Publications by authors named "Yu-Hsun Wang"

105 Publications

Female breast cancer incidence predisposing risk factors identification using nationwide big data: a matched nested case-control study in Taiwan.

BMC Cancer 2022 Aug 4;22(1):849. Epub 2022 Aug 4.

Department of Breast and Thyroid Surgery, Chung Shan Medical University Hospital, Taichung, 404332, Taiwan.

Background: Breast cancer is an umbrella term referring to a group of biologically and molecularly heterogeneous diseases originating from the breast. Globally, incidences of breast cancer has been increasing dramatically over the past decades. Analyses of multiple clinical "big data" can aid us in clarifying the means of preventing the disease. In addition, predisposing risk factors will be the most important issues if we can confirm their relevance. This study aims to provide an overview of the predisposing factors that contribute to a higher possibility of developing breast cancer and emphasize the signs that we ought to pay more attention to.

Methods: This is a matched nested case-control study. The cohort focused on identifying the eligible risk factors in breast cancer development by data screening (2000-2013) from the Taiwan National Health Insurance Research Database (NHIRD) under approved protocol. A total of 486,069 females were enrolled from a nationwide sampled database, and 3281 females was elligible as breast cancer cohort, 478,574 females who had never diagnosed with breast cancer from 2000 to 2013 were eligible as non-breast cancer controls, and matched to breast cancer cases according to age using a 1:6 ratio.

Results: We analyzed 3281 breast cancer cases and 19,686 non-breast cancer controls after an age-matched procedure. The significant predisposing factors associated with breast cancer development including obesity, hyperlipidemia, thyroid cancer and liver cancer. As for patients under the age of 55, gastric cancer does seem to have an impact on the development of breast cancer; compared with their counterparts over the age of 55, endometrial cancer appears to exhibit an evocative effect.

Conclusions: In this nationwide matched nested case-control study, we identified obesity, hyperlipidemia, previous cancers of the thyroid, stomach and liver as risk factors associated with breast cancer. However, the retrospective nature and limited case numbers of certain cancers still difficult to provide robust evidence. Further prospective studies are necessitated to corroborate this finding in order to nip the disease in the bud.

Trial Registration: The studies involving human participants were reviewed and approved by the China Medical University Hospital [CMUH104-REC2-115(AR-4)].
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http://dx.doi.org/10.1186/s12885-022-09913-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351234PMC
August 2022

Sjögren syndrome is a hidden contributor of macrovascular and microvascular complications in patients with type 2 diabetes.

Int J Rheum Dis 2022 Aug 2. Epub 2022 Aug 2.

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.

Objective: To investigate cardiovascular risk among diabetic patients with Sjögren syndrome.

Methods: This study was a nationwide population-based case-control study from 1997 to 2013, in which the association between autoimmune diseases and diabetes was investigated. The study population consisted of individuals with newly diagnosed type 2 diabetes with macrovascular or microvascular complications with at least two outpatient visits or one hospitalization as the outcome variables, and the exposure variables included traditional risk factors, medications, and autoimmune diseases. The odds ratio of cardiovascular events among each prevalent autoimmune disease and hydroxychloroquine's effect on cardiovascular risk were analyzed.

Results: The study included a total of 7026 individuals with diabetes with microvascular and macrovascular complications and the same number of patients in the control group. Sjögren syndrome was significantly higher in the diabetes complication group than in the non-complication group (0.8% vs 0.5%, P = 0.036). By using multivariate analysis, we found hypertension, hyperlipidemia, and Sjögren syndrome to be three independent risk factors for diabetes vascular complications (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.82-2.10; OR 1.53, 95% CI 1.42-1.64; and OR 1.67, 95% CI 1.06-2.65; respectively, all P < 0.05). Treatment with traditional statins and aspirin might be able to overcome the increased risk of developing cardiovascular events while comparing between diabetes patients with and without Sjögren syndrome.

Conclusion: Sjögren syndrome is an unrecognized independent risk factor for cardiovascular events among diabetes patients, which indicates that patients with diabetes combined with Sjögren syndrome require closer follow up regarding cardiovascular complications in clinical settings. Treatment with hydroxychloroquine might not be enough to lower the cardiovascular risk significantly in diabetes patients with Sjögren syndrome.
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http://dx.doi.org/10.1111/1756-185X.14400DOI Listing
August 2022

An Image-Based Data-Driven Model for Texture Inspection of Ground Workpieces.

Sensors (Basel) 2022 Jul 11;22(14). Epub 2022 Jul 11.

Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan.

Nowadays, the grinding process is mostly automatic, yet post-grinding quality inspection is mostly carried out manually. Although the conventional inspection technique may have cumbersome setup and tuning processes, the data-driven model, with its vision-based dataset, provides an opportunity to automate the inspection process. In this study, a convolutional neural network technique with transfer learning is proposed for three kinds of inspections based on 750-1000 surface raw images of the ground workpieces in each task: classifying the grit number of the abrasive belt that grinds the workpiece, estimating the surface roughness of the ground workpiece, and classifying the degree of wear of the abrasive belts. The results show that a deep convolutional neural network can recognize the texture on the abrasive surface images and that the classification model can achieve an accuracy of 0.9 or higher. In addition, the external coaxial white light was the most suitable light source among the three tested light sources: the external coaxial white light, the high-angle ring light, and the external coaxial red light. Finally, the model that classifies the degree of wear of the abrasive belts can also be utilized as the abrasive belt life estimator.
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http://dx.doi.org/10.3390/s22145192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9322439PMC
July 2022

No increased risk of alopecia in ankylosing spondylitis patients: A population-based cohort study in Taiwan.

Int J Rheum Dis 2022 Jul 26. Epub 2022 Jul 26.

Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan ROC.

Aim: To investigate the association between ankylosing spondylitis (AS) and alopecia.

Methods: In this cohort study, data from over 1 000 000 patients in the Taiwan Longitudinal Health Insurance Database were extracted. We selected newly diagnosed (outpatient department visit three or more times or admission at least once) patients with AS (ICD-9-CM = 720.0) from 2000 to 2012. For the non-AS comparison group, patients never diagnosed with AS were chosen from 1999 to 2013. In all, 3640 AS patients and 14 560 non-AS controls were selected. Cox proportional hazard model and Kaplan-Meier analysis were used to present the results. The adjusted hazard ratio (HR) in the Cox proportional hazard model was adjusted for age, sex, hypertension, hyperlipidemia, diabetes, atopic dermatitis, and mental disorder.

