiwan.

The magnetic assisted capsule endoscope (MACE) with a hand-held magnetic field navigator (MFN) for upper gastrointestinal examination achieved satisfactory results in a healthy volunteer study. We evaluated the feasibility of upper gastrointestinal examination in the home care setting with the MACE system. Home care patients with upper gastrointestinal symptoms that received an MACE exam were enrolled in the study. MACE procedure time; completeness of observation of important anatomical landmarks; endoscopic diagnosis; patient tolerance during the procedure; and patient data, including age, sex, comorbidities, symptoms, body weight, and height, were retrieved from hospital information system for data analysis. A total of 16 participants were enrolled with a mean age 74.3 ± 15.4 years (47 to 99 years). One patient failed to swallow the capsule and was excluded. The average procedure time was 23.7 ± 10.0 min (14.1 to 42.5 min) to complete each endoscopic exam for the remaining 15 patients. The overall maneuverability in the esophagus, stomach, and duodenum was 93.75%, 87.5%, and 75%, respectively. Overall completeness in the aforementioned regions was 93.75%, 81.25%, and 75%, respectively. No severe adverse events were noted. The results clearly demonstrate the promise of using this MACE system to perform endoscopic examination outside the hospital for patients confined to the community and home.
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http://dx.doi.org/10.3390/healthcare9050577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152223PMC
May 2021

Impact of the initial decline in estimated glomerular filtration rate on the risk of new-onset atrial fibrillation and adverse cardiovascular and renal events in patients with type 2 diabetes treated with sodium-glucose co-transporter-2 inhibitors.

Diabetes Obes Metab 2021 May 28. Epub 2021 May 28.

The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.

Aim: To investigate the impact of initial decline in estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes (T2D) following sodium-glucose co-transporter-2 inhibitor (SGLT2i) treatment.

Materials And Methods: We used medical data from a multicentre healthcare provider in Taiwan and recruited 11 769 patients with T2D with baseline/follow-up eGFR data available after 1 to 3 months of SGLT2i treatment from 1 June 2016 to 31 December 2018. Patients were followed up from the drug index date until the occurrence of adverse clinical events, SGLT2i discontinuation or the end of the study period, whichever took place first.

Results: Overall, SGLT2i treatment was associated with an initial eGFR decline of 3.5% ± 14.0% after a median treatment period of 10 weeks. A total of 37.1% (n = 4371) of patients experienced no eGFR decline, and 30.5% (n = 3593), 20.2% (n = 2376), 8.5% (n = 999) and 3.7% (n = 430) of patients experienced an eGFR decline of 0%-10%, 10%-20%, 20%-30% and more than 30%, respectively. The mean eGFR over time became stable after 6 months in all eGFR decline categories, even in the group with a pronounced eGFR decline of more than 30%. Compared with no eGFR decline, an initial eGFR decline of 0%-10%, 10%-20% or 20%-30% was not associated with a higher risk of atrial fibrillation (AF), major adverse cardiovascular events (MACE, including ischaemic stroke, systemic embolism and acute myocardial infarction)/heart failure (HF) and composite renal outcome (doubling of the serum creatinine level/end-stage kidney disease), whereas an eGFR decline of more than 30% was associated with a higher risk of new-onset AF (adjusted hazard ratio [aHR] = 2.20, 95% confidence interval [CI] = 1.40-3.47), MACE/HF (aHR = 2.09, 95% CI = 1.04-4.17) and composite renal outcome (aHR = 1.82, 95% CI = 1.18-2.83). The multivariate analysis indicated that the use of a diuretic or insulin, presence of stroke, older age, female sex, a higher HbA1c level, and a lower body mass index of less than 25 kg/m were independent factors associated with an eGFR decline of more than 30% following SGLT2i initiation.

Conclusions: A pronounced eGFR decline of more than 30% following SGLT2i treatment was associated with adverse cardiovascular or renal events among patients with T2D.
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http://dx.doi.org/10.1111/dom.14446DOI Listing
May 2021

The impact of weight loss related to risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium-glucose cotransporter 2 inhibitor.

Cardiovasc Diabetol 2021 04 30;20(1):93. Epub 2021 Apr 30.

The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.

Background: Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use reduces body weight (BW) in patients with type 2 diabetes mellitus (T2DM). Obesity and T2DM are strong risk factors of new-onset atrial fibrillation (AF). However, whether BW loss following SGLT2i treatment reduces AF risk in patients with T2DM remains unclear.

Methods: We used a medical database from a multicenter health care provider in Taiwan, which included 10,237 patients with T2DM, from June 1, 2016 to December 31, 2018, whose BW data at baseline and at 12 weeks of SGLT2i treatment were available. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the SGLT2i, or the end of the study period, whichever occurred first.

Results: The patients' baseline body mass index (BMI) was 28.08 [Formula: see text] 4.88 kg/m. SGLT2i treatment was associated with a BW loss of 1.35 [Formula: see text] 3.28 kg (1.78%[Formula: see text] 4.47%). There were 37.4%, 47.0%, and 15.6% of patients experienced no-BW loss (n = 3832), BW loss 0.0-4.9% (n = 4814), and [Formula: see text] 5.0% (n = 1591) following SGLT2i treatment, respectively. Compared with patients with baseline BMI < 23 kg/m, AF risk significantly increased in patients with baseline BMI [Formula: see text] 27.5 kg/m (P for trend = 0.015). Compared with those without BW loss after SGLT2i treatment, AF risk significantly decreased with a BW loss of [Formula: see text] 5.0% (adjusted hazard ratios [95% confidence intervals]: 0.39[0.22-0.68]). Use of diuretics, old age, high-dose SGLT2i, higher estimated glomerular filtration rate, and baseline BMI were independent factors associated with a BW loss of [Formula: see text] 5.0% following SGLT2i initiation. By contrast, neither baseline BMI nor BW loss after SGLT2i treatment predicted major cardiovascular adverse events or heart failure hospitalization risk (P for trend > 0.05).

