H-H Chen

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

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Publications (11)41.26 Total impact

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    ABSTRACT: Recent studies found that hepatitis C virus (HCV) may invade the central nervous system, and both HCV and Parkinson's disease (PD) have in common the overexpression of inflammatory biomarkers. We analysed data from a community-based integrated screening programme based on a total of 62 276 subjects. We used logistic regression models to investigate association between HCV infection and PD. The neurotoxicity of HCV was evaluated in the midbrain neuron-glia coculture system in rats. The cytokine/chemokine array was performed to measure the differences of amounts of cytokines released from midbrain in the presence and absence of HCV. The crude odds ratios (ORs) for having PD were 0.62 [95% confidence interval (CI), 0.48-0.81] and 1.91 (95% CI, 1.48-2.47) for hepatitis B virus (HBV) and HCV. After controlling for potential confounders, the association between HCV and PD remained statistically significant (adjusted OR = 1.39; 95% CI, 1.07-1.80), but not significantly different between HBV and PD. The HCV induced 60% dopaminergic neuron death in the midbrain neuron-glia coculture system in rats, similar to that of 1-methyl-4-phenylpyridinium (MPP(+) ) but not caused by HBV. This link was further supported by the finding that HCV infection may release the inflammatory cytokines, which may play a role in the pathogenesis of PD. In conclusion, our study demonstrated a significantly positive epidemiological association between HCV infection and PD and corroborated the dopaminergic toxicity of HCV similar to that of MPP(+) . © 2015 John Wiley & Sons Ltd.
    Journal of Viral Hepatitis 01/2015; DOI:10.1111/jvh.12392 · 3.31 Impact Factor
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    ABSTRACT: Background:We aim to report the prevalence of irritable bowel syndrome (IBS) and elucidate the influence of IBS on the incidence of colorectal neoplasm through a community-screening-based, longitudinal follow-up study.Methods:We enroled 39 384 community residents aged 40 years or older who had participated in a community-based colorectal cancer-screening programme with an immunochemical faecal occult test since 1999. We followed a cohort that was free of colorectal neoplasm (excluding colorectal neoplasm at baseline) to ascertain the incident colorectal neoplasm through each round of screening and used a nationwide cancer registry. Information on IBS was obtained by linking this screened cohort with population-based health insurance claim data. Other confounding factors were also collected via questionnaire or biochemical tests.Results:The overall period prevalence of IBS was 23%, increasing from 14.7% for subjects aged 40-49 years to 43.7% for those aged 70 years and more. After controlling for age, gender and family history of colorectal cancer, screenees who had been diagnosed as having IBS exhibited a significantly elevated level (21%; adjusted hazard ratio (HR)=1.21 (95% CI: 1.02-1.42)) of incident colorectal adenoma compared with those who had not been diagnosed with IBS. A similar finding was noted for invasive carcinoma; however, the size of the effect was of borderline statistical significance (adjusted HR=1.20 (95% CI: 0.94-1.53)).Conclusions:IBS led to an increased risk for incident colorectal neoplasm.British Journal of Cancer advance online publication, 4 December 2014; doi:10.1038/bjc.2014.575 www.bjcancer.com.
    British Journal of Cancer 12/2014; 112(1). DOI:10.1038/bjc.2014.575 · 4.82 Impact Factor
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    ABSTRACT: Background: Interferon (IFN)-based therapies could eradicate hepatitis C (HCV) and reduce the risk of hepatocellular carcinoma (HCC). However, HCC could still happen after sustained virological response (SVR). We aimed to develop a simple scoring system to predict the risk of HCC development among HCV patients after antiviral therapies. Methods: From 1999 to 2009, 1879 patients with biopsy-proven HCV infection treated with IFN-based therapies were analyzed. Results: Multivariable analysis showed old age (adjusted HR (aHR)=1.73, 95% CI=1.13–2.65 for aged 60–69 and aHR=2.20, 95% CI=1.43–3.37 for aged ⩾70), Male gender (aHR=1.74, 95% CI=1.26–2.41), platelet count <150 × 109/l (HR=1.91, 95% CI=1.27–2.86), α-fetoprotein ⩾20 ng ml−1 (HR=2.23, 95% CI=1.58–3.14), high fibrotic stage (HR=3.32, 95% CI=2.10–5.22), HCV genotype 1b (HR=1.53, 95% CI=1.10–2.14), and non SVR (HR=2.40, 95% CI=1.70–3.38) were independent risk factors for HCC. Regression coefficients were used to build up a risk score and the accuracy was evaluated by using the area under the receiver operating characteristic curve (AUC). Three groups as low-, intermediate-, and high-risk are classified based on the risk scores. One hundred sixty patients (12.78%) in the derivation and 82 patients (13.08%) in the validation cohort developed HCC with AUC of 79.4%, sensitivity of 84.38%, and specificity of 60.66%. In the validation cohort, the 5-year HCC incidence was 1.81%, 12.92%, and 29.95% in low-, intermediate-, and high-risk groups, with hazard ratios 4.49 in intermediate- and 16.14 in high-risk group respectively. The risk reduction of HCC is greatest in patients with SVR, with a 5-year and 10-year risk reduction of 28.91% and 27.99% respectively. Conclusion: The risk scoring system is accurate in predicting HCC development for HCV patients after antiviral therapies.
    British Journal of Cancer 10/2013; 109(9). DOI:10.1038/bjc.2013.564 · 4.82 Impact Factor
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    Y-Y Wu, M-F Yen, C-P Yu, H-H Chen
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    ABSTRACT: Background: We demonstrated how to comprehensively translate the existing and updated scientific evidence on genomic discovery, tumour phenotype, clinical features, and conventional risk factors in association with breast cancer to facilitate individually tailored screening for breast cancer. Methods: We proposed an individual-risk-score-based approach that translates state-of-the-art scientific evidence into the initiators and promoters affecting onset and subsequent progression of breast tumour underpinning a novel multi-variable three-state temporal natural history model. We applied such a quantitative approach to a population-based Taiwanese women periodical screening cohort. Results: Risk prediction for pre-clinical detectable and clinical-detected breast cancer was made by the two risk scores to stratify the underlying population to assess the optimal age to begin screening and the inter-screening interval for each category and to ascertain which high-risk group requires an alternative image technique. The risk-score-based approach significantly reduced the interval cancer rate as a percentage of the expected rate in the absence of screening by 30% and also reduced 8.2% false positive cases compared with triennial universal screening. Conclusion: We developed a novel quantitative approach following the principle of translational research to provide a roadmap with state-of-the-art genomic discovery and clinical parameters to facilitate individually tailored breast cancer screening.
    British Journal of Cancer 05/2013; 108(11). DOI:10.1038/bjc.2013.202 · 4.82 Impact Factor
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    ABSTRACT: BACKGROUND AND OBJECTIVES: While the chronic inflammation related to autoimmune diseases is known to be associated with an increased cardiovascular risk, much less is known about cerebrovascular risks. The present population-based, age- and sex-matched follow-up study was undertaken to investigate the risks of acute myocardial infarction (AMI) and ischaemic stroke in patients with dermatomyositis (DMS). METHODS: A total of 907 patients with DMS were enrolled, and compared with a non-DMS control group consisting of 4535 age- and sex-matched, randomly sampled subjects without DMS. The AMI-free and ischaemic stroke-free survival curves were generated using the Kaplan-Meier method. Cox proportional hazard regression was used to estimate the DMS-associated risks of AMI and ischaemic stroke. RESULTS: During the two-year follow-up period, 14 DMS patients (1.5%) and 18 in the non-DMS control group (0.4%) suffered AMIs. The crude hazard ratio (HR) for suffering an AMI in DMS patients compared to subjects in the non-DMS group was 3.96 (95% CI: 1.97-7.96, P = 0.0001), while the adjusted HR was 3.37 (95% CI, 1.67-6.80; P = 0.0007), after taking into account demographic characteristics and cardiovascular comorbidities. During the same follow-up period, 46 patients (5.1%) and 133 in the non-DMS control group (2.9%) developed ischaemic strokes. The crude HR for developing an ischaemic stroke in DMS patients compared to subjects in the non-DMS group was 1.78 (95% confidence interval [CI]: 1.27 -2.49, P = 0.0007), and the adjusted HR was 1.67 (95% CI, 1.19 - 2.34; P = 0.0028). CONCLUSIONS: These findings suggest that DMS is associated with an increased risk of cardiovascular and cerebrovascular events.
    British Journal of Dermatology 01/2013; 168(5). DOI:10.1111/bjd.12245 · 4.10 Impact Factor
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    ABSTRACT: To investigate the relationships of diabetic neuropathy to all-cause and diabetes-related mortality in patients with type 2 diabetes after controlling for significant correlates. We examined 326 patients diagnosed as diabetic polyneuropathy by nerve conduction study in Keelung city, Taiwan, in 2002 and followed them up to ascertain the cause and date of death until the end of 2006. The cause and date of death were recorded for the deceased patients. Information on significant correlates in association with diabetic polyneuropathy and all-cause and diabetes-related mortality was also collected. With median follow-up time of 62.28 months, 44 patients with type 2 diabetes died. The cause of death related to diabetes accounted for 59% (n = 26) of the deceased. Univariate analysis shows that the presence of diabetic neuropathy confers higher risk for all-cause mortality (hazard ratio [HR] = 4.88) and mortality from diabetes (HR = 6.58). The significant finding still persisted after adjustment for age, gender, blood pressure, smoking, history of cardiovascular/cerebrovascular disease, duration of diabetes, waist circumference, fasting plasma glucose, total cholesterol, hemoglobin, and creatinine (adjusted HR = 4.44 for all-cause death and adjusted HR = 11.82 for diabetes-related mortality, respectively). Diabetic polyneuropathy was an independent predictor for all-cause and diabetes-related mortality. The presence of neuropathy together with other significant prognostic factors is informative to predict all-cause death and death from diabetes-related disease for patients diagnosed as type 2 diabetes.
    European Journal of Neurology 01/2012; 19(9):1192-8. DOI:10.1111/j.1468-1331.2011.03659.x · 3.85 Impact Factor
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    ABSTRACT: Very few studies have explored the temporal relationship between hypertension and trigeminal neuralgia (TN). The aim of this population-based follow-up study was to investigate whether hypertension is associated with a higher risk of developing TN. A total of 138,492 persons with at least 2 ambulatory visits with the principal diagnosis of hypertension in 2001 were enrolled in the hypertension group. The nonhypertension group consisted of 276,984 age- and sex-matched, randomly sampled subjects without hypertension. The 3-year TN-free survival rate and the cumulative incidence of TN were calculated using the Kaplan-Meier method. Cox proportional hazard regression was used to estimate the hazard ratio of TN. In the hypertension group, 121 patients developed TN during follow-up, while, in the nonhypertension group, 167 subjects developed TN. The crude hazard ratio for the hypertension group was 1.52 (95% confidence interval [CI] 1.20-1.92; p = 0.0005), while, after adjustment for demographic characteristics and medical comorbidities, the adjusted hazard ratio was 1.51 (95% CI 1.19-1.90; p = 0.0006). This study shows a significantly increased risk of developing TN after hypertension. Further studies are needed to elucidate the underlying mechanism of the association between hypertension and TN.
    Neurology 10/2011; 77(17):1605-10. DOI:10.1212/WNL.0b013e3182343354 · 8.30 Impact Factor
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    ABSTRACT: Population-based randomized controlled trials (RCTs) often involve enormous costs and long-term follow-up to evaluate primary end points. Analytical decision-simulated model for sample size and effectiveness projections based on primary and surrogate end points are necessary before planning a population-based RCT. Based on the study design similar to two previous RCTs, transition rates were estimated using a five-state natural history model [normal, preclinical detection phase (PCDP) Dukes' A/B, PCDP Dukes' C/D, Clinical Dukes' A/B and Clinical Dukes' C/D]. The Markov cycle tree was assigned transition parameters, variables related to screening and survival rate that simulated results of 10-year follow-up in the absence of screening for a hypothetical cohort aged 45-74 years. The corresponding screened arm was to simulate the results after the introduction of population-based screening for colorectal cancer with fecal occult blood test with stop screen design. The natural course of mean sojourn time for five-state Markov model were estimated as 2.75 years for preclinical Dukes' A/B and 1.38 years for preclinical Dukes' C/D. The expected reductions in mortality and Dukes' C/D were 13% (95% confidence intervals: 7-19%) and 26% (95% confidence intervals: 20-32%), respectively, given a 70% acceptance rate and a 90% colonoscopy referral rate. Sample sizes required were 86,150 and 65,592 subjects for the primary end point and the surrogate end point, respectively, given an incidence rate up to 0.0020 per year. The sample sizes required for primary and surrogate end points and the projection of effectiveness of fecal occult blood test for colorectal cancer screening were developed. Both are very important to plan a population-based RCT.
    Journal of Evaluation in Clinical Practice 02/2011; 17(1):123-9. DOI:10.1111/j.1365-2753.2010.01378.x · 1.58 Impact Factor
