Risk and Outcome of Stroke in Patients with Liver Cirrhosis: Two Nationwide Studies

( Yi-chun Chou ),( Chien-chang Liao ),( Chun-chuan Shih ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: The association between liver cirrhosis (LC) and stroke was not completely understood. The purpose of this study is to evaluate stroke risk and post-stroke outcomes in patients with LC. Methods: Using the Taiwan National Health Insurance Research Database, we identified 6944 adults aged ≥20 years diagnosed with LC in 2000-2005. Non-LC cohort consisted of 27776 adults randomly selected and matched by age and sex (case-control ratio=1:4). Incident events of stroke occurring after LC from January 1, 2000, through the end of 2009 were identified in the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke associated with LC were calculated. We conducted another nested cohort study consisted of 21267 patients with hospitalization due to stroke between January 1, 2004, and December 31, 2010. We calculated the adjusted odds ratios (ORs) and 95% CIs of 30-day mortality after stroke in patients with and without LC during admission. Results: The incidences of stroke for people with and without LC were 7.5 and 4.9 per1000 person-years, respectively (P<0.0001). Compared to people without LC, patients with LC had increased risk of stroke (HR 1.75, 95% CI 1.52-2.01). The association was significant in both sexes. In the nested cohort study, LC was associated with post-hemorrhage mortality (OR 1.83, 95% CI 1.63-2.05) and epilepsy (OR 1.30, 95% CI 1.09-1.56). Conclusions: Patients with LC showed higher risks of stroke and post-stroke mortality. Our findings suggest the urgency of preventing and managing LC by a multidisciplinary medical team for this specific population.

A Genetic Analysis of Taoyuan Pig and Its Phylogenetic Relationship to Eurasian Pig Breeds

Kuan-Yi Li,Kuang-Ti Li,Chun-Chun Cheng,Chia-Hsuan Chen,Chien-Yi Hung,Yu-Ten Ju 아세아·태평양축산학회 2015 Animal Bioscience Vol.28 No.4

Taoyuan pig is a native Taiwan breed. According to the historical record, the breed was first introduced to Taiwan from Guangdong province, Southern China, around 1877. The breed played an important role in Taiwan’s early swine industry. It was classified as an indigenous breed in 1986. After 1987, a conserved population of Taoyuan pig was collected and reared in isolation. In this study, mitochondrial DNA sequences and 18 microsatellite markers were used to investigate maternal lineage and genetic diversity within the Taoyuan pig population. Population differentiation among Taoyuan, Asian type, and European type pig breeds was also evaluated using differentiation indices. Only one D-loop haplotype of the Taoyuan pig was found. It clustered with Lower Changjiang River Basin and Central China Type pig breeds. Based on the polymorphism of microsatellite markers, a positive fixation index value (FIS) indicates that the conserved Taoyuan population suffers from inbreeding. In addition, high FST values (>0.2105) were obtained, revealing high differentiation among these breeds. Non-metric multi-dimensional scaling showed a clear geometric structure among 7 breeds. Together these results indicate that maternally Taoyuan pig originated in the Lower Changjiang River Basin and Central China; however, since being introduced to Taiwan differentiation has occurred. In addition, Taoyuan pig has lost genetic diversity in both its mitochondrial and nuclear genomes.

A Genetic Analysis of Taoyuan Pig and Its Phylogenetic Relationship to Eurasian Pig Breeds

Li, Kuan-Yi,Li, Kuang-Ti,Cheng, Chun-Chun,Chen, Chia-Hsuan,Hung, Chien-Yi,Ju, Yu-Ten Asian Australasian Association of Animal Productio 2015 Animal Bioscience Vol.28 No.4

Taoyuan pig is a native Taiwan breed. According to the historical record, the breed was first introduced to Taiwan from Guangdong province, Southern China, around 1877. The breed played an important role in Taiwan's early swine industry. It was classified as an indigenous breed in 1986. After 1987, a conserved population of Taoyuan pig was collected and reared in isolation. In this study, mitochondrial DNA sequences and 18 microsatellite markers were used to investigate maternal lineage and genetic diversity within the Taoyuan pig population. Population differentiation among Taoyuan, Asian type, and European type pig breeds was also evaluated using differentiation indices. Only one D-loop haplotype of the Taoyuan pig was found. It clustered with Lower Changjiang River Basin and Central China Type pig breeds. Based on the polymorphism of microsatellite markers, a positive fixation index value ($F_{IS}$) indicates that the conserved Taoyuan population suffers from inbreeding. In addition, high $F_{ST}$ values (>0.2105) were obtained, revealing high differentiation among these breeds. Non-metric multi-dimensional scaling showed a clear geometric structure among 7 breeds. Together these results indicate that maternally Taoyuan pig originated in the Lower Changjiang River Basin and Central China; however, since being introduced to Taiwan differentiation has occurred. In addition, Taoyuan pig has lost genetic diversity in both its mitochondrial and nuclear genomes.

