Jou-Wei Lin

National Taiwan University, T’ai-pei, Taipei, Taiwan

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Publications (115)601.89 Total impact

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    ABSTRACT: -Reports of statin usage and increased risk of intracranial hemorrhage (ICH) have been inconsistent. This study examined potential associations between statin usage and the risk of ICH in subjects without a prior history of stroke. -Patients initiating statin therapy between 2005 and 2009 without a prior history of ischemic or hemorrhagic stroke were identified from Taiwan's National Health Insurance database. Participants were stratified by advanced age (≥ 70 years), sex, and diagnosed hypertension. The outcome of interest was hospital admission for ICH (ICD-9-CM codes 430, 431, 432). Cox regression models were applied to estimate the hazard ratio (HR) of ICH. The cumulative statin dosage stratified by quartile and adjusted for baseline disease risk score served as the primary variable using the lowest quartile of cumulative dosage as a reference. There were 1,096,547 statin initiators with an average follow-up of 3.3 years. The adjusted HR for ICH between the highest the lowest quartile was non-significant at 1.06 with a 95% confidence interval [CI] spanning 1.00 (0.94-1.19). Similar non-significant results were found in sensitivity analyses using different outcome definitions or model adjustments, reinforcing the robustness of the study findings. Subgroup analysis identified an excess of ICH frequency in patients without diagnosed hypertension (adjusted HR 1.36 [1.11-1.67]). -Generally, no association was observed between cumulative statin use and risk of ICH among subjects without a prior history of stroke. An increased risk was identified among the non-hypertensive cohort, but this finding should be interpreted with caution.
    Circulation 04/2015; DOI:10.1161/CIRCULATIONAHA.114.013046 · 14.95 Impact Factor
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    ABSTRACT: The purpose of this study was to explore the predictive factors of the effectiveness and treatment toxicity for pemetrexed as continuation maintenance therapy in patients with advanced nonsquamous non-small-cell lung cancer (NSCLC). Patients with advanced nonsquamous NSCLC treated with pemetrexed as continuation maintenance therapy were enrolled. The medical records were reviewed and analyzed, including data on basic characteristics, estimated creatinine clearance rate (Ccr), treatment responses, progression-free survival (PFS), overall survival (OS), and treatment-related toxicities. A total of 124 patients were included and all had adenocarcinoma. Patients with an estimated Ccr < 60 mL/min had a significantly longer PFS and OS (P = .045, and P = .006, respectively). Each 10 mL/min increase in estimated Ccr was associated with an increase of 9.8% in the risk of disease progression, and an increase of 9.2% in the risk of death. In contrast, an increase of 10 mL/min in estimated Ccr was associated with a decreased risk of Grade 3/4 neutropenia by 50.9% and anemia by 42.2%. Estimated Ccr is helpful in predicting the effectiveness and treatment toxicities of pemetrexed maintenance therapy. Copyright © 2015 Elsevier Inc. All rights reserved.
    Clinical Lung Cancer 01/2015; DOI:10.1016/j.cllc.2015.01.001 · 3.22 Impact Factor
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    ABSTRACT: Context: Metformin is the first-line oral therapy for type 2 diabetes with proven benefits against cardiovascular risk. Recent evidence suggested that acarbose might be similar to metformin in glucose-lowering efficacy and cardiovascular risk reduction. Therefore, international guidelines have suggested the use of acarbose as alternative first-line anti-diabetic therapy. Objective: To compare the cardiovascular outcomes in the first-line users of acarbose versus metformin. Design, Setting, Patients, and Outcome Measures: A nationwide cohort study was conducted by analysing the Taiwan National Health Insurance (NHI) Database. A total of 17,366 acarbose initiators and 230,023 metformin initiators were identified between January 1, 2009 and December 31, 2010. The primary outcome is hospitalization due to any cardiovascular events, including acute myocardial infarction, congestive heart failure, and ischemic stroke. The propensity score method was used to adjust for baseline differences between the two groups. Patients were followed from drug initiation to the earliest of outcome occurrence, death or disenrollment from NHI, or study termination. Results: In intention-to-treat analyses, acarbose was associated with a higher risk of any cardiovascular event (adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI], 1.01-1.09), heart failure (HR, 1.08; 95 % CI, 1.00-1.16), and ischemic stroke (HR, 1.05, 95% CI, 1.00-1.10). No significant difference in risk was found in subgroups of patients with or without underlying hypertension, ischemic heart disease, or cerebrovascular disease. Similar results were found in auxiliary as-treated analyses or analyses stratified by propensity score quintiles. Conclusion: Our data do not support that acarbose has a cardio-protective effect similar to metformin as a first-line anti-diabetic agent.