Results: No increased risk of alopecia in AS patients was shown in the Cox proportional hazard model (crude HR 1.16, P = 0.595; adjusted HR 1.16, P = 0.599). Negative results are found as well in subgroup analysis of different age, sex (age 20-40 y: HR 1.03, P = 0.925; Age ≥40 y: HR 1.49, P = 0.406; Female: HR 1.17, P = 0.759; Male: HR 1.15, P = 0.667), and phenotypes of alopecia (androgenetic alopecia: HR 1.19, 95% confidence interval [CI] 0.58-2.41; alopecia areata: HR 0.98, 95% CI 0.37-2.62). A significant positive correlation is found between atopic dermatitis and alopecia (adjusted HR 8.05, P = 0.039).

Conclusion: In this population-based cohort study, we found no association of risk of alopecia and AS.
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http://dx.doi.org/10.1111/1756-185X.14393DOI Listing
July 2022

Risk of Ankylosing Spondylitis in Patients With Endometriosis: A Population-Based Retrospective Cohort Study.

Front Immunol 2022 15;13:877942. Epub 2022 Jun 15.

Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.

Objectives: Previous research has shown a possible relationship between endometriosis and autoimmune diseases. However, the relationship between endometriosis and ankylosing spondylitis (AS) is lacking. Therefore, we intended to find possible associations between endometriosis and AS using ICD-9 coding data in a population-based retrospective cohort study in Taiwan.

Method: Data for this retrospective cohort study were collected from the Taiwan National Health Insurance Research Database (NHIRD) between 2000-2012. We collected 13,145 patients with endometriosis and a 78,870 non-endometriosis comparison cohort. Diagnoses of endometriosis and AS were defined by the International Classification of Diseases-9 (ICD-9-CM) code for at least 3 outpatients or 1 hospitalization. Propensity score matching by comorbidities, corticosteroids, and non-steroidal anti-inflammatory drugs (NSAIDs) usage were done for baseline comparability. Cox proportional hazard models were used to evaluate crude and adjusted hazard ratios.

Results: The cumulative incidence of AS was higher in patients with endometriosis compared to the non-endometriosis comparison cohort (log-rank test, p = 0.015). The adjusted hazard ratio (aHR) of incidental AS in patients with endometriosis was 1.61 (95% CI = 1.11 to 2.35) in comparison to the non-endometriosis comparison cohort. An increased risk of AS was also observed in subjects with major depressive disorder (aHR = 5.05, 95% CI = 1.85 to 13.78). Stratified analyses of age subgroups showed consistent results. NSAID users had a lower risk of AS than NSAID non-users (aHR 4.57 vs 1.35, p for interaction = 0.031).

Conclusions: In this retrospective population-based cohort study, we found a higher risk of AS in patients with endometriosis. We suggest that clinicians should pay attention to the occurrence of AS in patients with endometriosis.
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http://dx.doi.org/10.3389/fimmu.2022.877942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240188PMC
June 2022

Risk of Autoimmune Diseases Following Optic Neuritis: A Nationwide Population-Based Cohort Study.

Front Med (Lausanne) 2022 13;9:903608. Epub 2022 Jun 13.

Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.

Objectives: Optic neuritis is (ON) is believed to be an immune-mediated disease; however, the association between optic neuritis and autoimmune diseases remains unclear. This study aimed to identify the incidence rate and adjusted hazard ratio (aHR) of autoimmune diseases in patients with optic neuritis.

Methods: This nationwide, population-based, retrospective cohort study collected patients' data between 1999 and 2013 from the National Health Insurance Research Database in Taiwan. A total of 9,235 patients were included. Using 1:4 propensity scoring, 1,847 patients were enrolled in the optic neuritis group and 7,388 in the non-optic neuritis group according to age, sex, comorbidities, and corticosteroid use. Follow-up was started from the index date and the endpoint was a diagnosis of new-onset autoimmune diseases including, myasthenia gravis (MG), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and ankylosing spondylitis (AS).

Results: The Kaplan-Meier curves depicted that patients with optic neuritis had a higher cumulative incidence of autoimmune diseases than patients without optic neuritis. Cox proportional hazard regression showed that patients with optic neuritis were at a high risk of autoimmune diseases (aHR: 1.40; 95% C.I., 1.05-1.87), including MG (aHR: 4.16, 95% C.I.: 1.33-12.94), SLE (aHR: 3.33, 95% C.I.: 1.24-8.97), and AS (aHR: 2.86, 95% C.I.: 1.54-5.31). Subgroup analysis provided that patients with optic neuritis aged below 65 years (aHR: 1.42, 95% C.I.: 1.03-1.96) or who were females (aHR: 1.59, 95% C.I.: 1.11-2.27) had a significantly increased risk of autoimmune diseases compared to respective controls. The use of corticosteroids reduced the risk of autoimmune diseases in patients with optic neuritis (aHR for corticosteroids non-users: 1.46, 95% C.I.: 1.03-2.07).

Conclusion: Patients with optic neuritis presented with a high risk of autoimmune diseases such as MG, SLE, and AS, especially patients with optic neuritis who were young or females. Corticosteroids attenuated the link between optic neuritis and subsequent autoimmune diseases.
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http://dx.doi.org/10.3389/fmed.2022.903608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9234206PMC
June 2022

Association of Peripheral Arterial Occlusive Disease and Deep Venous Thrombosis with Risk of Consequent Sepsis Event: A Retrospective Population-Based Cohort Study.

Int J Environ Res Public Health 2022 05 31;19(11). Epub 2022 May 31.

Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan.

Peripheral artery occlusive disease (PAOD) and deep vein thrombosis (DVT) can cause a variety of acute and chronic vascular complications and put patients at risk of subsequent sepsis. This study aimed to determine whether DVT compared with PAOD patients would increase the risk of sepsis. This study recruited 43,535 patients newly diagnosed as having PAOD and 6932 patients who were newly diagnosed as having DVT from a population of 2 million patients from the Longitudinal Health Insurance Database. Propensity score matching (PSM) between the PAOD and DVT groups was performed for age, sex, comorbidities, and prior antibiotic administration. A total of 4383 patients with PAOD and 4383 patients with DVT were analyzed for risk of sepsis. The incidence density of sepsis per 1000 person years for patients with PAOD was 25.75 (95% CI = 23.90 to 27.74) and 35.61 (95% CI = 33.29 to 38.09) for patients with DVT. After age, sex, associated comorbidities, and antibiotic administration were adjusted for, the risk of sepsis for the DVT group was 1.46-fold (95% CI = 1.32-1.62) higher than that for the PAOD group. In conclusion, patients with DVT were associated with a higher risk of subsequent sepsis than patients with PAOD. Aging was another risk factor.
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http://dx.doi.org/10.3390/ijerph19116710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180137PMC
May 2022

Association of Permanent Vascular Access Dysfunction with Subsequent Risk of Cardiovascular Disease: A Population-Based Cohort Study.