Outcomes after Admission of Liver Disease in Patients with Influenza Vaccination: A Nationwide Study

( Yi-chun Chou ),( Chien-chang Liao ),( Ta-liang Chen ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: The influences of influenza vaccination (IV) on outcomes of admission of liver disease are unclear. The purpose of this study is to investigate IV’s effects on pneumonia and mortality after liver disease in geriatric patients. Methods: Using Taiwan’s National Health Insurance Research Database reimbursement claims data from 2008 to 2013, we conducted a retrospective cohort study of 21385 patients aged more than 66 years who admitted to hospitalization due to liver disease (included viral hepatitis, cancer, necrosis of liver, and chronic liver disease) and 21035 had IV before the admission within one year. Multivariate logistic regressions were used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of post-admission pneumonia and in-hospital mortality associated with IV. Results: Patients receiving IV showed less pneumonia after liver disease (OR 0.51, 95% CI 0.35-0.75). But there was no significant association between IV and in-hospital mortality (OR 0.85, 95% CI 0.46-1.56) compared with unvaccinated patients. Conclusions: Vaccinated geriatric patients showed lower risks of pneumonia compared with unvaccinated patients undergoing similar admission of liver disease. Further studies are needed to explain how IV improves the outcomes of liver disease.

Poster Session : PS 1007 ; GI Motility : Gastrointestinal Hemorrhage and Post-Hemorrhage Mortality in Patients with ITP: Two Cohort Studies

( Yi Chun Chou ),( Chien Chang Lia ),( Ta Liang Chen ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The relationship between immune thrombocytopenia (ITP) and gastrointestinal hemorrhage is not determined. This study evaluated the risk of gastrointestinalhemorrhage and post-hemorrhage mortality in patients with ITP. Methods: Using the Taiwan National Health Insurance Research Database, we identifi ed 1033 adults aged =18 years diagnosed with ITP in 2000-2003. Non-ITP cohort consisted of 10330 adults were randomly selected and matched by age and sex from the same dataset. Events of gastrointestinal hemorrhage in 2000-2008 were ascertained from medical claims. Adjusted hazard ratios (HR) and 95% confi dence interval (CI) of gastrointestinal hemorrhage associated with ITP was calculated. Another nested cohort study consisted of 27369 patients with hospitalization due to gastrointestinal hemorrhage between 2004 and 2010. We calculated the adjusted odds ratios (ORs) and 95% CIs of 30-day mortality after gastrointestinal hemorrhage in patients with and without ITP during admission. Results: During 78,073 person-years of follow-up, the incidences of gastrointestinal hemorrhage for people with and without ITP were 14.5 and 5.07 per 1000 person- years, respectively (p<0.0001). Compared to people without ITP, patients with ITP had increased risk of gastrointestinal hemorrhage (HR 2.61, 95% CI 2.05-3.32). In the nested cohort study, ITP was associated with post-hemorrhage mortality (OR 1.98, 95% CI 1.09-3.59). Conclusions: Our two nationwide retrospective cohort studies investigated the increased gastrointestinal hemorrhage and post-hemorrhage mortality in patients with ITP.

Diabetes risk in patients with chronic obstructive pulmonary disease: a retrospective cohort study

( Yi-chun Chou ),( Ta-liang Chen ),( Chien-chang Liao ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: The relationship between chronic obstructive pulmonary disease (COPD) and diabetes remains incompletely understood. This study evaluated the risk of diabetes in COPD patients with and without exacerbations. Methods: We identified 4671 adults newly diagnosed with COPD exacerbations and 9342 adults newly diagnosed with COPD without exacerbations during 2000-2008 using Taiwan’s National Health Insurance Research Database. A comparison cohort of 18684 adults without COPD, matched by age and sex, was randomly selected from the same dataset for the control group. Diabetes events during 2000-2013 were ascertained from medical claims during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes associated with COPD with or without exacerbations were calculated. Results: During the follow-up period, the incidences of diabetes for patients without COPD and for patients with COPD without or with exacerbations were 3.4, 4.1 and 7.4 per 1000 person-years, respectively (P < 0.0001). Increased risk of diabetes for patients with COPD without exacerbations (HR 1.09, 95% CI 1.02-1.17) and COPD with exacerbations (HR 2.18, 95% CI 1.88-2.52) was noted. The associaiton between COPD and diabetes risk was significant in various subgroups. Conclusion: Prevention and intervention strategies for diabetes risk is needed for this susceptible population.