Conclusion: BW loss of ≥ 5.0% following SGLT2i treatment was associated with a lower risk of new-onset AF in patients with T2DM in real-world practice.
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http://dx.doi.org/10.1186/s12933-021-01285-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091721PMC
April 2021

Respiratory diseases are positively associated with PM2.5 concentrations in different areas of Taiwan.

PLoS One 2021 22;16(4):e0249694. Epub 2021 Apr 22.

College of Management, Fu Jen Catholic University, Taipei, Taiwan.

The health effects associated with fine particulate matter (PM2.5) have attracted considerable public attention in recent decades. It has been verified that PM2.5 can damage the respiratory and cardiovascular systems and cause various diseases. While the association between diseases and PM2.5 has been widely studied, this work aims to analyze the association between PM2.5 and hospital visit rates for respiratory diseases in Taiwan. To this end, a disease mapping model that considers spatial effects is applied to estimate the association. The results show that there is a positive association between hospital visit rates and the PM2.5 concentrations in the Taiwanese population in 2012 after controlling for other variables, such as smoking rates and the number of hospitals in each region. This finding indicates that control of PM2.5 could decrease hospital visit rates for respiratory diseases in Taiwan.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249694PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062073PMC
April 2021

A reappraisal of the prevalence of pediatric hypertension through a nationwide database in Taiwan.

Sci Rep 2021 Feb 24;11(1):4475. Epub 2021 Feb 24.

Department of Pediatrics, Shuangho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC.

Hypertension in childhood and adolescence is associated with adult cardiovascular morbidity and mortality. However, the reported prevalence of pediatric hypertension varies considerably. We conducted a pioneer nationwide population-based study to investigate the prevalence of hypertension among children and adolescents. Pediatric patients who had been diagnosed with hypertension between 2000 and 2013 were selected from the National Health Insurance Research Database in Taiwan. Other metabolic syndrome-related diseases that would increase cardiovascular risk, including diabetes mellitus (DM), hyperlipidemia, and obesity, were also retrieved for further evaluation. In total, 10,364 children and adolescents diagnosed with hypertension were identified. The prevalence of pediatric hypertension in Taiwan ranged from 0.19 to 0.38 per 1000 children and adolescents between 2000 and 2013. Essential hypertension was most commonly coded (90.6%), which was much more than secondary hypertension (14.3%). Children and adolescents with hypertension were often associated with DM, hyperlipidemia, and obesity, with the odds ratios as 14.05 (95% confidence interval (CI) 11.74-16.81, p < 0.001), 10.65 (95% CI 9.48-11.97, p < 0.001), and 19.08 (95% CI 15.65-23.26, p < 0.001), respectively. To improve lifelong cardiovascular health, our results emphasize the importance of early proper recognition and suitable management of hypertension, as well as metabolic syndrome-related diseases, among children and adolescents.
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http://dx.doi.org/10.1038/s41598-021-84001-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904942PMC
February 2021

A Nationwide Population-Based Study on the Incidence of Parapharyngeal and Retropharyngeal Abscess-A 10-Year Study.

Int J Environ Res Public Health 2021 01 25;18(3). Epub 2021 Jan 25.

Sleep Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan.

This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of over two million enrollees of the National Health Insurance system that covers over 99% of Taiwan's citizens. During 2007-2016, 5779 patients received a diagnosis of PRPA. We calculated the population-wide incidence rates of PRPA by sex and age group (20-44, 45-64, and >64) as well as in-hospital mortality. The annual incidence rate of PRPA was 2.64 per 100,000 people. The gender-specific incidence rates per 100,000 people were 3.34 for males and 1.94 for females with a male:female gender ratio of 1.72. A slight increase in incidence rates among both genders over the study period was noted. Age-specific rates were lowest in the 20-44 age group with a mean annual incidence of 2.00 per 100,000 people, and the highest rates were noted in the age groups of 45-64 and >64 years with mean annual incidences of 3.21 and 3.20, respectively. We found that PRPA is common in Taiwan, males and older individuals are more susceptible to it, and incidence has increased in recent years.
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http://dx.doi.org/10.3390/ijerph18031049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908373PMC
January 2021

Definitive intensity-modulated radiotherapy or surgery for early oral cavity squamous cell carcinoma: Propensity-score-matched, nationwide, population-based cohort study.

Head Neck 2021 04 12;43(4):1142-1152. Epub 2020 Dec 12.

Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan.

Background: No evidence is currently available to estimate the outcomes of intensity-modulated radiation therapy (IMRT) and surgery for patients with early oral cavity squamous cell carcinoma (E-OCSCC).

Methods: We recruited patients from the Taiwan Cancer Registry Database who had received a diagnosis of E-OCSCC. Propensity score matching was performed, and Cox proportional hazards model was used to analyze all-cause mortality.

Results: In the multivariate Cox regression analyses, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive IMRT, T2N0M0 compared with T1N0M0, and male patients compared with female patients were 0.303 (0.245, 0.375), 1.340 (1.077, 1.668), and 2.012 (1.432, 2.826), respectively. The aHRs (95% CIs) for age 61 to 70, 71 to 80, and ≧81 years compared with <40 years were 2.984 (1.43, 4.225), 3.353 (2.578, 4.112), and 4.277 (4.104, 5.679), respectively.