J Pers Med 2022 Apr 8;12(4). Epub 2022 Apr 8.

School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan.

A functional permanent vascular access (VA) is required to perform a successful hemodialysis procedure. Hemodialysis VA dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. Cardiovascular disease (CVD) is the leading cause of death in patients receiving chronic hemodialysis. Information about CVD associated with hemodialysis VA dysfunction is unclear. We analyzed the association between dialysis VA dysfunction and the risk of developing CVD in hemodialysis patients. This nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. One million subjects were sampled from 23 million beneficiaries and data was collected from 2000 to 2013. Patients with end-stage renal disease who had received permanent VA construction and hemodialysis and were aged at least 20 years old from 2000 to 2007 were included in the study population. The primary outcome was CVD, as defined by ICD-9-CM codes 410-414 and 430-437. A total of 197 individuals with permanent VA dysfunction were selected as the test group, and 100 individuals with non-permanent VA dysfunction were selected as the control group. Compared with the control group, the adjusted hazard ratio of CVD for the VA dysfunction group was 3.05 (95% CI: 1.14-8.20). A Kaplan-Meier analysis revealed that the cumulative incidence of CVD was higher in the permanent VA dysfunction group than in the comparison group. Permanent VA dysfunction is significantly associated with an increased risk of subsequent CVD.
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http://dx.doi.org/10.3390/jpm12040598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9033058PMC
April 2022

Congenital Syphilis and the Prozone Phenomenon: Case Report.

Pediatr Infect Dis J 2022 06 6;41(6):e268-e270. Epub 2022 May 6.

From the Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX.

Congenital syphilis represents an important public health challenge in the United States, and its prevalence has been increasing for the past 10 years because of many factors. The diagnosis can be difficult given its various and nonspecific clinical manifestations in newborns, and the possibility of false negative results during prenatal care. The prozone phenomenon, caused by an excess of antibody, which interferes with the regular screening tests, is a cause of false negative tests. This could delay the diagnosis and increase morbidity and mortality in the newborn. We present a case of congenital syphilis in a 3-month-old infant whose mother had prenatal care and negative tests for syphilis, which contributed to the late diagnosis. In the face of clinical findings suggestive of congenital syphilis and negative maternal syphilis tests healthcare providers should consider the possibility of maternal false negative test caused by the prozone phenomenon.
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http://dx.doi.org/10.1097/INF.0000000000003522DOI Listing
June 2022

A Cohort Study: Comorbidity and Stage Affected the Prognosis of Melanoma Patients in Taiwan.

Front Oncol 2022 3;12:846760. Epub 2022 Mar 3.

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.

Background: Comorbidities and stages may influence the prognosis of melanoma patients in Taiwan and need to be determined.

Methods: We performed a retrospective cohort study by using the national health insurance research database in Taiwan. Patients with a primary diagnosis of melanoma by the Taiwan Cancer Registry from 2009 to 2017 were recruited as the study population. The comparison group was never diagnosed with melanoma from 2000 to 2018. The Charlson comorbidity index was conducted to calculate the subjects' disease severity. The Cox proportional hazards model analysis was used to estimate the hazard ratio of death.

Results: We selected 476 patients, 55.5% of whom had comorbidity. A higher prevalence of comorbidity was associated with a more advanced cancer stage. The mortality rate increased with an increasing level of comorbidity in both cohorts and was higher among melanoma patients. The interaction between melanoma and comorbidity resulted in an increased mortality rate.

Conclusion: An association between poorer survival and comorbidity was verified in this study. We found that the level of comorbidity was strongly associated with mortality. A higher risk of mortality was found in patients who had localized tumors, regional metastases, or distant metastases with more comorbidity scores. Advanced stage of melanoma patients with more comorbidities was significantly associated with the higher risk of mortality rate.
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http://dx.doi.org/10.3389/fonc.2022.846760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8927660PMC
March 2022

The Risk of Gout in Patients with Psoriasis: A Population-Based Cohort Study in Taiwan.

Clin Epidemiol 2022 8;14:265-273. Epub 2022 Mar 8.

Department of Public Health, Chung Shan Medical University, Taichung, Taiwan.

Background: Previous research has pointed to the relationship between psoriasis and the development of gout. However, most previous studies had either small sample sizes or short study durations. Therefore, in this nationwide cohort study, we investigated the effect of psoriasis on the risk of gout development.

Methods: The study group included one million patients from Taiwan, whom we followed for 14 years. The participants were divided into two cohorts designated as psoriasis and non-psoriasis. A 1:4 propensity score matching test was used to compare age, sex, and index year between the two cohorts. Cox proportional hazard regression was used to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of gout. Sensitivity analyses were conducted to evaluate the HR for gout after the occurrence of psoriasis.

Results: The incidence densities of gout in the psoriasis and non-psoriasis cohorts were 6.96 and 5.09 per 1000 person-years, respectively. After adjusting for age, sex, urbanization, comorbidities, and nonsteroidal anti-inflammatory drug (NSAID) use, the adjusted hazard ratio (aHR) with 95% CI for incidental gout in the psoriasis group was 1.38 (1.2-1.6). Moreover, the aHR (95% CI) values for gout risk in patients with psoriasis using NSAIDs and those who did not were 1.21 (1.0-1.47) and 1.65 (1.33-2.05), respectively.

Conclusion: This study demonstrated an association between psoriasis and risk of developing gout. Clinically, patients with psoriasis should be evaluated for incidental gout.
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http://dx.doi.org/10.2147/CLEP.S346128=DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8928107PMC
March 2022

The efficacy of pioglitazone for renal protection in diabetic kidney disease.

PLoS One 2022 17;17(2):e0264129. Epub 2022 Feb 17.

School of Medicine of Chung Shan Medical University, Taichung City, Taiwan.

