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Chen H.-F.,Far Eastern Memorial Hospital | Chen P.,Central Medicine Hospital Group | Li C.-Y.,China Medical University at Taichung
Hepatology | Year: 2010

We prospectively investigated 615,532 diabetic patients and 614,871 age-matched and sex-matched control subjects selected from National Health Insurance claims for malignant neoplasms of liver and biliary tract (International Statistical Classification of Diseases and Related Health Problems, 9th edition, codes 155 and 156, respectively) between 2000 and 2006. The person-year approach with Poisson assumption was used to estimate the hazard rates. We also evaluated the age-specific and sex-specific relative risks of these two malignancies in relation to diabetes with Cox proportional hazard regression model with adjustment for potential confounders. The overall hazard rate of malignant neoplasm of the liver was 32.76 and 17.41 per 10,000 patient-years, respectively, for diabetic men and women; the corresponding figures for biliary tract neoplasm were much lower at 1.42 and 1.60 per 10,000 patient-years. Compared with control subjects, diabetic patients had a two-fold increased risk of malignant neoplasm of the liver, but this risk was attenuated by adjusting for selected clinical risk factors (hazard ratio [HR] 1.21; 95% confidence interval [CI] 1.17-1.25). Additionally, diabetic patients were associated with increased risk of biliary neoplasms with an approximate magnitude of 20%-30%, but the HR was attenuated and became insignificant after adjustment for clinical risk factors (HR 1.07; 95% CI 0.95-1.21). Diabetic patients with cirrhosis had the highest relative risk of liver neoplasm (HR 85.25; 95% CI 76.84-94.58), whereas those with cholangitis had the highest risk of biliary tract neoplasm (HR 70.30; 95% CI 51.95-95.12) compared with control subjects without any clinical risk factors. Conclusion: This population-based study confirms the association of diabetes with liver neoplasm and suggests that diabetic patients with certain clinical risk factors should be educated for strict adherence of liver neoplasm screening. Copyright © 2010 by the American Association for the Study of Liver Diseases. Source

Kuo H.-C.,Tzu Chi University | Liao C.-H.,Fu Jen Catholic University | Chung S.-D.,Far Eastern Memorial Hospital
European Urology | Year: 2010

Background: Intravesical injection of botulinum toxin type A (BoNTA) provides effective treatment for detrusor overactivity and overactive bladder (OAB). However, the high rates of treatment-related adverse events (AEs) prevent its more widespread use. Objective: To investigate the risk factors of increasing AEs after BoNTA injection for idiopathic detrusor overactivity (IDO). Design, setting, and participants: This study included a total of 217 patients receiving their first intravesical BoNTA injection for refractory IDO in a tertiary university hospital from 2004 to 2009. Measurements: AE incidence was analyzed according to gender, age, comorbidities, prostate condition in men, OAB subtype, BoNTA dose, injection site, and baseline urodynamic parameters. Successful outcome was determined based on patient perception of improvement of bladder condition at 3 mo. Results and limitations: Successful outcomes were reported by 144 (66.3%) patients. By multivariable analysis, male gender (p = 0.013) and baseline postvoid residual (PVR) ≥100 ml (p = 0.003) were independent predictors of acute urinary retention (AUR). Baseline PVR ≥100 ml (p = 0.007) and receiving >100 U BoNTA (p = 0.029) were predictors of straining to void. The incidence of large PVR after treatment was associated with comorbidity (p = 0.011). Urinary tract infection occurred more frequently in women (p = 0.003) and in men with retaining prostate (p = 0.008). No AUR developed after bladder base/trigonal injection. Nevertheless, the occurrence of AUR or large PVR did not affect therapeutic outcome. This study is limited by nonconsecutive enrollment of patients. Conclusions: Male gender, baseline PVR ≥100 ml, comorbidity, and BoNTA dose >100 U are risk factors for increasing incidence of AEs after intravesical BoNTA injection for IDO. © 2010 European Association of Urology. Source

Chen H.F.,Far Eastern Memorial Hospital
The Tohoku journal of experimental medicine | Year: 2012