Conclusions: For patients with E-OCSCC, surgery may be considered the first option rather than definitive IMRT.
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http://dx.doi.org/10.1002/hed.26575DOI Listing
April 2021

Classification of Changes in the Fecal Microbiota Associated with Colonic Adenomatous Polyps Using a Long-Read Sequencing Platform.

Genes (Basel) 2020 11 20;11(11). Epub 2020 Nov 20.

College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan.

The microbiota is the community of microorganisms that colonizes the oral cavity, respiratory tract, and gut of multicellular organisms. The microbiota exerts manifold physiological and pathological impacts on the organism it inhabits. A growing body of attention is being paid to host-microbiota interplay, which is highly relevant to the development of carcinogenesis. Adenomatous polyps are considered a common hallmark of colorectal cancer, the second leading cause of carcinogenesis-mediated death worldwide. In this study, we examined the relevance between targeted operational taxonomic units and colonic polyps using short- and long-read sequencing platforms. The gut microbiota was assessed in 132 clinical subjects, including 53 healthy participants, 36 patients with occult blood in the gut, and 43 cases with adenomatous polyps. An elevation in the relative abundance of , , and was identified in patients with adenomatous polyps compared with the other groups using long-read sequencing workflow. In contrast, the relatively high abundances of , , and were characterized in the healthy groups. The diversities in gut microbiota communities were similar in all recruited samples. These results indicated that alterations in gut microbiota were characteristic of participants with adenomatous polyps, which might be relevant to the further development of CRC. These findings provide a potential contribution to the early prediction and interception of CRC occurrence.
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http://dx.doi.org/10.3390/genes11111374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699842PMC
November 2020

The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors.

Cardiovasc Diabetol 2020 11 6;19(1):188. Epub 2020 Nov 6.

Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.

Background: Sodium glucose cotransporter 2 inhibitor (SGLT2i) reduces the risk of hard cardiovascular endpoints in type 2 diabetes mellitus (T2DM) patients with/without established cardiovascular diseases. Whether SGLT2i is associated with a lower risk of new-onset atrial fibrillation (AF) in T2DM patients is unclear. We aimed to evaluate the risk of new-onset AF associated with the use of SGLT2i compared to dipeptidyl peptidase-4 inhibitor (DPP4i) among a longitudinal cohort of diabetic patients.

Methods: We used medical data from a multi-center healthcare provider in Taiwan, which included a total of 15,606 and 12,383 patients treated with SGLT2i and DPP4i, respectively, from June 1, 2016 to December 31, 2018. We used propensity-score weighting to balance covariates across study groups. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the index drug, or the end of the study period, whichever occurred first.

Results: Overall, 55%, 45%, and 0% of the patients were treated with empagliflozin, dapagliflozin, and canagliflozin, respectively. Most patients in the DPP4i group were prescribed with linagliptin (51%), followed by sitagliptin (24%), saxagliptin (13%), vildagliptin (8%) and alogliptin (5%). The use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i after propensity-score weighting [hazard ratio: 0.61; 95% confidential interval: 0.50-0.73; P < 0.001]. Subgroup analysis revealed that the use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i across several subgroups including old age, female in gender, the presence of cardiovascular disease, hemoglobin A1c [Formula: see text] 8%, and chronic kidney disease. The advantage of SGLT2i over DPP4i persisted with different SGLT2i (dapagliflozin or empagliflozin) and either low- or standard-dose SGLT2i.

Conclusions: SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i among T2DM patients in real-world practice.
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http://dx.doi.org/10.1186/s12933-020-01162-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648323PMC
November 2020

Characterization of Fecal Microbiota with Clinical Specimen Using Long-Read and Short-Read Sequencing Platform.

Int J Mol Sci 2020 Sep 26;21(19). Epub 2020 Sep 26.

PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan.

Accurate and rapid identification of microbiotic communities using 16S ribosomal (r)RNA sequencing is a critical task for expanding medical and clinical applications. Next-generation sequencing (NGS) is widely considered a practical approach for direct application to communities without the need for in vitro culturing. In this report, a comparative evaluation of short-read (Illumina) and long-read (Oxford Nanopore Technologies (ONT)) platforms toward 16S rRNA sequencing with the same batch of total genomic DNA extracted from fecal samples is presented. Different 16S gene regions were amplified, bar-coded, and sequenced using the Illumina MiSeq and ONT MinION sequencers and corresponding kits. Mapping of the sequenced amplicon using MinION to the entire 16S rRNA gene was analyzed with the cloud-based EPI2ME algorithm. V3-V4 reads generated using MiSeq were aligned by applying the CLC genomics workbench. More than 90% of sequenced reads generated using distinct sequencers were accurately classified at the genus or species level. The misclassification of sequenced reads at the species level between the two approaches was less substantial as expected. Taken together, the comparative results demonstrate that MinION sequencing platform coupled with the corresponding algorithm could function as a practicable strategy in classifying bacterial community to the species level.
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http://dx.doi.org/10.3390/ijms21197110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582668PMC
September 2020

Correction to: Increased risk of tinnitus following a trigeminal neuralgia diagnosis: a one-year follow-up study.

J Headache Pain 2020 09 18;21(1):113. Epub 2020 Sep 18.

Department of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s10194-020-01184-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499855PMC
September 2020

Definitive radiotherapy or surgery for early oral squamous cell carcinoma in old and very old patients: A propensity-score-matched, nationwide, population-based cohort study.