Implementation of the Land Surface Processes into a Vector Vorticity Equation Model (VVM) to Study its Impact on Afternoon Thunderstorms over Complex Topography in Taiwan

Chien-Ming Wu,Hsiao-Chun Lin,Fang-Yi Cheng,Mu-Hua Chien 한국기상학회 2019 Asia-Pacific Journal of Atmospheric Sciences Vol.55 No.4

In this study, we aim to evaluate the impact of fast land-atmosphere interactions on the afternoon thunderstorm in Taiwan through high-resolution meteorological simulations. For this purpose, the Noah land surface model (LSM) is implemented into the vector vorticity equation cloud-resolving model (VVM) with corresponding realistic land surface data of Taiwan into the coupling system, called TaiwanVVM. Two idealized experiments are conducted by giving the same surface forcing but one with direct land-atmosphere coupling from Noah LSM (called Coupled experiment) and the other with prescribed surface fluxes (called Prescribed experiment). Our results show that the fast land-atmosphere interaction over complex topography has a significant influence on rainfall intensity, especially in the heavy precipitating region where the interaction is strong.Without direct coupling between the land surface and the atmosphere in the Prescribed experiment, the diurnal intensity is suppressed by 50%over whole Taiwan and 70% for East Taiwan. Our findings demonstrate that the intensity of the afternoon thunderstorm is sensitive to fast land-atmosphere interactions by modifying local circulation in the mountainous region of Taiwan.

Protective Effects of Influenza Vaccination on the Admission Outcomes of Liver Cancer: A Nationwide Matched Study

( Yi-chun Chou ),( Ta-liang Chen ),( Chien-chang Liao ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Limited information is available on the association between influenza vaccination (IV) and cancer outcomes. The purpose of this study is to evaluate the effects of IV on the out comes of liver cancer. Methods: Using reimbursement claims data of National Health Insurance in Taiwan in 2008-2013, we conducted a matched cohort study including 32330 patients aged ≥20 years underwent inpatient care of liver cancer and 5841 of them received IV within previous one year. Using propensity score matching procedure, we selected 5621 patients with IV and 5621 patients without IV for comparison. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) of IV associated with complications and in-hospital mortality during admission of liver cancer. Results: Patients with liver cancer receiving IV showed less pneumonia (P<0.0001), septicemia (P<0.0001), urinary tract infection (P<0.0001), and in-hospital mortality (P<0.0001) compared with unvaccinated patients with liver cancer. IV was associated with decreased risk of in-hospital mortality during the cancer admission (OR, 0.60; 95% CI, 0.47-0.76) after adjustment. Vaccinated patients with liver cancer also had shorter length of hospital stay (P<0.0001) and lower medical expenditure (P<0.0001) than non-vaccinated patients. Conclusions: Among patients with admission of liver cancer, vaccinated patients showed lower risks of complications and in-hospital mortality compared with unvaccinated patients. Further studies are needed to explain how IV improves outcomes of liver cancer.

Enhancing Training Program Completion Rates for 2-Year Registered Nursing Staff in Haematology-Oncology Wards through Innovative Evidence-Based Nursing

Yi-Chun Lin,Pei-Chi Hsieh,Pei-Chien Lu 한국간호과학회 2015 한국간호과학회 학술대회 Vol.2015 No.10

Predictors of Positive Bone Metastasis in Newly Diagnosed Prostate Cancer Patients

Chien, Tsu-Ming,Lu, Yen-Man,Geng, Jiun-Hung,Huang, Tsung-Yi,Ke, Hung-Lung,Huang, Chun-Nung,Li, Ching-Chia,Chou, Yii-Her,Wu, Wen-Jeng,Huang, Shu-Pin Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.3

Background: The prevalence of prostate cancer (PCa) has been increasing in recent years. Treatment strategies are largely based on the results of bone scan screening. Therefore, our aim was to investigate predictors of positive bone metastasis in newly diagnosed PCa patients. Materials and Methods: After extensive review, 336 consecutive patients newly diagnosed with PCa between April 2010 and November 2013 at our institution were enlisted in the study. Patients were divided into two groups according to bone scan results. Univariate analyses (Chi-square test for discrete variables and independent t-test for continuous variables) were applied to determine the potentially significant risk factors associated with distant bone metastasis. Binary logistic regression analyses were used to further investigate the influence of these factors on bone metastasis. Results: The patient mean age was $71.9{\pm}8.6years$ (range: 48 to 94 years). The mean prostate specific antigen (PSA) level and biopsy Gleason score were $260.2{\pm}1107.8ng/mL$ and $7.4{\pm}1.5$, respectively. The body mass index (BMI) for the series was $24.5{\pm}3.4kg/m^2$. