Buddhist Tzu Chi Medical Foundation

Taipei, Taiwan

Buddhist Tzu Chi Medical Foundation

Taipei, Taiwan
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Wu C.-C.,Buddhist Tzu Chi Medical Foundation | Wu C.-C.,Dalin Tzu Chi Hospital | Hsu T.-W.,Buddhist Tzu Chi Medical Foundation | Hsu T.-W.,Dalin Tzu Chi Hospital | And 10 more authors.
Medicine (United States) | Year: 2015

We studied the effect of Age-Adjusted Comorbidity Index Score in colorectal cancer patients who underwent similarly aggressive treatment.Using the National Health Insurance Research Database of Taiwan, we identified 5643 patients with colorectal cancer who underwent surgical resection and chemoradiation from 2007 through 2011. We estimated survival according to Age-Adjusted Comorbidity Index Scores and 5-year survival using Cox proportional hazard regression analysis, adjusting for sex, oxaliplatin-based chemotherapy, socioeconomic status, geographic region, and hospital characteristics.In the cohort were 3230 patients with colonic cancer and 2413 patients with rectal cancer, who had undergone combined surgical resection and either neoadjuvant or adjuvant chemoradiation. After adjusting for patient characteristics (sex, oxaliplatin-based chemotherapy, socioeconomic status, geographic region, and hospital-characteristics), colonic cancer patients with age-adjusted Charlson (AAC) â⠰Â16 had a 106% greater risk of death within 5 years (adjusted HR=2.06; 95% CI, 1.66-2.56). In rectal cancer patients, patients with an AAC score of 4-5 had a 28% greater risk of death within 5 years (adjusted HR=1.28; 95% CI, 1.02-1.61), and those with AAC ââ°Â16 had a 47% greater risk (adjusted HR=1.47; 95% CI, 1.15-1.90).Age and burden of comorbidities influence survival of patients with colonic or rectal cancer. Age-Adjusted Comorbidity Score remains an independent prognostic factor even after adjusting for the aggressiveness of treatment. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


PubMed | Buddhist Tzu Chi Medical Foundation, Kurume University, Junshin Clinic Bile Acid Institute and National Taiwan University Hospital
Type: | Journal: Journal of lipid research | Year: 2017

Tetrahydroxy bile acids (THBAs) are hydrophilic and are present at minimal or undetectable levels in healthy human adults but are present at high levels in bile salt export pump (abcb11)-knockout mice. The roles of THBAs in human cholestatic diseases are unclear. We aimed to investigate the presence of THBAs in patients with infantile intrahepatic cholestasis and its correlation with outcome. Urinary bile acids were analysed by GC-MS. Data were compared between good (N=21) (disease-free before 1 year old) and poor prognosis groups (N=19). Good prognosis patients had a higher urinary THBA proportion than poor prognosis patients (25.89% (3.45-76.73) vs. 1.93% (0.05-48.90)). A urinary THBA proportion >7.23% predicted good prognosis with high sensitivity (95.24%), specificity (84.21%) and area under the curve (0.91) (p<0.0001). A THBA proportion 7.23% was an independent factor for decreased transplant-free survival (hazard ratio=7.16, confidence interval: 1.24-41.31, p=0.028). Patients with a confirmed ABCB11 or TJP2 mutation (N=7) had a minimally detectable THBA proportion (0.23-2.99% of total bile acids). Three patients with an ATP8B1 mutation had an elevated THBA proportion (7.51-37.26%). In conclusion, in addition to disease entity as a major determinant of outcome, a high THBA level was associated with good outcome in the infantile intrahepatic cholestasis patients.


Chang C.-M.,Buddhist Tzu Chi Medical Foundation | Chang C.-M.,Tzu Chi University | Yin W.-Y.,Buddhist Tzu Chi Medical Foundation | Yin W.-Y.,Tzu Chi University | And 15 more authors.
Medicine (United States) | Year: 2014

The impact of important preexisting comorbidities, such as liver and renal disease, on the outcome of liver resection remains unclear. Identification of patients at risk of mortality will aid in improving preoperative preparations. The purpose of this study is to develop and validate a population-based score based on available preoperative and predictable parameters predicting 90-day mortality after liver resection using data from a hepatitis endemic country. We identified 13,159 patients who underwent liver resection between 2002 and 2006 in the Taiwan National Health Insurance Research Database. In a randomly selected half of the total patients, multivariate logistic regression analysis was used to develop a prediction score for estimating the risk of 90-day mortality by patient demographics, preoperative liver disease and comorbidities, indication for surgery, and procedure type. The score was validated with the remaining half of the patients. Overall 90-day mortality was 3.9%. Predictive characteristics included in the model were age, preexisting cirrhosis-related complications, ischemic heart disease, heart failure, cerebrovascular disease, renal disease, malignancy, and procedure type. Four risk groups were stratified by mortality scores of 1.1%, 2.2%, 7.7%, and 15%. Preexisting renal disease and cirrhosis-related complications were the strongest predictors. The score discriminated well in both the derivation and validation sets with c-statistics of 0.75 and 0.75, respectively. This population-based score could identify patients at risk of 90-day mortality before liver resection. Preexisting renal disease and cirrhosis-related complications had the strongest influence on mortality. This score enables preoperative risk stratification, decisionmaking, quality assessment, and counseling for individual patients. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Wu C.-C.,Buddhist Tzu Chi Medical Foundation | Hsu T.-W.,Buddhist Tzu Chi Medical Foundation | Hsu T.-W.,Tzu Chi University | Chang C.-M.,Buddhist Tzu Chi Medical Foundation | And 8 more authors.
Oncologist | Year: 2016

Introduction. Although palliative chemotherapy during endof-life care is used for relief of symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive end-of-life care and lessuse of hospice service.This is a population based study of the association between palliative chemotherapy and aggressiveness of end-of-life care. Patients and Methods. Using the National Health Insurance Research Database of Taiwan, we identified 49,920 patients with metastatic cancer who underwent palliative chemotherapy from January 1, 2009, to December 31, 2011. Patients who received chemotherapy 2-6 months before death were included. Aggressiveness of end-of-life care was examined by previously reported indicators. Cardiopulmonary resuscitation and endotracheal tube intubation were included as indicators of aggressive end-of-life care. The association between palliative chemotherapy and hospice care was studied. Results. Palliative chemotherapy was associated with more aggressive treatment. After adjustment for patient age, sex, Charlson Comorbidity Index score, cancer group, primary physician’s specialty, postdiagnosis survival, hospital characteristics, hospital caseload, urbanization, and geographic regions, more than one emergency room visit (p, .001), more than one intensive care unit admission (p, .001), and endotracheal intubation (p 5 .02) during end-of-life care were significantlymore common in patients receiving palliative chemotherapy. Patients who did not receive palliative chemotherapy received more hospice care in the last 6 months of life (p,.001). Conclusion. Although the decision to initiate palliative chemotherapy was made several months before death, this study showed that palliative chemotherapy was associated with more aggressive end-of-life care, including more emergency room visits and intensive care unit admissions, and endotracheal intubation. The patients who received palliative chemotherapy received less hospice service toward the end of life. © AlphaMed Press 2016.


Chang C.-H.,National Cheng Kung University | Wang Y.-W.,National Cheng Kung University | Wang Y.-W.,Buddhist Tzu Chi Medical Foundation | Yeh Liu P.-Y.,National Cheng Kung University | Kao Yang Y.-H.,National Cheng Kung University
Journal of Clinical Pharmacy and Therapeutics | Year: 2014

What is known and objective The many interactions between warfarin and other drugs and foods generate great challenges for clinicians and patients in maintaining stable anitcoagulation. Interactions due to variable vitamin K content of different dietary items influence the therapy of nearly all patients on warfarin. Unfortunately, there is no widely acceptable, patient-friendly strategy for managing such interactions. In this contribution, we propose a practical approach to managing this troublesome interaction, consisting of 'maintaining constant weekly dietary vitamin K intake scores'. Methods Twenty-three vitamin K-rich vegetables commonly seen in Taiwanese meals were identified and classified into seven score grades according to their relative vitamin K content per serving. The scores were based on published vitamin K content of different foods. Results and discussion The vitamin K score was equivalent to 5 points for spinach and garland chrysanthemum per bowel, followed by (baby) bok choy, amaranth, arden lettuce (4 points); leaf mustard, edible rape, sweet potato leaf, bai cai and Chinese leek (3 points); and okra and Chinese celery (0·5 points). This classification can be used to guide patients in recording their weekly vitamin K scores with a view to maintaining it when on warfarin. What is new and conclusion We suggest a novel approach to patient counselling on warfarin to maintain consistent dietary vitamin K intake and achieve a more stable anticoagulation response. A prospective randomized controlled trial to validate this pragmatic approach would be useful. Twenty-three vitamin K-rich vegetables commonly seen in Taiwanese meals were identified and classified into seven score grades according to their relative vitamin K content per serving. The scores were based on published vitamin K content of different foods. The vitamin K score was equivalent to 5 points for spinach and garland chrysanthemum per bowel. We suggest a novel approach to patient counseling on warfarin to maintain consistent dietary vitamin K intake and achieve a more stable anticoagulation response. A prospective randomized controlled trial to validate this pragmatic approach would be useful. © 2013 John Wiley & Sons Ltd.

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