Radiother Oncol 2020 10 29;151:214-221. Epub 2020 Aug 29.

Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan. Electronic address:

Purpose: Although patients aged >70 years are subject to early oral cavity squamous cell carcinoma (E-OCSCC), evidence is currently lacking regarding the probable outcomes of definitive radiotherapy (RT) compared to surgery in this population.

Methods: We recruited patients aged ≥70 years with a diagnosis of E-OCSCC from the Taiwan Cancer Registry Database. Propensity score matching was performed, and Cox proportional-hazards model curves were used to analyze all-cause mortality of patients at different age intervals undergoing different treatments.

Results: The matching process yielded a final cohort of 604 patients in the definitive RT and surgery cohorts who were eligible for further analysis. These patients were classified as old (70-80 years) and very old (>80 years). In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive RT was 0.465 (0.354-0.610, P < 0.001). The aHR (95% CI) for age >80 years compared with age 70-80 years was 2.370 (1.720, 3.265, P < 0.001). The aHR (95% CI) for T2N0M0 compared with T1N0M0 was 1.752 (1.321-2.32, P < 0.001). The aHR (95% CI) for Charlson Comorbidity Index (CCI) ≥ 2 compared with CCI = 0 was 1.264 (1.137-1.738, P = 0.011). After stratified analysis, the aHRs for surgery compared with definitive RT were 0.484 (0.352-0.665, P < 0.001) and 0.411 (0.232-0.728, P = 0.002) among old and very old patients with E-OCSCC, respectively.

Conclusions: Surgery may be more beneficial than definitive RT in selected elderly patients with E-OCSCC.
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http://dx.doi.org/10.1016/j.radonc.2020.08.016DOI Listing
October 2020

Fixed-dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia.

J Clin Hypertens (Greenwich) 2020 10 29;22(10):1846-1853. Epub 2020 Aug 29.

Division of Cardiology, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.

Hypertension and dyslipidemia are important risk factors for cardiovascular disease. However, the clinical outcomes of fixed-dose combination (FDC) versus free-equivalent combination (FEC) of amlodipine and atorvastatin in the treatment of concurrent hypertension and dyslipidemia remain unknown. In this study, we included patients with newly diagnosed hypertension and dyslipidemia, without previously established cardiovascular disease, and treated with either FDC or FEC of amlodipine and atorvastatin were identified from the National Health Insurance Research Database of Taiwan and follow-up for 5 years. By using 1:1 propensity score matching, a total of 1756 patients were enrolled in this study. The composite of major adverse cardiovascular events, including all-cause mortality, myocardial infarction (MI), stroke, and coronary revascularization, occurred more frequently in the FEC group than in the FDC group (hazard ratio, 1.88; 95% confidence interval [CI], 1.42 to 2.5). Although the all-cause mortality did not differ (hazard ratio, 0.46; 95% CI, 0.36 to 1.59), the FEC group developed increased MI, stroke, and coronary revascularization (hazard ratio, 2.87; 95% CI, 1.07 to 7.68; hazard ratio, 1.97; 95% CI, 1.41 to 2.74; and hazard ratio, 2.44; 95% CI, 1.26 to 4.69, respectively). Furthermore, as an unexpected result, a higher risk to develop new-onset diabetes mellitus was observed with FEC regimens (hazard ratio, 2.19; 95% CI, 1.6 to 3.0). In conclusion, although the all-cause mortality did not differ between the two groups, the FDC regimen of amlodipine and atorvastatin improved clinical outcomes when compared to FEC in patients with newly diagnosed hypertension and dyslipidemia.
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http://dx.doi.org/10.1111/jch.14016DOI Listing
October 2020

Sodium glucose cotransporter-2 inhibitor was associated with an improvement in left ventricular systolic function in patients with type 2 diabetes mellitus with impaired left ventricular systolic function.

ESC Heart Fail 2020 10 6;7(5):2784-2796. Epub 2020 Jul 6.

The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan.

Aims: Recent studies indicated that sodium glucose cotransporter-2 inhibitors (SGLT2i) reduced heart failure hospitalization in patients with type 2 diabetes mellitus (T2DM). However, whether SGTL2i can improve left ventricular (LV) systolic and diastolic function remained unclear. This study aimed to compare the change in echocardiographic parameters in T2DM patients receiving SGLT2i with a different baseline LV ejection fraction (LVEF). The change in echocardiographic parameters was also compared between T2DM patients treated with SGLT2i and those treated with dipeptidyl peptidase-4 inhibitor (DPP4i).

Methods And Results: This multicentre cohort study consecutively enrolled 665, 119, and 132 T2DM patients treated with SGLT2i with a preserved (≥50%), moderately reduced (40-50%), and reduced baseline LVEF (<40%), respectively, with paired baseline and post-treatment echocardiographic data available between 1 June 2016 and 31 May 2018. There were 212 patients treated with DPP4i with paired baseline and post-treatment echocardiographic data available at the same time. For those patients treated with DPP4i, 45 patients had impaired baseline LVEF of <50%. Echocardiographic parameters, including LVEF, LV end-diastolic volume, LV end-systolic volume (LVESV), and LV diastolic function, were analysed at baseline and after treatment. After a median SGLT2i treatment period of 230 days, patients with reduced LVEF were associated with an improvement in LVEF from 29.4 ± 7.4% to 42.2 ± 15.2% (P < 0.0001) and decrease in LVESV from 133.2 ± 49.2 to 117.4 ± 60.1 mL (P = 0.0002). Patients with moderately reduced LVEF were associated with an improvement in LVEF from 44.8 ± 2.9% to 49.7 ± 12.4% (P < 0.0001) and decrease in LVESV from 90.7 ± 31.1 to 80.0 ± 36.2 mL (P = 0.0017). Patients with preserved LVEF did not show an improvement in LVEF and LVESV after SGLT2i treatment. There were no significant changes of LV end-diastolic volume, LV diastolic function, and LV wall thickness in three study groups after SGLT2i treatment. In contrast, patients with impaired baseline LVEF (<50%) did not show any change in LVEF and LVESV after DPP4i treatment.