There is limited information on the efficacy of pioglitazone in diabetic kidney diseases (DKD). We evaluated whether pioglitazone exerts renal-protective effects in DKD patients. We designed a retrospective cohort study, which included 742 type 2 diabetes mellitus (T2DM) patients with DKD in Taiwan, with eGFR between 30 and 90 ml/min/1.73 m2 and UACR level 300-5000 mg/g. Patients not meeting the target range for HbA1c (above 7%) were given additional medication with pioglitazone (n = 111) or received standard care (non-pioglitazone group, n = 631). The primary endpoint was the occurrence of composite renal endpoints, which was defined as sustained eGFR<15 ml/min/1.73 m2 (confirmed by two measurements within 90 days); doubling of serum creatinine (compared to baseline); and the presence of hemodialysis or renal transplantation. The median follow-up duration was two years. At baseline, the mean HbA1C levels in the pioglitazone and non-pioglitazone groups were 8.8% and 8.1%, respectively; mean ages were 64.4 and 66.2 years old, respectively; diabetes durations were 14.3 and 12.3 years, respectively. Baseline eGFR showed no significant difference between the pioglitazone and non-pioglitazone groups (55.8 and 58.8 mL/min/1.73 m2, respectively). In terms of gender, 63% of patients were male in the pioglitazone group compared with 57% in the non-pioglitazone group. Pioglitazone use did not reduce the risk of composite renal endpoints in DKD patients (HR: 0.97, 95% CI = 0.53-1.77), including persistent eGFR<15 ml/min/1.73 m2 (HR = 1.07, 95% CI = 0.46-2.52), doubling of serum creatinine (HR = 0.97, 95% CI = 0.53-1.77), or ESRD (HR = 2.58, 95% CI = 0.29-23.04). The results were not changed after various adjustments. A non-significant albuminuria reduction was also noted after pioglitazone prescription in DKD patients. Further randomized controlled studies are needed to establish the effects of pioglitazone definitively.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264129PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8853567PMC
February 2022

Patients with ankylosing spondylitis have high risk of irritable bowel syndrome: a long-term nationwide population-based cohort study.

Postgrad Med 2022 Apr 21;134(3):290-296. Epub 2022 Feb 21.

Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.

Objective: Ankylosing spondylitis (AS) is a chronic inflammatory disease, might carry a high risk of irritable bowel syndrome (IBS) due to abnormal gut microbiota or inflammatory reaction.

Methods: We conducted a 14-year retrospective cohort study based on Taiwan's National Health Insurance Research Database (NHIRD). A total of 4007 patients with newly diagnosed AS (outpatient visits≧3 times, or hospitalization≧1 time) and 988,084 non-AS comparisons were enrolled during 2000-2012. To ensure baseline comparability, the propensity score was matched by age, gender, comorbidities, and other possible confounders. The outcome was the incidence of IBS, followed up to the end of 2013. Cox proportional hazard model calculated adjusted hazard ratio (aHR) and the cumulative incidence of both groups was analyzed by the Kaplan-Meier method.

Result: After propensity score matching, baseline demographic characteristics were comparable between AS patients and the comparison group. The crude HR for IBS in the AS group was significantly higher 2.41 (95%C.I. = 1.84-3.16) than comparison group. After adjusting for possible confounders, adjusted HR was 2.50 (95%C.I. = 1.91-3.29). The cumulative incidence of IBS in AS was significantly higher than non-AS comparisons during the 14-year follow-up (P < 0.001).

Conclusion: This nationwide population-based cohort study showed that patients with AS have higher risks of IBS than those of the non-AS comparison group.
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http://dx.doi.org/10.1080/00325481.2022.2041338DOI Listing
April 2022

The implementation of domiciliary dental care from a university hospital: A retrospective review of the patients and performed treatments in central Taiwan from 2010 to 2020.

J Dent Sci 2022 Jan 7;17(1):96-99. Epub 2021 Jul 7.

School of Dentistry, Chung Shan Medical University, Taichung, Taiwan.

Background/purpose: People who suffer with chronic illness, functional impairment, or cognitive impairment are not easily to visit dental clinics. Domiciliary dental care (DDC) can provide the feasible alternative for these clients. In this study, we first reported the DDC services from a university hospital in central Taiwan from 2010 to 2020.

Materials And Methods: This retrospective study collected the DDC data from Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan. The data including age, sex, geographic locations, place of residence, grade of disability, and type of dental treatment for the patients were obtained and analyzed.

Results: A total of 419 patients (168 females and 251 males) who received dental treatment were included in the study. The average age was 57.4 years old. The total DDC services were up to 2444 visits. The top of place of residence for DDC is patient's home (231/419; 55.13%). Scaling was the most common type of dental treatment for DDC (317/419; 75.67%). The male patients whose age <60 years old had received more DDC (p = 0.002). The profound grade of disability had higher DDC in age <60 years old group (p < 0.001).

Conclusion: Taken together, this study demonstrates the demographic data of DDC in central Taiwan. The results may be valuable for governmental policy to improve the availability of DDC and in turn to facilitate oral health in this specific group of dental patients.
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http://dx.doi.org/10.1016/j.jds.2021.06.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8740079PMC
January 2022

Risk of atrial fibrillation in patients with pneumonia.

Heart Lung 2022 Mar-Apr;52:110-116. Epub 2022 Jan 4.

Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan. Electronic address:

Background: Cardiac arrhythmias have a strong association with pneumonia due to the cardiovascular response to infection. Electrocardiographic (ECG) changes in patients with pneumonia are associated with greater disease severity. Atrial fibrillation (AF) is the most common type of cardiac arrhythmia.

Objective: This population-based cohort study investigated the incidence of AF among Taiwanese adults with pneumonia using data from the National Health Insurance Research Database in Taiwan.

Methods: A total of 34,883 patients with pneumonia and an equal number of individuals without pneumonia were eligible after excluding those with a previous diagnosis of AF and matching 1:1 by age, sex, and comorbidities. The Cox proportional hazards model was used to estimate hazard ratios for AF in both groups.

Results: Patients were more likely to develop AF throughout the 1-year follow-up period after the diagnosis of pneumonia. The incidence of AF was 1.2 (414/334,746) per 1000 person-months. Patients with pneumonia had a 4.08-fold (95% confidence interval 3.37-4.95) increased risk for AF compared to patients without pneumonia.

Conclusion: Patients with pneumonia exhibited an increased risk for AF, especially in the early period after diagnosis of pneumonia.
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http://dx.doi.org/10.1016/j.hrtlng.2021.12.006DOI Listing
May 2022

Anti-gout Medications and Risk of Cardiovascular Disease: A Nested Case-Control Study.

Front Med (Lausanne) 2021 18;8:739680. Epub 2021 Oct 18.

School of Public Health, Chung Shan Medical University, Taichung, Taiwan.

Gout is the leading cause of inflammatory arthritis and is also correlated with multiple comorbidities, including cardiovascular disease (CVD), whose future risk can be lowered by urate-lowering therapy (ULT) in gout patients. It is, however, still not clear whether its effect is associated with the days of usage and the adherence rate of ULT. Data were collected from Taiwan's National Health Insurance Research Database. The study period was from 1999/1/1 to 2013/12/31. In addition, patients with newly diagnosed gout from 2000 to 2012 and usage of antigout preparations (allopurinol or benzbromarone) within half a year among age ≥20 years old were enrolled in the study. The outcome of interest is CVD. New diagnosis of CVD after half a year of diagnosis of gout was included in the CVD group. Moreover, conditional logistic regression was used to evaluate the odds ratio of CVD in relation to the days of usage and to the adherence rate of ULT after the adjustment for potentially confounding variables. A total of 3,706 gout patients with and without CVD have been included in the final analysis after a 1:1 propensity score that matched for age, sex, comorbidities, aspirin, and statin. The days of usage of allopurinol was <180 days and benzbromarone, in its turn, presupposed a higher risk of CVD. The adherence rate of allopurinol and benzbromarone at ≥ 0.7 both have a lower CVD risk: allopurinol (adjusted OR: 0.66 95% CI: 0.46-0.96), benzbromarone (adjusted OR: 0.68 95% CI: 0.50-0.91). The subgroup analysis revealed an adherence rate of ≥0.7 of ULT with a lower CVD was only found to be present in males and at age <65. Furthermore, the correlations were more pronounced in the ischemic heart disease subgroup than in the cerebrovascular disease group. This study reveals that gout patients taking ULT (allopurinol and benzbromarone) with an adherence rate of ≥0.7 are at a lower risk of developing CVD, especially with a younger age (<65) and if they are male. On top of this, the benefit is more pronounced in ischemic heart disease. Despite further prospective trials needing to be warranted to confirm our findings, health care providers may, bearing these conclusions in mind, emphasize the importance of adherence to ULT in gout patients.
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http://dx.doi.org/10.3389/fmed.2021.739680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558358PMC
October 2021

Association between obesity and chronic periodontitis: A nationwide population-based cohort study in Taiwan.

Medicine (Baltimore) 2021 Oct;100(41):e27506

School of Dentistry, Chung Shan Medical University, Taichung, Taiwan.

Abstract: Previous studies have suggested that obesity might be associated with chronic periodontitis (CP); however, no clear conclusions have been reached so far. In this retrospective cohort study, we aimed to investigate the association between obesity and CP by using a large population-based dataset in Taiwan.A population-based retrospective cohort study was conducted using the Longitudinal Health Insurance Database 2010 (LHID2010) derived from the National Health Insurance Research database in Taiwan, from 2000 to 2013. Obesity and non-obesity groups were matched with sex, age, urbanization level, socioeconomic status, and the related comorbidities by using the propensity score method at a 1:2 ratio.An obese cohort (n = 4140) and a non-obese cohort (n = 8280) were included in this study, with an average age of 41.7 ± 13.8 years and 42.0 ± 14.0 years, respectively. The risk of CP for the patients with obesity was 1.12-fold compared with those without obesity (hazard ratio, 1.12; 95% confidence interval, 1.01-1.25). In the subgroup analysis according to age and sex, the hazard ratio of CP were 1.98 (95% confidence interval, 1.22-3.22) in the subgroup of age equal to or older than 65 years. The risk of CP showed no difference between obesity and non-obesity groups in both sex.This population-based cohort study demonstrated that obesity was associated with the development of CP in Taiwan.
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http://dx.doi.org/10.1097/MD.0000000000027506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519219PMC
October 2021

Influenza Vaccination Is Associated With Lower Incidental Asthma Risk in Patients With Atopic Dermatitis: A Nationwide Cohort Study.

Front Immunol 2021 12;12:729501. Epub 2021 Oct 12.

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.

Background: Atopic march refers to the natural history of atopic dermatitis (AD) in infancy followed by subsequent allergic rhinitis and asthma in later life. Respiratory viruses interact with allergic sensitization to promote recurrent wheezing and the development of asthma. We aimed to evaluate whether influenza vaccination reduces asthma risk in people with AD.

Methods: This cohort study was conducted retrospectively from 2000 to 2013 by the National Health Insurance Research Database (NHIRD). Patients with newly diagnosed AD (International Classification of Diseases, Ninth Revision, Clinical Modification code 691) were enrolled as the AD cohort. We matched each vaccinated patient with one non-vaccinated patient according to age and sex. We observed each participant until their first asthma event, or the end of the study on December 31, 2013, whichever came first.

Results: Our analyses included 4,414 people with a mean age of 53 years. Of these, 43.8 were male. The incidence density of asthma was 12.6 per 1,000 person-years for vaccinated patients, and 15.1 per 1000 person-years for non-vaccinated patients. The adjusted hazard ratio (aHR) of asthma in the vaccinated cohort relative to the non-vaccinated cohort was 0.69 (95% CI = 0.55-0.87). Vaccinated patients had a lower cumulative incidence of asthma than unvaccinated patients. Vaccinated participants in all age and sex groups trended toward a lower risk of asthma. People will reduce more asthma risk when taking shots every year.

Conclusion: Influenza vaccination was associated with lower asthma risk in patients with AD.
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http://dx.doi.org/10.3389/fimmu.2021.729501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548273PMC
December 2021

Tonsillectomy as a risk factor of periodontitis: A population-based cohort study.

J Periodontol 2022 05 19;93(5):721-731. Epub 2022 Jan 19.

Graduate Institute of Integrated Medicine, China Medical University Hospital, Taichung, Taiwan.

Background: To determine whether patients who had undergone tonsillectomy would have higher risks of postoperative periodontitis.