    Journal of Clinical Endocrinology &amp Metabolism 01/2015; DOI:10.1210/jc.2014-2443 · 6.31 Impact Factor
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    ABSTRACT: Three dimensional (3D) echocardiography-derived measurements of myocardial deformation and twist have recently advanced as novel clinical tools. However, with the exception of left ventricular ejection fraction and mass quantifications in hypertension and heart failure populations, the prognostic value of such imaging techniques remains largely unexplored. We studied 200 subjects (mean age: 60.2±16 years, 54% female, female n = 107) with known hypertension (n = 51), diastolic heart failure (n = 61), or systolic heart failure (n = 30), recruited from heart failure outpatient clinics. Fifty-eight healthy volunteers were used as a control group. All participants underwent 3D-based myocardial deformation and twist analysis (Artida, Toshiba Medical Systems, Tokyo, Japan). We further investigated associations between these measures and brain natriuretic peptide levels and clinical outcomes. The global 3D strain measurements of the healthy, hypertension, diastolic heart failure, and systolic heart failure groups were 28.03%, 24.43%, 19.70%, and 11.95%, respectively (all p<0.001). Global twist measurements were estimated to be 9.49°, 9.77°, 8.32°, and 4.56°, respectively. We observed significant differences regarding 3D-derived longitudinal, radial, and global 3D strains between the different disease categories (p<0.05), even when age, gender, BMI and heart rate were matched. In addition, 3D-derived longitudinal, circumferential, and 3D strains were all highly correlated with brain natriuretic peptide levels (p<0.001). At a mean 567.7 days follow-up (25th-75th IQR: 197-909 days), poorer 3D-derived longitudinal, radial, and global 3D strain measurements remained independently associated with a higher risk of cardiovascular related death or hospitalization due to heart failure, after adjusting for age, gender, and left ventricular ejection fraction (all p<0.05). 3D-based strain analysis may be a feasible and useful diagnostic tool for discriminating the extent of myocardial dysfunction. Furthermore, it is able to provide a prognostic value beyond traditional echocardiographic parameters in terms of ejection fraction.
    PLoS ONE 12/2014; 9(12):e115260. DOI:10.1371/journal.pone.0115260 · 3.53 Impact Factor
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    ABSTRACT: The objective was to evaluate time-trend bias in the context of a series of studies reporting that a national hepatitis B virus vaccination program (launched in mid-1980s) substantially reduced childhood hepatocellular carcinoma (HCC) incidence.
    Journal of Clinical Epidemiology 12/2014; 68(4). DOI:10.1016/j.jclinepi.2014.11.014 · 5.48 Impact Factor
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    ABSTRACT: Angiotensin-converting enzyme (ACE) inhibitors have been widely used in the treatment of hypertension, but the comparative effectiveness in reducing mortality among different drugs is seldom reported. We identified hypertensive patients who started captopril, enalapril, lisinopril, fosinopril, perindopril, ramipril, or imidapril therapy from Taiwan's National Health Insurance database between 1 January 2004 and 31 December 2009. Overall and cause-specific mortalities were ascertained through a linkage to Taiwan's National Death Registry. Patients were followed from the initiation of ACE inhibitors to death, disenrollment, or study termination (31 December 2010). A Cox proportional hazard regression model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI), using ramipril as the reference group. A total of 989,489 hypertensive patients were included, with a mean follow-up ranging from 3.5 years for imidapril to 4.5 years for enalapril. Captopril initiators had the highest overall mortality rate (117.8 per 1,000,000 person-days) as compared to other ACE inhibitors (54.3-79.4 per 1,000,000 person-days). Patients who started captopril therapy had a significantly increased risk of overall mortality (HR: 1.28, 95% CI: 1.24-1.31) when compared with ramipril. Enalapril (HR: 1.08, 95% CI: 1.05-1.11) and fosinopril (HR: 1.08, 95% CI: 1.05-1.12) were also associated with a modestly increased risk. No difference in mortality was found for lisinopril, perindopril, and imidapril, as compared with ramipril. There are differences in the mortality risk associated with different ACE inhibitors. However, potential residual confounding effects might still exist. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    American Journal of Hypertension 12/2014; DOI:10.1093/ajh/hpu237 · 3.40 Impact Factor
