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Kao C.-H.,China Medical University at Taichung | Sun L.-M.,Zuoying Armed Forces General Hospital | Chen P.-C.,National Taiwan University | Lin M.-C.,E DA Hospital | And 4 more authors.
Annals of Oncology

Background: The purpose of the study was to explore the possible association between the use of insulin sensitizers (thiazolidinediones, TZDs) and the risk of cancer in Taiwanese diabetic patients. Patients and Methods: From the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 22 910 diabetic patients newly diagnosed from 2001 to 2009 and 91 636 non-diabetic comparisons frequency matched with age, sex, and calendar year, excluding those with cancer at the baseline. Among the diabetics, 4159 patients were treated with TZDs and the rest of 18 752 patients were on other anti-diabetic medications (non-TZDs). Results: In comparison to the non-diabetes group, the non-TZDs group had an increased risk of developing cancer [the adjusted hazard ratio (HR): 1.20 and 95% confidence interval (CI) = 1.11-1.30]. The TZDs group had a HR of 1.18 (95% CI = 0.98-1.42). Analysis of site-specific cancer risks showed that both TZDs and non-TZDs groups with elevated risks of colorectal and pancreatic cancer. However, the non-TZDs group had an increased risk of liver cancer when comparing with TZD and non-diabetes groups. Conclusion: This study suggests that patients with diabetes are at an elevated risk of cancer (especially in colorectal and pancreatic cancers), and the use of TZDs might decrease the liver cancer risk in diabetic patients. Further investigation using large samples and rigorous methodology is warranted. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

Yang C.-S.,Yuan Ze University | Wei C.-P.,National Taiwan University | Yuan C.-C.,Zuoying Armed Forces General Hospital | Schoung J.-Y.,Saint Marys Hospital
Decision Support Systems

A burn injury is a disastrous trauma and can have wide-ranging impacts on burn patients, their families, and society. Burn patients generally experience long hospital stays, and the accurate prediction of the length of those stays has strong implications for healthcare resource management and service delivery. In addition to prediction accuracy, the timing of length of hospital stay (LOS) predictions is also relevant, because LOS predictions during earlier clinical stages (e.g., admission) can provide an important component for service and resource planning as well as patient and family counseling, whereas LOS predictions at later clinical stages (e.g., post-treatment) can support resource utilization reviews and cost controls. This study evaluates the effectiveness of LOS predictions for burn patients during three different clinical stages: admission, acute, and post-treatment. In addition, we compare the prediction effectiveness of two artificial intelligence (AI)-based prediction techniques (i.e., model-tree-based regression and support vector machine regression), using linear regression analysis as our performance benchmark. On the basis of 1080 burn cases collected in Taiwan, the empirical evaluation suggests that the accuracy of LOS predictions at the acute stage does not improve compared with those during the admission stage, but LOS predictions at the post-treatment stage are significantly more accurate. Moreover, the AI-based prediction techniques, especially support vector machine regression, appear more effective than the regression technique for LOS predictions for burn patients across stages. © 2010 Elsevier B.V. All rights reserved. Source

Tseng W.-S.,Zuoying Armed Forces General Hospital | Tseng W.-S.,National Defense Medical Center | Tzeng N.-S.,National Defense Medical Center | Tzeng N.-S.,Counseling Center
International Psychogeriatrics

The occurrence of mania in the geriatric population is rare. Furthermore, there were only six case reports of elderly patients with secondary mania resulting from treatment with cholinesterase inhibitors. In all cases, patients had a prior psychiatric history. We report the case of an elderly patient with no prior history of psychiatric or other organic disorders who experienced first episode mania following treatment with rivastigmine. We discuss the possible mechanism of mania in this patient. © 2012 Copyright International Psychogeriatric Association. Source

Chen A.,National Sun Yat - sen University | Tsao M.-J.,Zuoying Armed Forces General Hospital | Chuang J.-F.,National Sun Yat - sen University | Lin C.-H.,National Sun Yat - sen University
Electrochimica Acta

Verapamil is commonly used for the treatments of supraventricular arrhythmias, angina and hypertension. The chemical structure and properties of Verapamil are stable and show no significant electrochemical activity without treating Verapamil with strong chemicals or high-energy radio-waves. This research develops a simple and effective method to oxidize Verapamil into electrochemical active derivatives with a novel ozone pre-treatment process. The oxidation reaction of Verapamil is investigated and confirmed with the UV-vis spectrometry and mass-spectrometry analyses. In order to further quantitatively evaluate the concentration of Verapamil, the oxidized Verapamil products are then detected using an electrochemical microchip with a gold nanoelectrode ensemble electrode (GNEE) as the working electrode. Enhanced by the excellent electrochemical catalytic properties of the GNEE working electrode, a significant redox peak is observed in the cyclic voltammetry test for the ozone treated Verapamil. Compared to the conventional analytical method of the UV absorption approach, the method developed greatly improves the sensitivity for detecting Verapamil without using complex pre-treatment process. The limit of detection for analyzing Verapamil with the method developed is 1.0 ng/mL, which is 125-fold lower than the reported serum concentration of 125.0 ng/mL. The experimental measured linear dynamic range is from 1.0 ng/mL to 100.0 μg/mL with a correlation factor of 0.99. The development method provides a rapid and efficient way to quantitatively analyze Verapamil for clinical applications. © 2012 Elsevier Ltd. All Rights Reserved. Source

Huang E.-Y.,Chang Gung University | Sun L.-M.,Zuoying Armed Forces General Hospital | Lin H.,Chang Gung University | Lan J.-H.,Chang Gung University | And 4 more authors.
International Journal of Radiation Oncology Biology Physics

Purpose: To compare the treatment results of 2 fractionation schedules for high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer. Methods and Materials: From June 2001 through January 2008, 267 patients with stage IB-IVA cervical cancer were enrolled in the study. All patients underwent 4-field pelvic irradiation and HDR-ICBT. The median central and parametrial doses were 39.6 Gy and 45 Gy, respectively. Patient underwent either 6 Gy × 4 (HDR-4) (n=144) or 4.5 Gy × 6 (HDR-6) (n=123) to point A of ICBT using 192Ir isotope twice weekly. The rates of overall survival, locoregional failure, distant metastasis, proctitis, cystitis, and enterocolitis were compared between HDR-4 and HDR-6. Results: There were no significant differences in the demographic data between HDR-4 and HDR-6 except for total treatment time. The 5-year proctitis rates were 23.0% and 21.5% in HDR-4 and HDR-6 (P=.399), respectively. The corresponding rates of grade 2-4 proctitis were 18.7% and 9.6% (P=.060). The corresponding rates of grades 3-4 proctitis were 5.2% and 1.3% (P=.231). Subgroup analysis revealed that HDR-4 significantly increased grade 2-4 proctitis in patients aged ≥62 years old (P=.012) but not in patients aged <62 years (P=.976). The rates of overall survival, locoregional failure, distant metastasis, cystitis, and enterocolitis were not significantly different between HDR-4 and HDR-6 schedules. Conclusion: The small fraction size of HDR-ICBT is associated with grade 2 proctitis without compromise of prognosis in elderly patients. This schedule is suggested for patients who tolerate an additional 2 applications of HDR-ICBT. © 2013 Elsevier Inc. Source

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