Methods: Data were collected from the Taiwan Longitudinal Health Insurance Dataset from 1999 to 2013, a population-based cohort study consisting of cases of newly-onset sleep apnoea, chronic diseases of tonsils and adenoids, peritonsillar abscess, and periodontal diseases. A total of 1482 tonsillectomy cases and 14,796 non-tonsillectomy controls were selected. Propensity score matching between the tonsillectomy group and the non-tonsillectomy group was conducted to exclude the confounding effect resulting from indications of tonsillectomy. Cox proportional hazard model and subgroup analyses were conducted to identify subpopulations at risk of tonsillectomy-associated periodontitis, and a sub-outcome analysis was applied to identify the subtype of tonsillectomy-associated periodontitis.

Results: A total of 648 patients who had undergone tonsillectomy and 648 out of 6509 propensity score-matched controls were retrieved, among which 230 cases in the tonsillectomy group were associated with post-surgical periodontitis (adjusted HR = 1.31, 95% CI = 1.08 to 1.59). The association persisted in a subpopulation of patients with periodontitis who received mechanical and surgical treatments for periodontitis (adjusted HR = 1.33, 95% CI = 1.09 to 1.63). The incidence of periodontitis was significantly high in the individuals who underwent tonsillectomy and was particularly high in those that were below 12 years of age (HR = 1.58, 95% CI = 1.10 to 2.27). The risk of periodontitis increased 4 years after tonsillectomy (HR = 1.82; 95% CI = 1.29 to 2.59). The majority of post-tonsillectomy periodontitis was aggressive and acute periodontitis (HR = 1.37; 95% CI = 1.10 to 1.71).

Conclusions: Tonsillectomy performed in pediatric patients of < 12 years old, increased the risk of developing periodontitis. Aggressive and acute periodontitis as a long-term, postoperative adverse event took place at 4 years or longer after tonsillectomy.
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http://dx.doi.org/10.1002/JPER.21-0215DOI Listing
May 2022

CHA2DS2-VASc Score for Major Adverse Cardiovascular Events Stratification in Patients with Pneumonia with and without Atrial Fibrillation.

J Clin Med 2021 Sep 10;10(18). Epub 2021 Sep 10.

Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan.

Background: Recent studies have shown an association between CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category) score and outcome of acute myocardial infarction, stroke, and chest pain. As pneumonia can affect the cardiovascular system, this study aimed to investigate the performance of the CHA2DS2-VASc score for major adverse cardiovascular events (MACEs) risk stratification in patients with pneumonia.

Methods: A retrospective population-based cohort study including 61,843 patients with pneumonia. These patients were divided into two cohorts that were stratified based on the presence or absence of underlying atrial fibrillation (AF). We calculated the CHA2DS2-VASc score and incidence density rates of MACEs in each cohort. Cox regression was conducted to calculate hazard ratio of MACEs in pneumonia patients. The diagnostic performance of CHA2DS2-VASc with regard to MACEs was tested using the receiver operator characteristic curve.

Results: Pneumonia patients with higher CHA2DS2-VASc score were more likely develop MACEs in both the AF and non-AF groups. In the AF group, the areas under the curve (AUC), sensitivity, and specificity were 0.824 (0.7773-0.8708), 0.7, and 0.84 respectively. In the non-AF group, the AUC, sensitivity, and specificity were 0.8185 (0.8152-0.8217), 0.75, and 0.83 respectively.

Conclusions: The CHA2DS2-VASc score showed good performance in the prediction of MACE in patients with pneumonia.
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http://dx.doi.org/10.3390/jcm10184093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8466520PMC
September 2021

Do Children With Constipation Have Increased Risk of Asthma? Real-World Data From a Nationwide Population-Based Cohort Study.

Front Pediatr 2021 30;9:714406. Epub 2021 Aug 30.

Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.

Asthma is one of the most burdensome childhood disorders. Growing evidence disclose intestinal dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microbiota. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess whether pediatric constipation influence the risk of developing asthma by a nationwide population-based cohort study. We analyzed 10,363 constipated patients and 10,363 individuals without constipation between 1999 and 2013 from Taiwan's National Health Insurance Research Database. Analysis of propensity score was utilized to match age, sex, comorbidities, and medications at a ratio of 1:1. In addition, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and a stratified analysis were performed. After adjustment for age, sex, comorbidities, and medications, constipated patients had a 2.36-fold greater risk of asthma compared to those without constipation [adjusted hazard ratio (aHR): 2.36, 95% C.I. 2.04-2.73, < 0.001]. Furthermore, the severity of constipation is associated with an increased risk of asthma; the adjusted hazard ratio was 2.25, 2.85, and 3.44 within < 3, 3-12, and ≥12 times of laxatives prescription within 1 year, respectively ( < 0.001). Constipation was correlated with a significantly increased risk of asthma. Pediatricians should be aware of the possibility of asthma in constipated patients. Further research is warranted to investigate the possible pathological mechanisms of this association.
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http://dx.doi.org/10.3389/fped.2021.714406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435704PMC
August 2021

A nationwide register-based study of the prevalence of burning mouth syndrome in Taiwan from 2004 to 2013.

J Dent Sci 2021 Oct 12;16(4):1074-1079. Epub 2021 Jul 12.

School of Dentistry, Chung Shan Medical University, Taichung, Taiwan.

Background/purpose: Burning mouth syndrome (BMS) is defined as a chronic burning pain of the oral mucosa with no associated clinical signs or apparent extraneous cause. Limited epidemiologic data have been published. In this study, we probed the nationwide registered database to assess the prevalence of BMS in Taiwan.

Materials And Methods: A retrospective study was conducted to analyze the dental dataset compiled by the Taiwan's National Health Insurance Research Database from 2004 to 2013. The diagnosis of BMS was identified in accordance with the International Classification of Disease, Ninth revision. In addition, sex and age were analyzed by multivariate Poisson regression.

Results: The prevalence of BMS revealed from 2.24 (per 10) to 3.11 (per 10) over past 10 year period. Female has higher risk of BMS than male (RR: 1.39; 95% CI: 1.37-1.41). The 50-59 years old group, 60-69 years old group, and >70 years old group had 1.55-, 2.06-, and 2.58-fold risk than 40-49 years old group for BMS (p < 0.001), respectively.

Conclusion: Taken together, this is the first reported nationwide population based prevalence data for BMS in Taiwan. The risk for BMS is highly associated with female and advancing age.
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http://dx.doi.org/10.1016/j.jds.2021.06.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403878PMC
October 2021

Relationship of Hydroxychloroquine and Ophthalmic Complications in Patients with Type 2 Diabetes in Taiwan.

Int J Environ Res Public Health 2021 08 1;18(15). Epub 2021 Aug 1.

Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.