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    ABSTRACT: Angiotensin-converting enzyme (ACE) inhibitors might decrease the risk of pneumonia, but head-to-head comparisons with angiotensin receptor blockers (ARBs) were seldom made. The objective of this study was to evaluate incidence of pneumonia and mortality for different ACE inhibitors as compared to losartan, an ARB that has similar indications. Adult patients aged more than 20 years who initiated ACE inhibitors and losartan between 1 January 2004 and 31 December 2009 were identified from Taiwan's National Health Insurance Database. The outcomes of interest were hospitalization for pneumonia and pneumonia-related mortality. Participants were followed from treatment initiation to the earliest of outcome occurrence, death or disenrollment, treatment discontinuation, switching to other ACE inhibitors or ARBs, or study termination (31 December 31 2010). Proportional-hazards regression model was used to calculate the hazard ratios and their 95% confidence intervals (CIs), adjusted on baseline characteristics. A total of 1 192 082 ACE inhibitors and 175 668 losartan initiators were included. The risk of hospitalization for pneumonia was significantly higher for captopril (hazard ratio 1.94, 95% CI 1.82-2.07), enalapril (hazard ratio 1.14, 95% CI 1.07-1.22), fosinopril (hazard ratio 1.11, 95% CI 1.02-1.21), perindopril (hazard ratio 1.14, 95% CI 1.04-1.25), and ramipril (hazard ratio 1.11, 95% CI 1.02-1.22), as compared with losartan. Captopril was associated with a significantly increased risk of pneumonia mortality (hazard ratio 2.43, 95% CI 1.79-3.31). Treatment with ACE inhibitors is not associated with a lower risk of pneumonia incidence and mortality as compared with losartan.
    Journal of Hypertension 12/2014; DOI:10.1097/HJH.0000000000000438 · 4.22 Impact Factor
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    ABSTRACT: Objective: Whether retroperitoneal fat should be included in the measurement of visceral fat remains controversial. We compared the relationships of fat areas in peritoneal, retroperitoneal, and subcutaneous compartments to metabolic syndrome, adipokines, and incident hypertension and diabetes. Methods: We enrolled 432 adult participants (153 men and 279 women) in a community-based cohort study. Computed tomography at the umbilicus level was used to measure the fat areas. Results: Retroperitoneal fat correlated significantly with metabolic syndrome (adjusted odds ratio (OR), 5.651, p < 0.05) and the number of metabolic abnormalities (p < 0.05). Retroperitoneal fat area was significantly associated with blood pressure, plasma glycemic indices, lipid profile, C-reactive protein, adiponectin (r = -0.244, p < 0.05), and leptin (r = 0.323, p < 0.05), but not plasma renin or aldosterone concentrations. During the 2.94 +/- 0.84 years of follow-up, 32 participants developed incident hypertension. Retroperitoneal fat area (hazard ration (HR) 1.62, p = 0.003) and peritoneal fat area (HR 1.62, p = 0.009), but not subcutaneous fat area (p = 0.14) were associated with incident hypertension. Neither retroperitoneal fat area, peritoneal fat area, nor subcutaneous fat areas was associated with incident diabetes after adjustment. Conclusions: Retroperitoneal fat is similar to peritoneal fat, but differs from subcutaneous fat, in terms of its relationship with metabolic syndrome and incident hypertension. Retroperitoneal fat area should be included in the measurement of visceral fat for cardio-metabolic studies in human.
    PLoS ONE 11/2014; 9(11):e112355. DOI:10.1371/journal.pone.0112355 · 3.53 Impact Factor
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    ABSTRACT: Introduction Constipation is a non-motor symptom of Parkinson's disease (PD). We investigated the association between the severity of constipation and subsequent risk of PD in a population-based sample. Methods 551,324 participants free of PD, dementia, and stroke were retrospectively ascertained between January 1, 2005 and December 31, 2005 using the Taiwan National Health Insurance Research Database. The association between constipation at the beginning of the study and the incidence of PD was examined using a Cox regression model. Information regarding comorbidities and concomitant medications use was adjusted in the proportional hazards models. Results After an average follow-up of 5.5 years, 2336 incident PD cases were diagnosed. The crude incidence rate of PD per 1,000,000 person-days was 1.57 for subjects without constipation and 4.04, 5.28, and 12.67 for mild, moderate, and severe constipation, respectively. After adjusting for age, sex, comorbidities, and concomitant medication use, patients with constipation were more likely to develop PD than subjects without constipation; the adjusted hazard ratio (aHR) was 3.28 (95% CI: 2.14–5.03), 3.83 (2.51–5.84), and 4.22 (2.95–6.05) for individual constipation severity categories. Constipation severity was also associated with an increased likelihood of PD in the time-varying analysis; the aHR was 2.84 (2.43–3.33), 5.22 (4.61–5.92), and 10.47 (9.46–11.58) for mild, moderate, and severe constipation, respectively (P < 0.0001). After excluding PD patients diagnosed within 3 years of constipation, the association remained significant. Conclusions Our study suggests that the severity of constipation is associated with a future diagnosis of PD in a dose-dependent manner.
    Parkinsonism & Related Disorders 09/2014; 20(12). DOI:10.1016/j.parkreldis.2014.09.026 · 4.13 Impact Factor
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    ABSTRACT: Patients with type 2 diabetes mellitus are at a higher risk of colorectal cancer (CRC). The objective of this study was to examine the inter-relationship among infection sites, systemic antibiotic use, and risk of colorectal cancer among type 2 diabetes mellitus. From a diabetic cohort from Taiwan's National Health Insurance claims database, we identified 3,593 incident colon cancer cases, 1,979 rectal cancer cases, and 22,288 controls, and conducted a nested case-control study to examine the association between antibiotic use and colorectal cancer incidence. Logistic regression models were applied to estimate the odds ratio (OR) and the 95% confidence interval (95% CI) between infection sites, antibiotic use, and colorectal cancer incidence. Patients with intra-abdominal infection were significantly associated with increased risk for colon cancer (OR: 2.01, 95% CI: 1.73-2.35) and rectal cancer (OR: 1.59, 95% CI: 1.26-2.00). Any anti-anaerobic antibiotic use was associated with a higher risk of colon cancer (OR: 2.31, 95% CI: 2.12-2.52) and rectal cancer (OR: 1.69, 95% CI: 1.50-1.90) but without an obvious dose-response relation for cumulative use. Anti-anaerobic antibiotics also increased the risks for those with non-intra-abdominal infection. No association was found between anti-aerobic agent use and the CRC risk. The results suggest intra-abdominal infections and anti-anaerobic antibiotic use may be a marker for precancerous lesions or early CRC, although the possibility of anti-anaerobic antibiotics playing an additional role cannot be excluded. Further research examining the relationship between intra-abdominal infection, anti-anaerobic antibiotics use and possible change of microbiota leading to colorectal carcinogenesis is warranted. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 08/2014; 135(4). DOI:10.1002/ijc.28738 · 5.01 Impact Factor
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    ABSTRACT: Purpose: The aim was to investigate the effects of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) and compare the results with those of in-hospital cardiac arrest (IHCA). Methods: We analyzed our extracorporeal membrane oxygenation (ECMO) results for patients who received ECPR for OHCA or IHCA in the last 5 years. Pre-arrest, resuscitation, and post-resuscitative data were evaluated. Results: In the last 5 years, ECPR was used 230 times for OHCA (n = 31) and IHCA (n = 199). The basic demographic data showed significant differences in age, cardiomyopathy, and location of the initial CPR. Duration of ischemia was shorter in the IHCA group (44.4 +/- 24.7 min vs. 67.5 +/- 30.6 min, p < 0.05). About 50% of each group underwent a further intervention to treat the underlying etiology. ECMO was maintained for a shorter duration in the OHCA patients (61 +/- 48 h vs. 94 +/- 122 h, p < 0.05). Survival to discharge was similar in the two groups (38.7% for OHCA vs. 31.2% for IHCA, p > 0.05), as was the favorable outcome rate (25.5% for OHCA vs. 25.1% for IHCA, p > 0.05). Survival was acceptable (about 33%) in both groups when the duration of ischemia was no longer than 75 min. Conclusions: In addition to having a beneficial effect in IHCA, ECPR can lead to survival and a positive neurological outcome in selected OHCA patients after prolonged resuscitation. Our results suggest that further investigation of the use of ECMO in OHCA is warranted.
    Resuscitation 06/2014; 85(9). DOI:10.1016/j.resuscitation.2014.06.022 · 3.96 Impact Factor
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    ABSTRACT: Background and Purpose: Hypertension has been associated with Parkinson's disease (PD), but data on antihypertensive drugs and PD are inconclusive. We aim to evaluate antihypertensive drugs for an association with PD in hypertensive patients. Methods: Hypertensive patients who were free of PD, dementia and stroke were recruited from 2005-2006 using Taiwan National Health Insurance Database. We examined the association between the use of calcium channel blockers (CCBs), angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) and the incidence of PD using betablockers as the reference. Cox regression model with time-varying medication use was applied. Results: Among 65,001 hypertensive patients with a mean follow-up period of 4.6 years, use of dihydropyridine CCBs, but not non-dihydropyridine CCBs, was associated with a reduced risk of PD (adjusted hazard ratio [aHR] = 0.71; 95% CI, 0.570.90). Additionally, use of central-acting CCBs, rather than peripheral-acting ones, was associated with a decreased risk of PD (aHR =.69 [55-0.87]. Further decreased association was observed for higher cumulative doses of felodipine (aHR = 0.54 [0.36-0.80]) and amlodipine (aHR = 0.60 [0.45-0.79]). There was no association between the use of ACEIs (aHR = 0.80 [0.641.00]) or ARBs (aHR = 0.86 [0.69-1.08]) with PD. A potentially decreased association was only found for higher cumulative use of ACEIs (HR = 0.52 [0.34-0.80]) and ARBs (HR = 0.52 [0.33-0.80]). Conclusions: Our study suggests centrally-acting dihydropyridine CCB use and high cumulative doses of ACEIs and ARBs may associate with a decreased incidence of PD in hypertensive patients. Further long-term follow-up studies are needed to confirm the potential beneficial effects of antihypertensive agents in PD.
    PLoS ONE 06/2014; 9(6):e98961. DOI:10.1371/journal.pone.0098961 · 3.53 Impact Factor
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    ABSTRACT: BackgroundAngiotensin receptor blockers (ARBs) have been shown to exert various peroxisome proliferator-activated receptor gamma (PPARγ) binding activities and insulin-sensitizing effects. The objective of this study was to investigate the association of different ARBs with new-onset diabetes mellitus.MethodsIn the respective cohort, a total of 492,530 subjects who initiated ARB treatment between January 2004 and December 2009 were identified from Taiwan National Health Insurance Database. The primary outcome was newly diagnosed diabetes, defined as at least one hospital admission or two or more outpatient visits within a year with an ICD-9-CM code 250. Cox proportional regression was used to estimate the risk of diabetes associated with each ARB, using losartan as the reference.ResultsA total of 65,358 incident diabetes cases were identified out of 1,771,173 person-years. Olmesartan initiators had a small but significantly increased risk of developing diabetes after adjusting for baseline characteristics and mean daily dose (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.12). After excluding those followed for less than one year, the increase in diabetes risk are more pronounced (HR, 1.09; 95% CI, 1.05-1.14). This association was consistent across all subgroup analyses. Similar results were observed when a more strict definition of diabetes combining both diabetes diagnosis and anti-diabetic treatment was used. On the other hand, there was no difference in diabetes risk between telmisartan and losartan.ConclusionsAmong all ARBs, olmesartan might be associated with a slightly increased risk of diabetes mellitus. Our data suggest differential diabetes risks associated with ARBs beyond a class effect.