Diabetes has been reported to increase the risk of colorectal neoplasm in most but not all studies. However, the data on age- and sex-specific incidence rates and relative risks associated with diabetes are limited. We carried out this population-based cohort study to investigate the overall sex- and age-specific risks of colorectal cancer in association with diabetes. Diabetic patients (n = 615,532) and age- and sex-matched control individuals (n = 614,871), selected from the claim datasets, were followed up from 2000 to 2006. The rates of admission due to colon and rectum cancers were estimated using the person-years approach, and the age- and sex-specific hazard ratio (HR) for both the malignancies were determined using the Cox regression model. The overall incidence rate of colon cancer was 9.94 per 10,000 patient-years for the diabetic patients, as opposed to 7.84 per 10,000 patient-years for the control-group patients. The corresponding observation for rectal cancer was 7.16 and 6.28 per 10,000 patient-years. Diabetic patients aged ≥ 45 years had significantly high HRs for developing colon cancer (1.20-1.45-fold). We also noted a significantly high HR of rectal cancer in diabetic men (1.18-fold) aged ≥ 45 years, but not in diabetic women. In conclusion, diabetes may significantly increase the risk of colorectal cancer, especially in patients aged 45-64 years. Diabetologists should keep this relationship in mind while treating middle-aged diabetic men and should also advise these patients to undergo regular screening tests for colorectal cancer. Source

Chung S.-D.,Far Eastern Memorial Hospital | Kuo H.-C.,Tzu Chi University
Pain Physician | Year: 2012

Background: Bladder pain associated with interstitial cystitis and painful bladder syndrome (IC/PBS) is frequently excruciating and intractable. The use of onabotulinumtoxinA (BoNT-A) for relief of this type of bladder pain has not been well described. Objectives: To evaluate the efficacy and safety of intravesical BoNT-A injection for treatment of IC/PBS refractory to conventional treatment. Study Design: Prospective, non-randomized study. Setting: A tertiary medical center in Taiwan. Methods: Sixty-seven patients with characteristic IC/PBS were enrolled. Intravesical injection of 100U of BoNT-A immediately followed by cystoscopic hydrodistention under intravenous general anesthesia. Changes of the urodynamic parameters, O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), visual analog score (VAS) for pain, functional bladder capacity, and global response assessment (GRA) were evaluated at baseline and 6 months after BoNT-A injection. Adverse events that occurred after this procedure were also assessed. Results: Significant improvement was shown after intravesical injection of 100 U of BoNT-A. Baseline and 6 months after injection scores were: ICSI and ICPI (23.6 ± 5.9 versus 15.2 ± 8.5, P = 0.000), VAS (5.3 ± 2.2 versus 3.3 ± 2.4, P = 0.000), functional bladder capacity (136 ± 77.6 versus 180 ± 78.2, P = 0.000) and GRA (0.3 ± 0.8 versus 1.4 ± 1.0, P = 0.000). Limitations: This study lacks a placebo control group so the placebo effect cannot be eliminated. This study also does not provide information about the efficacy of this treatment after 6 months. Conclusion: Intravesical onabotulinumtoxinA injection appears to be a safe and effective therapeutic option for analgesia and increased bladder capacity for patients with IC/PBS. Institutional Review: This study was approved by the Institutional Review Board of the Buddhist Tzu-chi General Hospital. Source

Su L.-H.,Far Eastern Memorial Hospital | Chen T.H.-H.,National Taiwan University
British Journal of Dermatology | Year: 2010

Background Several previous studies have investigated the association between factors related to metabolic syndrome, which is known to increase the risk of type 2 diabetes mellitus and cardiovascular disease, and androgenetic alopecia (AGA). However, the results of these studies have been inconsistent. Objectives To determine if there is an association between metabolic syndrome and AGA after adjustment for potential confounders. Methods A population-based cross-sectional survey was conducted in Tainan, Taiwan. A total of 740 subjects aged 40-91 years participated in the survey between April and June 2005. The Norwood classification was used to assess the degree of hair loss. Information on components of metabolic syndrome together with other possible risk factors was collected. Results A statistically significant association was found between AGA and the presence of metabolic syndrome [odds ratio (OR) 1·67, 95% confidence interval (CI) 1·01-2·74] as well as between AGA and the number of fulfilled metabolic syndrome components (OR 1·21, 95% CI 1·03-1·42) after controlling for age, family history of AGA and smoking status. Among metabolic syndrome components, high-density lipoprotein cholesterol (HDL-C) (OR 2·36, 95% CI 1·41-3·95; P = 0·001) was revealed as the most important factor associated with AGA. Conclusions Our population-based study found a significant association between AGA and metabolic syndrome; among the components of metabolic syndrome, HDL-C was found to be of particular importance. This finding may have significant implications for the identification of metabolic syndrome in patients with moderate or severe AGA. Early intervention for metabolic syndrome is critical to reduce the risk and complications of cardiovascular disease and type 2 diabetes mellitus later in life. © 2010 British Association of Dermatologists. Source

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