The purpose of this study is to evaluate the relationship between hydroxychloroquine (HCQ) and diabetic retinopathy (DR) via the national health insurance research database (NHIRD) of Taiwan. All patients with newly diagnosed type 2 diabetes ( = 47,353) in the NHIRD (2000-2012) were enrolled in the study. The case group consists of participants with diabetic ophthalmic complications; 1:1 matching by age (±1 year old), sex, and diagnosis year of diabetes was used to provide an index date for the control group that corresponded to the case group ( = 5550). Chi-square test for categorical variables and Student's t-test for continuous variables were used. Conditional logistic regression was performed to estimate the adjusted odds ratio (aOR) of DR. The total number of HCQ user was 99 patients (1.8%) in the case group and 93 patients (1.7%) in the control group. Patients with hypertension (aOR = 1.21, 95% CI = 1.11-1.31) and hyperlipidemia (aOR = 1.65, 95% CI = 1.52-1.79) significantly increased the risk of diabetic ophthalmic complications ( < 0.001). Conversely, the use of HCQ and the presence of rheumatoid diseases did not show any significance in increased risk of DR. HCQ prescription can improve systemic glycemic profile, but it does not decrease the risk of diabetic ophthalmic complications.
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http://dx.doi.org/10.3390/ijerph18158154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345959PMC
August 2021

Deep Venous Thrombosis and Risk of Consequent Sepsis Event: A Retrospective Nationwide Population-Based Cohort Study.

Int J Environ Res Public Health 2021 07 25;18(15). Epub 2021 Jul 25.

Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.

Deep vein thrombosis causes several acute and chronic vessel complications and puts patients at risk of subsequent sepsis development. This unique study aimed to estimate the risk of sepsis development in DVT patients compared with non-DVT patients. This population-based cohort study used records of a longitudinal health insurance database containing two million patients defined in Taiwan's National Health Insurance Research Database (NHIRD). Our study included patients aged over 20 years with a new diagnosis of DVT with at least two outpatient department visits or an admission between 2001 and 2014. Patients with a diagnosis of sepsis before the index date were excluded. Propensity score matching (PSM) was used to homogenize the baseline characteristics between the two groups. To define the independent risk of the DVT group, a multivariate Cox proportional hazard model was used to estimate the hazard ratios. After PSM, the DVT group ( = 5753) exhibited a higher risk of sepsis (adjusted hazard ratio, aHR, 1.74; 95% CI, 1.59-1.90) compared with non-DVT group ( = 5753). Patients with an increased risk of sepsis were associated with being elderly aged, male, having diabetes, chronic kidney disease, chronic obstructive pulmonary disease, stroke, malignancy, and use of antibiotics. In conclusion, this population-based cohort study demonstrated an increased risk of sepsis in DVT patients compared with non-DVT patients. Thus, early prevention and adequate treatment of DVT is necessary in clinical practice.
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http://dx.doi.org/10.3390/ijerph18157879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345651PMC
July 2021

Gout Augments the Risk of Cardiovascular Disease in Patients With Psoriasis: A Population-Based Cohort Study.

Front Immunol 2021 15;12:703119. Epub 2021 Jul 15.

Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.

Objective: Patients with psoriasis (PsO) have a high frequency of concomitant gout and increased risk of cardiovascular diseases (CVD). We aimed to estimate the synergistic impact of gout on the risk of CVD in patients with PsO.

Methods: A population-based cohort of patients registered in the National Health Insurance Research Database of Taiwan between 2000 and 2013 was stratified according to the presence of PsO and gout. Propensity score analysis was used to match age and gender at a ratio of 1:4. Cox proportional hazard models and subgroup analyses were used to estimate the hazard ratios (HRs) for CVD adjusted for traditional risk factors. The Kaplan-Meier method was used to plot the cumulative incidence curves.

Results: Patients with combined PsO and gout (n = 97), PsO alone (n = 388), gout alone (matched, n = 388) and matched controls (n = 388) were identified. Compared with the patients with PsO alone, the patients with combined PsO and gout had a significantly higher risk of CVD (relative risk 2.39, 95% CI 1.56 to 3.65). After adjustment for traditional risk factors, the risk of CVD was higher in patients with gout alone (HR 2.16, 95% CI 1.54 to 3.04) and in patients with combined PsO and gout (HR 2.72, 95% CI 1.73 to 4.28).

Conclusions: Gout augments the risk of CVD independently of traditional risk factors in patients with PsO.
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http://dx.doi.org/10.3389/fimmu.2021.703119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320695PMC
December 2021

Chinese herbal medicine might be associated with a lower rate of joint replacement in patients with osteoarthritis: A 12-year population-based matched cohort analysis.

J Ethnopharmacol 2021 Nov 17;280:114419. Epub 2021 Jul 17.

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan. Electronic address:

Ethnopharmacological Relevance: To determine whether adjuvant Chinese herbal medicine (CHM) treatment is associated with the risk of joint replacement in osteoarthritis (OA) patients.

Materials And Methods: This retrospective study used a population-based national health insurance (NHI) database from 2000 to 2012 in Taiwan. A total of 125,023 newly diagnosed OA patients were selected from one million beneficiaries of longitudinal health insurance database. Based on applying ten selected frequently used CHM formulas for OA, patients were divided into CHM user and non-CHM user. One-CHM to four-non-CHM user were propensity score matched with age, gender, monthly income, urbanization, comorbidities, Nonsteroidal anti-inflammatory drugs (NSAIDs) and index year were adjusted to reduce selection bias and confounding. Cox regression model was used for comparing the hazard ratios (HR) for the risk of joint replacement and Kaplan-Meier curve for the proportion of joint replacement.

Results: OA patients who were female, younger (20-60 years), higher income and lived in urbanization location were found to preferred using CHM. Younger CHM users had a lower adjusted HR (0.63) of the risk of joint replacement (95% confidence interval (CI) = 0.42-0.94). Compared to non-CHM user, HR among CHM users (≥225 days annually) is 0.48 (95% CI = 0.31-0.76). The proportion of joint replacement in younger non-CHM user began to rise notably with time (log-rank test, p = 0.026). However, this benefit by CHM did not apply to older (over 60 years) OA patients.

Conclusion: This study suggested that adjuvant CHM might be associated with a lower rate of joint replacement in OA patients. CHM therapy might be considered in OA patients to reduce the need of joint replacement.
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http://dx.doi.org/10.1016/j.jep.2021.114419DOI Listing
November 2021

Increased risk of valvular heart disease in patients with ankylosing spondylitis: a nationwide population-based longitudinal cohort study.