    Cardiovascular Diabetology 05/2014; 13(1):91. DOI:10.1186/1475-2840-13-91 · 3.71 Impact Factor
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    Ai-Tzu Li, Jou-Wei Lin
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    ABSTRACT: The objective of this study was to construct a framework of core competency indicators of medical doctors who teach in the clinical setting in Taiwan and to evaluate the relative importance of the indicators among these clinical teachers. The preliminary framework of the indicators was developed from an in-depth interview conducted with 12 clinical teachers who had previously been recognized and awarded for their teaching excellence in university hospitals. The framework was categorized into 4 dimensions: 1) Expertise (i.e., professional knowledge and skill); 2) Teaching Ability; 3) Attitudes and Traits; and 4) Beliefs and Values. These areas were further divided into 11 sub-dimensions and 40 indicators. Subsequently, a questionnaire built upon this qualitative analysis was distributed to another group of 17 clinical teachers. Saaty's eigenvector approach, or the so-called analytic hierarchy process (AHP), was applied to perform the pairwise comparisons between indicators and to determine the ranking and relative importance of the indicators. Fourteen questionnaires were deemed valid for AHP assessment due to completeness of data input. The relative contribution of the four main dimensions was 31% for Attitudes and Traits, 30% for Beliefs and Values, 22% for Expertise, and 17% for Teaching Ability. Specifically, 9 out of the 10 top-ranked indicators belonged to the "Attitudes and Traits" or "Beliefs and Values" dimensions, indicating that inner characteristics (i.e., attitudes, traits, beliefs, and values) were perceived as more important than surface ones (i.e., professional knowledge, skills, and teaching competency). We performed a qualitative analysis and developed a questionnaire based upon an interview with experienced clinical teachers in Taiwan, and used this tool to construct the key features for the role model. The application has also demonstrated the relative importance in the dimensions of the core competencies for clinical teachers in Taiwan.
    BMC Medical Education 04/2014; 14(1):75. DOI:10.1186/1472-6920-14-75 · 1.41 Impact Factor
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    ABSTRACT: Apelin regulates insulin sensitivity and secretion in animals. However, whether plasma apelin predicts incident diabetes in humans remains unknown. We studied a cohort including 447 subjects (148 men, 299 women) without diabetes and followed for an average of 3y. Diabetes was diagnosed by an oral glucose tolerance test, plasma hemoglobin A1c, and if the subject was taking medications for diabetes. Plasma apelin-12 at baseline was measured with a commercial kit. Plasma apelin concentrations were higher in women than in men at baseline (p=0.007). During follow-up, 43 subjects developed type 2 diabetes. Higher plasma apelin concentrations were associated with a higher risk of diabetes in men (p=0.049) but not in women. Plasma apelin predicted incident type 2 diabetes in men (hazard ratio, 2.13, 95% CI 1.29-3.51, p<0.05), but not in women, adjusted for age, family history of diabetes, hemoglobin A1c, body mass index, hypertension, and HOMA2-IR. Apelin could improve the prediction ability beyond traditional risk factors in men, and the sensitivity and specificity of plasma apelin at 0.9ng/ml for this prediction were 63.2% and 58.9%, respectively. In men at risk for diabetes (HbA1c 5.7-6.4%, FPG 100-125mg/dl, or OGTT-2h-PG 140-199mg/dl), the risk for developing diabetes was higher in those with higher plasma apelin concentration than in those with lower plasma apelin concentrations (10.6%/year vs. 5.1%/year, p<0.001). Plasma apelin is a novel biomarker for predicting type 2 diabetes in men.