Conclusions: Sodium glucose cotransporter-2 inhibitor was associated with an improvement in LV systolic function in patients with T2DM with reduced and moderately reduced LVEF. In contrast, DPP4i treatment was not associated with any improvement in LVEF among patients with impaired LVEF.
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http://dx.doi.org/10.1002/ehf2.12877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524050PMC
October 2020

Irritable bowel syndrome increases the risk of chronic obstructive pulmonary disease: A retrospective cohort study.

Sci Rep 2020 06 19;10(1):10008. Epub 2020 Jun 19.

Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.

Both inflammation and infection are associated with the development of irritable bowel syndrome (IBS) and chronic obstructive pulmonary disease (COPD). The purpose of this study is to further elucidate the association between IBS and COPD through a retrospective cohort study. We enrolled IBS patients diagnosed between 2000 and 2011 with follow-up for at least one year. The non-IBS patients as comparison group were selected with 1:3 matching by propensity score. Statistical analysis was utilized to assess the differences in characteristic distribution, and to compare the cumulative incidence of COPD between the IBS and non-IBS cohorts. We selected 14,021 IBS patients and 42,068 non-IBS patients for comparison. The IBS patients exhibited a significant risk to develop COPD compared with non-IBS patients. Additionally, the cumulative incidence rate of COPD in the IBS cohort increased significantly during the follow-up period of more than ten years, compared to the non-IBS cohort, based on the Kaplan-Meier analysis. The risk of COPD was also significantly decreased in those patients with more than eighteen IBS-related clinical visits. This retrospective cohort study demonstrates the significantly increased risk of COPD in patients with IBS. Therefore, early inspection and prevention of COPD is essential for patients with IBS.
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http://dx.doi.org/10.1038/s41598-020-66707-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305148PMC
June 2020

Association of cervical spondylosis with obstructive sleep apnea.

Sleep Med 2020 07 3;71:54-58. Epub 2020 Apr 3.

Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan; School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan. Electronic address:

Objective: The study objective was to evaluate the association between cervical spondylosis (CS) and a subsequent diagnosis of obstructive sleep apnea (OSA) in light of the expected constricting impact of CS-associated cervical spine changes on the pharyngeal airway space, a key contributor to OSA.

Methods: Data were retrieved from the Taiwan National Health Insurance Research Dataset. A total of 98,234 patients who newly received a diagnosis of OSA were identified. We identified four propensity score-matched controls per OSA patient (n = 392,936). Chi-square tests were used to compare cases and controls on sociodemographic characteristics, and multivariable logistic regression modelling to examine the association of OSA with prior CS.

Results: Of the 98,234 sampled patients, 18,070 (18.4%) patients had a prior CS diagnosis, significantly different among cases compared to controls, being 18.4% and12.1%, respectively, p < 0.001. Logistic regression analysis showed an adjusted odds ratio (OR) of prior CS of 1.778 (95% confident interval (CI): 1.744-1.814) relative to controls. The adjusted odds of prior CS without myelopathy was 1.764 for cases relative to controls (95% CI: 1.727-1.801), and for prior CS with myelopathy (adjusted OR: 1.778, 95% CI: 1.721-1.837). Analysis stratified by age showed that in the 45-64- and >64-year age groups, the adjusted ORs of CS were 1.803 (95% CI: 1.758-1.850) and 1.634 (95% CI: 1.568-1.703), respectively, for cases relative to controls.

Conclusions: Our results suggest that OSA is associated with prior CS. The results call for professionals to be alert to the possibility of subsequent development of OSA among patients with CS.
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http://dx.doi.org/10.1016/j.sleep.2020.03.025DOI Listing
July 2020

Application of Neural Network and Cluster Analyses to Differentiate TCM Patterns in Patients With Breast Cancer.

Front Pharmacol 2020 8;11:670. Epub 2020 May 8.

Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.

Background And Purpose: Pattern differentiation is a critical element of the prescription process for Traditional Chinese Medicine (TCM) practitioners. Application of advanced machine learning techniques will enhance the effectiveness of TCM in clinical practice. The aim of this study is to explore the relationships between clinical features and TCM patterns in breast cancer patients.

Methods: The dataset of breast cancer patients receiving TCM treatment was recruited from a single medical center. We utilized a neural network model to standardize terminologies and address TCM pattern differentiation in breast cancer cases. Cluster analysis was applied to classify the clinical features in the breast cancer patient dataset. To evaluate the performance of the proposed method, we further compared the TCM patterns to therapeutic principles of Chinese herbal medication in Taiwan.

Results: A total of 2,738 breast cancer cases were recruited and standardized. They were divided into 5 groups according to clinical features cluster analysis. The pattern differentiation model revealed that liver-gallbladder dampness-heat was the primary TCM pattern identified in patients. The main therapeutic goals of the top 10 Chinese herbal medicines prescribed for breast cancer patients were to clear heat, drain dampness, and detoxify. These results demonstrated that the neural network successfully identified patterns from a dataset similar to the prescriptions of TCM clinical practitioners.