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    ABSTRACT: Ano-perianal tuberculosis (TB) is a rare extrapulmonary form of the disease. Most publications are in case report form. We report our cohort retrospective study on ano-perianal TB, which is one of the very few original reports in the literature. Over a period of 15 years (January 1992-December 2006), file records revealed cases with confirmed diagnosis of ano-perianal TB after screening from a total of 1251 patients with the diagnosis of TB from Chang Gung Memorial Hospital-Kaohsiung, Taiwan. This study recruited 17 patients (14 male patients and 3 female patients). The age ranged from 18 to 81 years with a mean age of 44.8 +/- 18.2 years. Thirteen patients had coexistent pulmonary TB (76.5%). Eight patients had at least one concomitant co-morbid illness (47.1%). The most common clinical manifestations were anal fistulae (n = 16). All patients who completed a full course of anti-mycobacterial treatment for at least 6 months after surgical intervention were cured without recurrence except for one patient who was lost to follow-up after 2 months of treatment. Seven of the nine patients with complicated fistulae needed longer anti-mycobacterium treatment duration (9-18 months). Ano-perianal TB should be kept in mind for all patients with prolonged or repeatedly recurrent ano-perianal symptoms and signs such as complicated fistulae in an endemic TB area like Taiwan. Management strategy is with conventional anti-mycobacterium therapy for at least 6 months after surgery. An extension of the anti-mycobacterium treatment course to 9-18 months is mandatory for patients with complicated disease presentations.
    Colorectal Disease 10/2009; 12(7 Online):e114-20. DOI:10.1111/j.1463-1318.2009.02057.x · 2.02 Impact Factor
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    ABSTRACT: A case report and a review of literature. To present the first youngest infant of a 4-month-old boy with spontaneous spinal epidural hematoma in cervicothoracic spine. National Cheng Kung University Hospital, Tainan, Taiwan. A 4-month-old boy who initially presented with irritable crying, neck stiffness, and fever followed by progressive quadriparesis. Magnetic resonance imaging (MRI) of the spine disclosed a space-occupying lesion on the right posterior-lateral aspect of the cervicothoracic spinal canal. Laminectomy with reconstruction in situ from C4 to T4 was performed 5 days after the onset of symptoms. The boy had gradual improvement of his neurological status. Follow-up visit 1 year later, the infant's growth and development was within normal limit without any neurological deficits; his repeat MRI showed complete fusion of each implanted lamina and well expansion of the spinal cord. Prompt surgical decompression is valuable, irrespective of the time interval between symptom onset and operation in infant.
    Spinal Cord 09/2007; 45(8):586-90. DOI:10.1038/sj.sc.3101976 · 1.70 Impact Factor
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    ABSTRACT: Extrauterine mullerian adenosarcoma is rare and is thought to arise from endometriotic deposits or pluripotent mesothelial and mesenchymal cells of the pelvic cavity. Concomitant colon-rectal neoplasm was reported but the relationship between extrauterine adenosarcoma and colon tumor was not studied. We describe an extrauterine adenosarcoma with a concomitant rectal tubulovillous adenoma. The patient had a long-term history of endometriosis and unopposed estrogen therapy. Immunohistochemical study was performed to investigate the origin and nature of the adenosarcoma. Immunostaining provided the evidence to distinguish between rectal tumor and adenosarcoma. Extrauterine adenosarcoma may arise from endometriosis, and hormone replacement therapy may have some role in the malignant transformation process. Adenosarcoma should be considered in the differential diagnosis of a new pelvic tumor in a patient with a history of endometriosis.
    International Journal of Gynecological Cancer 03/2005; 15(2):361-5. DOI:10.1111/j.1525-1438.2005.15230.x · 1.95 Impact Factor

Publication Stats

44 Citations
41.26 Total Impact Points

Institutions

  • 2012–2014
    • National Taiwan University
      • Graduate Institute of Epidemiology and Preventive Medicine
      T’ai-pei, Taipei, Taiwan
  • 2011
    • University of Tampere
      Tammerfors, Province of Western Finland, Finland
    • Taipei Medical University
      • Department of Physical Medicine and Rehabilitation
      T’ai-pei, Taipei, Taiwan
  • 2009
    • Chang Gung University
      Hsin-chu-hsien, Taiwan, Taiwan
  • 2007
    • National Cheng Kung University Hospital
      • Department of Pediatrics
      臺南市, Taiwan, Taiwan
  • 2005
    • Chang Gung Memorial Hospital
      T’ai-pei, Taipei, Taiwan