Ther Adv Musculoskelet Dis 2021 18;13:1759720X211021676. Epub 2021 Jun 18.

Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Road, Taichung, 40201.

Aims: We aimed to evaluate the risk of valvular heart disease (VHD) among patients with ankylosing spondylitis (AS).

Methods: This was a population-based cohort study utilizing the Longitudinal Health Insurance Research Database of the National Health Insurance in Taiwan. Patients with and without coding of newly diagnosed AS from 1999 to 2013 were assigned to the AS and non-AS groups, respectively. Primary outcome was the incidental risk of VHD. Multiple Cox regression was used to estimate the adjusted hazard ratio of VHD. Subgroup analysis and sensitivity tests were also conducted.

Results: The AS group included 3780 patients, and 22,680 matched subjects without an AS diagnosis were identified as controls. The AS group had an increased risk of VHD compared with non-AS controls (adjusted hazard ratio: 1.63; 95% confidence interval: 1.43-1.86;  < 0.001). Subgroup analysis also revealed an increased risk of individual types of VHD, including aortic, mitral, and tricuspid valve disease. Patients in the AS group had a higher incidence of valve replacement surgery after the onset of VHD.

Conclusion: Patients with AS had a significant risk of VHD compared to non-AS controls in this population-based cohort study. Screening for VHD may be needed in caring patients with AS. We suggest that echocardiography may be performed when patients are diagnosed with AS.
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http://dx.doi.org/10.1177/1759720X211021676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216336PMC
June 2021

Increased Risk of Sjögren's Syndrome in Patients with Obsessive-Compulsive Disorder: A Nationwide Population-Based Cohort Study.

Int J Environ Res Public Health 2021 06 1;18(11). Epub 2021 Jun 1.

Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.

Obsessive-compulsive disorder (OCD) includes a wide range of symptoms and is often associated with comorbidities. Although psychiatric involvement may be an early manifestation of Sjögren's syndrome (SS), only a few studies have demonstrated the relationship between OCD and SS. This is a nationwide cohort study identifying the risk of SS in OCD patients. We studied a longitudinal health insurance database for the period from 1999 to 2013. The study group was OCD patients with at least three outpatient visits or one hospitalization. The comparison cohort was matched by age and sex, as well as comorbidities. We calculated the risk of Sjögren's syndrome using Cox proportional hazard regression models. We performed a propensity score match for confounders and effect modifiers between the two groups. The propensity score probability was estimated through logistic regression. Primary outcome was the incidental SS. A total of 1678 patients with OCD (49% women, mean age: 35.6 years) and 3356 controls were followed up, resulting in 13,077 and 25,856 person-years, respectively. The hazard ratio for developing SS was 3.31 (95% C.I.: 1.74-6.28) in patients with OCD, compared to those without OCD after adjusting for age, sex, and comorbidities. Furthermore, the risk of SS significantly increased over the 2-year follow-up period after OCD diagnosis. We concluded that risk of SS is significantly increased in patients with OCD compared to those without OCD. Clinically, Sjögren's symptoms in OCD patients should be regularly assessed.
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http://dx.doi.org/10.3390/ijerph18115936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199316PMC
June 2021

The influence of constipation on asthma: A real-world, population-based cohort study.

Int J Clin Pract 2021 Oct 29;75(10):e14540. Epub 2021 Jun 29.

Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung City, Taiwan.

Background: Among respiratory diseases, asthma is one of the most burdensome disorder worldwide. Growing evidence disclose gut dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microflora. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess the risk of asthma in constipated patients by a nationwide population-based cohort study.

Methods: We analysed 86 860 constipated patients and 86 860 individuals without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Analysis of propensity score was utilised to match age, gender, comorbidities and medications at a ratio of 1:1. Besides, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and stratified analysis were conducted.

Results: The incidence of asthma was 10.4 per 1000 person-years in the constipation group, which was higher than the rate of 5.7 per 1000 person-years observed in the non-constipation group. After adjustment for age, gender, urbanisation, comorbidities and medications, constipated patients had a 1.81-fold greater risk of asthma compared with those without constipation (adjusted hazard ratio [aHR]: 1.81, 95% CI: 1.74-1.88). In subgroup analyses, patients aged 20-39 years had a 2.01-fold highest risk of asthma in the constipation cohort (aHR: 2.01, 95% CI: 1.82-2.22). Besides, the severity of constipation is associated with an increased risk of asthma; the aHR was 1.92 (1.84-2.00), 2.07 (1.94-2.21) and 2.10 (1.96-2.25) for ≤ 30 days, 31-120 days and >120 days of laxatives prescription within 1 year after the index date, respectively (P < .001).

Conclusion: Constipation relates to a significantly increased risk of asthma. Physicians should be aware of the possibility of asthma in constipated people. Further research is warranted to investigate the possible pathological mechanisms of this association.
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http://dx.doi.org/10.1111/ijcp.14540DOI Listing
October 2021

Association Between Chinese Herbal Medicine Therapy and the Risk of Chronic Kidney Disease in Gout Patients.

Front Pharmacol 2021 17;12:661282. Epub 2021 May 17.

Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.

Chinese herbal medicine (CHM) has been nationally and globally used in treating gout for over a millennium. The potential relationship between the incidence of chronic kidney disease (CKD) in gout patients and CHM therapy is unclear. Thus, this study aimed to provide some evidence regarding the relationship between CHM therapy and the occurrence of CKD in gout patients. : We used data from the National Health Insurance Research database (NHIRD) in Taiwan. In this population-based nested case-control study, all participants were identified by International Classification of Diseases, Ninth Revision (ICD-9). Conditional logistic regression was used to calculate the odds ratio (OR) of the risk of CKD in gout patients treated with CHM therapy. : Data on 1718 gout patients with CKD and 1:1 matched 1718 gout patients without CKD were collected for analysis. The results showed that CHM therapy in gout patients did not increase the risk of developing CKD (adjusted OR = 1.01; 95% confidence interval [CI]: 0.86-1.18; > 0.05). Moreover, CHM therapy in gout patients for >365 days did not increase the incidence of CKD (adjusted OR = 1.30; 95% CI: 0.90-1.88; = 0.162). : Traditional CHM therapy does not increase the incidence of CKD in gout patients.
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http://dx.doi.org/10.3389/fphar.2021.661282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165605PMC
May 2021
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