Conclusion: This is the first study using machine-learning methodology to standardize and analyze TCM electronic medical records. The patterns revealed by the analyses were highly correlated with the therapeutic principles of TCM practitioners. Machine learning technology could assist TCM practitioners to comprehensively differentiate patterns and identify effective Chinese herbal medicine treatments in clinical practice.
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http://dx.doi.org/10.3389/fphar.2020.00670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227602PMC
May 2020

Increased risk of tinnitus following a trigeminal neuralgia diagnosis: a one-year follow-up study.

J Headache Pain 2020 May 6;21(1):46. Epub 2020 May 6.

Department of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan.

Background: Tinnitus due to hyperactivity across neuronal ensembles along the auditory pathway is reported. We hypothesized that trigeminal neuralgia patients may subsequently suffer from tinnitus. Using nationwide, population-based data and a retrospective cohort study design, we investigated the risk of tinnitus within 1 year following trigeminal neuralgia.

Methods: We used the Taiwan National Health Insurance Research Dataset, a claims database, to identify all patients diagnosed with trigeminal neuralgia from January 2001 to December 2014, 12,587 patients. From the remaining patients, we identified 12,587 comparison patients without trigeminal neuralgia by propensity score matching, using sex, age, monthly income, geographic region, residential urbanization level, and tinnitus-relevant comorbidities (hyperlipidemia, diabetes, coronary heart disease, hypertension, cervical spondylosis, temporomandibular joint disorders and injury to head and neck and index year). All study patients (n = 25,174) were tracked for a one-year period to identify those with a subsequent diagnosis of tinnitus over 1-year follow-up.

Results: Among total 25,174 sample patients, the incidence of tinnitus was 18.21 per 100 person-years (95% CI = 17.66 ~ 18.77), the rate being 23.57 (95% CI = 22.68 ~ 24.49) among patients with trigeminal neuralgia and 13.17 (95% CI = 12.53 ~ 13.84) among comparison patients. Furthermore, the adjusted Cox proportional hazard ratio for tinnitus in the trigeminal neuralgia group was 1.68 (95% CI = 1.58 ~ 1.80) relative to the comparison cohort.

Conclusions: We found a significantly increased risk of tinnitus within 1 year of trigeminal neuralgia diagnosis compared to those without the diagnosis. Further studies in other countries and ethnicities are needed to explore the relationship between trigeminal neuralgia and subsequent tinnitus.
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http://dx.doi.org/10.1186/s10194-020-01121-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203585PMC
May 2020

Association of Systemic Hypertension With Primary Open-angle Glaucoma: A Population-based Case-Control Study.

Am J Ophthalmol 2020 10 28;218:99-104. Epub 2020 Apr 28.

Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan; School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan. Electronic address:

Purpose: To examine the association between systemic hypertension (HTN) and primary open-angle glaucoma (POAG) using Taiwan's nationwide health insurance claims data.

Design: A case-control study.

Methods: Data for this case-control study were retrieved from the Taiwan National Health Insurance Research Database for all 112,929 newly diagnosed patients with POAG from January 2010 through December 2015 (cases), and 449,840 propensity score-matched controls from Taiwan's National Health Insurance system. We performed multiple logistic regression analysis to estimate the odds (ORs) of prior HTN among cases vs controls.

Results: Of total 562,300 study patients, 296,975 (52.81%) had HTN prior to the index date, 63,528 (56.49%) among cases and 233,447 (51.90%) among controls (P < .001). POAG was significantly associated with prior HTN (OR 1.31, 95% CI 1.29-1.33) after adjusting for age, sex, monthly income, geographic location and residential urbanization level, hyperlipidemia, diabetes, coronary heart disease, migraine, hypotension, and obstructive sleep apnea syndrome.

Conclusions: POAG is associated with pre-existing HTN, suggesting that internal medicine/family medicine physicians should refer patients with hypertension periodically for regular ophthalmological examinations and ophthalmologists should alert patients with glaucoma to have their blood pressure regularly monitored.
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http://dx.doi.org/10.1016/j.ajo.2020.04.020DOI Listing
October 2020

A Population-Based Study of Healthcare Resource Utilization in Patients with Mitral Valve Prolapse.

Int J Environ Res Public Health 2020 03 3;17(5). Epub 2020 Mar 3.

School of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan.

This study investigated differences in the utilization of healthcare services between subjects with mitral valve prolapse (MVP) and comparison subjects using data from Taiwan's National Health Insurance population-based database, 138,493 patients with MVP (study group) and 138,493 matched patients without MVP (comparison group). We calculated the utilization of healthcare services in the year 2016 for each study sample. Patients with MVP had more outpatient cardiological services during the year (5.3 vs. 0.7, < 0.001) and higher outpatient cardiology costs (US$226.0 vs. US$30.8, < 0.001) than patients without MVP. As expected, patients with MVP had a longer inpatient stay (0.5 vs. 0.1, < 0.001) and higher inpatients costs (US$158.0 vs. US$22.9, < 0.001) than patients without MVP for cardiology services. Furthermore, patients with MVP also had more outpatient non-cardiology services (20.8 vs. 16.5, < 0.001) and associated costs (US$708.3 vs. US$518.7, < 0.001) than patients without MVP in the year 2016. Multiple regression analysis indicated that patients with MVP had higher total costs for all healthcare services than patients without MVP after adjusting for the urbanization level, monthly income, and geographic region. This study demonstrated that healthcare utilization by patients with MVP is substantially higher than comparison patients. Future studies are encouraged to explore MVP treatment with less expensive modalities while maintaining care quality and without jeopardizing patient outcomes.
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http://dx.doi.org/10.3390/ijerph17051622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084436PMC
March 2020

Malignant Otitis Externa is Associated with Diabetes: A Population-Based Case-Control Study.