    Clinica chimica acta; international journal of clinical chemistry 04/2014; DOI:10.1016/j.cca.2014.03.030 · 2.76 Impact Factor
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    ABSTRACT: Background Acute thoracic empyema is a common clinical problem worldwide, resulting in substantial morbidity and mortality. The objective of this study was to report its clinical characteristics and to evaluate whether thoracoscopic surgery is associated with a lower rate of in-hospital mortality compared with nonoperative drainage. Methods Between 2001 and 2010, we retrospectively reviewed the clinical characteristics, bacteriological studies, and treatment outcomes of 602 patients with acute thoracic empyema. Thoracoscopic surgery was performed in 417 (69.2%) patients, while the remaining patients underwent nonoperative drainage. After treatment, 77 patients (12.8%) died in the hospital. A propensity score-based process, matched on potential risk factors for in-hospital mortality, was performed to select patients with equalized potential prognostic factors in the thoracoscopy and nonoperative groups. The log-rank test was used to compare the survival time with discharge between the two matched groups. Results Multivariate analysis showed that age, malignancy, chronic lung disease, chronic renal insufficiency, liver cirrhosis, polymicrobial infection, and positive bacterial culture were risk factors for in-hospital mortality. The propensity score-matched analysis showed that the in-hospital mortality difference was significant (p = 0.014) and the Kaplan–Meier survival analysis revealed a higher survival rate to discharge (p < 0.001 by log-rank test), both favoring thoracoscopy over nonoperative drainage. Conclusions Acute thoracic empyema carries a high mortality rate, especially in elderly patients with coexisting medical conditions and polymicrobial and positive bacterial cultures. Our study results also showed that thoracoscopy is feasible and might provide better chances for survival in borderline operable patients than nonoperative drainage.
    Journal of the Formosan Medical Association 04/2014; 113(4). DOI:10.1016/j.jfma.2013.12.010 · 1.70 Impact Factor
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    ABSTRACT: Concerns about an increased cardiovascular risk with the angiotensin receptor blocker, olmesartan, prompted the current study to examine associations between olmesartan and other angiotensin receptor blockers with overall and cause-specific mortalities. We collected patients who started to use losartan, valsartan, irbesartan, candesartan, telmisartan, and olmesartan between January 1, 2004, and December 31, 2009, from Taiwan's National Health Insurance claims database. Prescribed drug types, dosage, and other clinical information were collected. Overall mortality and cause-specific mortality were ascertained through linkages with Taiwan's National Death Registry. Two follow-up analyses, labeled intention-to-treat and as-treated, were conducted. A Cox proportional hazard regression model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) using losartan as the reference group. A total of 690 463 subjects were included, with a mean follow-up ranging from a low of 2.8 years for olmesartan to a high of 4.1 years for irbesartan. Subjects who began with valsartan had a modest but significantly increased risk of overall mortality (HR, 1.04; 95% CI, 1.02-1.06) compared with losartan. Irbesartan (HR, 0.96; 95% CI, 0.94-0.99), candesartan (HR, 0.95; 95% CI, 0.92-0.99), telmisartan (HR, 0.93; 95% CI, 0.90-0.96), and olmesartan (HR, 0.93; 95% CI, 0.88-0.97) were associated with a slightly lower overall mortality risk than losartan. The analysis indicates that the differences in mortality risk among individual angiotensin receptor blockers were only marginal and thus less likely to be clinically important. Although uncontrolled confounding might still exist, olmesartan does not seem to increase cardiovascular risk compared with losartan.
    Hypertension 02/2014; 63(5). DOI:10.1161/HYPERTENSIONAHA.113.02550 · 7.63 Impact Factor
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    ABSTRACT: The process of weaning may impose cardiopulmonary stress on ventilated patients. Heart rate variability (HRV), a noninvasive tool to characterize autonomic function and cardiorespiratory interaction, may be a promising modality to assess patient capability during the weaning process. We aimed to evaluate the association between HRV change and weaning outcomes in critically ill patients. This study included 101 consecutive patients recovering from acute respiratory failure. Frequency domain analysis, including very low frequency, low frequency, high frequency and total power, of HRV was assessed during a 1-hour spontaneous breathing trial (SBT) through a T-piece and following extubation after successful SBT. Out of 101 patients, 24 (24%) had SBT failure and HRV analysis in these patients showed a significant decrease in total power (P = 0.003); 77 patients passed SBT and were extubated, but 13 (17%) of them required reintubation within 72 hours. In successfully extubated patients, very low frequency and total power from SBT to post-extubation significantly increased (P = 0.003 and P = 0.004, respectively). Instead, patients with extubation failure were unable to increase HRV after extubation. HRV responses differ between patients with different weaning outcomes. Measuring HRV change during the weaning process may help clinicians predict weaning results and in the end, improve patient care and outcome.
    Critical care (London, England) 01/2014; 18(1):R21. DOI:10.1186/cc13705
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    ABSTRACT: -This study examined the effect of radiofrequency catheter ablation (RFA) on reducing morbidity and mortality among patients with atrial fibrillation (AF). -A retrospective cohort of AF patients without prior stroke or heart failure (HF) who underwent RFA between 2003 and 2009 was identified using Taiwan's National Health Insurance claims database. Outpatients with AF who met the same enrollment criteria but did not receive RFA were matched (up to 1:20) by hospitals and dates to serve as controls. Outcomes of interest were death, stroke, or hospitalization for HF. A proportional hazard Cox regression model adjusted by propensity scores (based on age, sex, hypertension, diabetes, co-morbidities, medications, and medical resource utilization) was applied to estimate the hazard ratio and 95% confidence interval. A total of 846 AF patients who received RFA and 11,324 matched AF controls were included, with a mean follow-up of 3.74 and 3.96 years, respectively. RFA was associated with a lower hazard for stroke (HR: 0.57, 95% CI: 0.35-0.94, p = 0.026). The reduction in the hazard for death and HF did not reach statistical significance (HR: 0.88, 95% CI: 0.62-1.23, p = 0.451 and HR: 0.78, 95% CI: 0.55-1.12, p = 0.185, respectively). Additional analysis using death as a competing risk showed similar results for stroke and HF. -RFA did not reduce mortality or hospitalization for HF during the immediate 3.5-year follow-up. Although a beneficial effect on stroke prevention associated with RFA was suggested, residual confounding due to unmeasured factors remains a concern.
    Circulation Arrhythmia and Electrophysiology 01/2014; 7(1). DOI:10.1161/CIRCEP.113.000597 · 5.42 Impact Factor
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    ABSTRACT: Background Carotid angioplasty and stent (CAS) placement has emerged as an attractive revascularization strategy for patients with internal carotid artery stenosis. However, the effectiveness and safety of CAS were not fully evaluated, mainly because of methodological difficulties in finding an appropriate comparison group. Methods Patients who underwent CAS were identified from Taiwan's National Health Insurance claims database between 2005 and 2008. The incidence rate of ischemic stroke after CAS was compared with that of the year prior to the procedure using a self-controlled case series analysis and a conditional Poisson regression model. Logistic regression was conducted to identify factors associated with poor outcome. Results A total of 1258 patients who had undergone CAS were included, and 73 cases (5.8%) of death or ischemic stroke occurred during the index hospitalization. Within 1 year after CAS, 74 patients died and 80 experienced an ischemic stroke. Of the 1184 patients who were followed for 360 days, the rate ratio for ischemic stroke decreased to 0.21 (95% CI: 0.08–0.51) between 31 and 180 days, and 0.10 (95% CI: 0.03–0.32) between 181 and 360 days. Statin therapy was associated with a reduced risk of death or ischemic stroke in the 1st month (odds ratio of 0.53; 95% CI: 0.32–0.90). Conversely, the use of nonsteroidal anti-inflammatory agents, possibly histamine-2 receptor blockers, and CAS performed by low-volume operators were associated with a twofold increased risk. Conclusion CAS reduced the long-term risk for ischemic stroke. Self-controlled case series analysis might be an appropriate design for evaluating device safety and effectiveness.
    Journal of the Formosan Medical Association 01/2014; 114(3). DOI:10.1016/j.jfma.2014.05.001 · 1.70 Impact Factor

Publication Stats

1k Citations
601.89 Total Impact Points

Institutions

  • 2006–2014
    • National Taiwan University
      • • School of Medicine
      • • College of Medicine
      T’ai-pei, Taipei, Taiwan
    • National Taiwan University Hospital
      • Department of Internal Medicine
      T’ai-pei, Taipei, Taiwan
  • 2013
    • Cathay General Hospital
      T’ai-pei, Taipei, Taiwan
  • 2012
    • Cardinal Tien Hospital
      T’ai-pei, Taipei, Taiwan
  • 2010
    • University of North Texas HSC at Fort Worth
      • Department of Environmental & Occupational Health
      Fort Worth, Texas, United States
  • 2007–2008
    • National Chung Cheng University
      Chia-i-hsien, Taiwan, Taiwan
  • 2002
    • Far Eastern Memorial Hospital
      T’ai-pei, Taipei, Taiwan