Ann Otol Rhinol Laryngol 2020 Jun 24;129(6):585-590. Epub 2020 Jan 24.

Sleep Research Center, Taipei Medical University Hospital, Taipei.

Objective: Despite studies reporting a possible association between malignant otitis externa (MOE) and diabetes, there are no large-scale population-based empirical studies. This nationwide, population-based case-control study explored the association of MOE occurrence with previously diagnosed diabetes.

Methods: Data were retrieved from Taiwan's National Health Insurance Research Database, 753 patients with MOE (cases) and 2 259 propensity score-matched patients without MOE (controls). Multiple logistic regressions were conducted to examine the association of MOE with previously diagnosed diabetes.

Results: In total, 728 (24.2%) out of 3 012 sample patients had diabetes prior to the index date. Chi-square test revealed a significant difference in diabetes prevalence among cases and controls (54.8% vs 13.9%,  < 0.001). Simple logistic regression showed the odds ratio for prior diabetes among cases versus controls was 7.50 (95% CI, 6.22~9.03). The adjusted odds ratio of prior diabetes for cases versus controls was 10.07 (95% CI, 8.15~12.44) after adjusting for patient demographics and medical co-morbidities.

Conclusions: This study found an association between MOE and diabetes. One clinical practice implication of our study is that when a patient with diabetes complains of otalgia or otorrhea, and physical examination shows swelling of the ear canal or granulation growth, physicians should consider the possibility of MOE.
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http://dx.doi.org/10.1177/0003489419901139DOI Listing
June 2020

Outcomes for Elderly Patients Aged 70 to 80 Years or Older with Locally Advanced Oral Cavity Squamous Cell Carcinoma: A Propensity Score-Matched, Nationwide, Oldest Old Patient-Based Cohort Study.

Cancers (Basel) 2020 Jan 21;12(2). Epub 2020 Jan 21.

Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan.

: Although clinicians encounter patients aged ≥70 years with locally advanced oral cavity squamous cell carcinoma (LA-OCSCC), no evidence is available to facilitate decision making regarding treatment for this elderly population. : We selected elderly (≥70 years) patients from the Taiwan Cancer Registry database who had received a diagnosis of LA-OCSCC. Propensity score matching was performed. Cox proportional hazards model curves were used to analyze all-cause mortality in patients in different age groups receiving different treatments. : The matching process yielded a final cohort of 976 patients in concurrent chemoradiotherapy (CCRT), non-treatment, radiotherapy (RT) alone, and surgery cohorts who were eligible for further analysis. After stratified analysis, the adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]) derived for surgery, RT alone, and non-treatment compared with CCRT were 0.66 (0.52 to 0.83), 1.02 (0.81 to 1.28), and 1.52 (1.21 to 1.91), respectively, in patients aged 70 to 80 years. In the oldest patients (aged >80 years), multivariate analysis indicated that the results of surgery or RT alone were nonsignificant compared with those of CCRT. The aHR (95% CI) derived for the highest mortality was 1.81 (1.11 to 2.40) for non-treatment compared with CCRT. : Surgery for elderly patients with LA-OCSCC is associated with a significant survival benefit, but the association is nonsignificant in the oldest elderly patients. No survival differences were observed between RT alone and CCRT in these elderly patients. Non-treatment should not be an option for these patients.
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http://dx.doi.org/10.3390/cancers12020258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072345PMC
January 2020

Associations between Attention-Deficit/Hyperactivity Disorder and Ocular Abnormalities in Children: A Population-based Study.

Ophthalmic Epidemiol 2020 06 26;27(3):194-199. Epub 2019 Dec 26.

School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.

: Attention-deficit/hyperactivity disorder (ADHD) was reported to be associated with disturbances in the prefrontal circuitry and seems to be associated with dysfunctions of eye motility. This study aimed to explore associations between ADHD and ocular abnormalities, including amblyopia, hypermetropia, astigmatism, and heterotropia, using a large, nationwide population-based dataset in Taiwan.: We retrieved our sample for this cross-sectional study from the Taiwan National Health Insurance Research Database. In total, 116,308 children with ADHD were selected as the study group and 116,308 randomly selected children without ADHD as the comparison group. We used conditional logistic regression analyses to examine the odds ratios (ORs) of amblyopia, hypermetropia, astigmatism, and heterotropia between children with and those without ADHD.: We found that children with ADHD had significantly higher prevalences of amblyopia (1.6% vs. 0.9%, < .001), hypermetropia (2.4% vs. 1.3%, < .001), astigmatism (0.2% vs. 0.1%, < .001), and heterotropia (1.1% vs. 0.5%, < .001) than children without ADHD. The ORs of amblyopia, hypermetropia, astigmatism and heterotropia for children with ADHD were 1.89 (95% confidence interval (CI) = 1.76 ~ 2.05), 1.82 (95% CI = 1.68 ~ 1.92), 1.73 (95% CI = 1.34 ~ 2.16), and 2.01 (95% CI = 1.82 ~ 2.21) compared to children without ADHD.: The findings suggest that ADHD is associated with ocular abnormalities, including amblyopia, hypermetropia, astigmatism, and heterotropia.
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http://dx.doi.org/10.1080/09286586.2019.1704795DOI Listing
June 2020

Association between pioglitazone use and head and neck cancer: Population-based case-control study.

Head Neck 2020 04 13;42(4):653-659. Epub 2019 Dec 13.

Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan.

Background: This study aimed to evaluate the association between pioglitazone use and the occurrence of head and neck cancer.

Methods: Data for this case-control study were retrieved from the Taiwan National Health Insurance Research Database. A total of 21 464 diabetic patients newly diagnosed with head and neck cancers were identified. We used propensity score matching to select 64 392 comparison patients (3:1 ratio). Multiple logistic regression modeling was used to examine the association of head and neck cancer with pioglitazone use in the 5 years preceding the cancer diagnosis.

Results: Bivariate analysis showed a significant difference in the prevalence of prior using pioglitazone between cases and controls (19.3% vs 18.5%, P < .001) was observed. Multiple regression analysis showed adjusted odds of pioglitazone use of 1.06 (95% CI: 1.02-1.10) among cases relative to controls.

Conclusions: Prior pioglitazone use was associated with oral cavity cancer.
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http://dx.doi.org/10.1002/hed.26046DOI Listing
April 2020

Cancer risk in chronic rhinosinusitis: a propensity score matched case-control cohort study.

Am J Transl Res 2019 15;11(11):7146-7156. Epub 2019 Nov 15.

Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University Taichung, Taiwan.

Background: Chronic rhinosinusitis (CRS) have infection, innate immune disorder and chronic inflammation problems which are considered as potential mechanism of tumorigenesis. To estimate cancer risk in CRS using propensity scores matching (PSM) case-control cohort study.

Methods: A nationwide retrospective case-control cohort study is conducted on claim data from National Health Insurance Research Database in Taiwan. From January 2000 to December 2005, case group included 32677 CRS patients (including 544 with surgery in case 1 group and 32133 without surgery in case 2 group), and control group included 98031 subjects without CRS which were matching by PSM method on all baseline characteristics. All subjects were followed up from January 2006 till December 2013, the risk of cancers were calculated during the period. Conditional logistic regression Analysis of Cancer Risk is used to calculate the odds ratio (OR) and 95% confidence interval (CI) for case, case 1 and case 2 compared with control group. The difference in cancer risk among case, case 1 and case 2 drew the conclusions of this paper.

Results: The risk of cancers in head and neck (adjusted OR: 1.53, 95% CI: 1.33-1.75), colon (adjusted OR: 1.23, 95% CI: 1.09-1.39), liver (adjusted OR: 1.24, 95% CI: 1.09-1.41), lung (adjusted OR: 1.14, 95% CI: 1-1.3), skin (adjusted OR: 1.37, 95% CI: 1.05-1.79), breast (adjusted OR: 1.17, 95% CI: 1.01-1.36), prostate (adjusted OR: 1.85, 95% CI: 1.54-2.22) and bladder (adjusted OR: 1.48, 95% CI: 1.17-1.48) were statistical significantly higher in CRS patients than non-CRS group. Compared with CRS patients without surgery, risk of cancers in head and neck, colon, liver, lung, skin, breast, and prostate were higher in CRS patients receiving surgery.

Conclusion: Cancer risk in CRS patients is significant high than non-CRS patients, especially in head and neck, breast, lung, bladder, colorectal, liver, prostate, and skin cancers. Surgical interventions in CRS patients could not decrease cancer risk in CRS patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895518PMC
November 2019

Age comorbidity scores as risk factors for 90-day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy: A National Population-Based Study.

Cancer Med 2020 01 2;9(2):562-574. Epub 2019 Dec 2.

Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.

Background: To estimate easily assessed preoperative factors for predicting 90-day mortality in patients with a pancreatic head adenocarcinoma (PHA) receiving a pancreaticoduodenectomy.

Methods: We analyzed data from the Taiwan Cancer Registry Database of patients with a PHA who received a pancreaticoduodenectomy. Basic demographic characteristics, including gender and age, were categorized. The selection of preoperative comorbidities was based on the preoperative American Society of Anesthesiologists score and Charlson comorbidity index.

Results: We enrolled 8490 patients with a PHA who received a pancreaticoduodenectomy without distant metastasis. Currently, a pancreaticoduodenectomy for a PHA achieves an overall 90-day mortality rate of 8.39%. Univariate and multivariate Cox regression analyses indicated that an older age (65-74 and ≥75 years) and specific comorbidities (chronic obstructive pulmonary disease, chronic kidney disease, dementia, and sepsis) were significant independent prognostic factors for predicting 90-day mortality after a pancreaticoduodenectomy. After adjustment, the adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]) of subjects with middle and high comorbidity scores for 90-day mortality in 65 to 74-year-old patients were 1.36 (1.05-1.75) and 2.25 (1.03-4.90), respectively, compared to subjects with low comorbidity scores. The aHRs (95% CIs) of subjects with middle and high comorbidity scores for 90-day mortality in ≥75-year-old patients were 1.35 (1.07-1.78) and 2.07 (1.19-3.62), respectively, compared to those with low comorbidity scores.

Conclusions: Elderly patients with a PHA and moderate or high comorbidity scores have an increased risk of 90-day mortality after a pancreaticoduodenectomy.
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http://dx.doi.org/10.1002/cam4.2730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970054PMC
January 2020

A population-based time trend study in the incidence of malignant otitis externa.

Clin Otolaryngol 2019 09 23;44(5):851-855. Epub 2019 Jul 23.

Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

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http://dx.doi.org/10.1111/coa.13387DOI Listing
September 2019
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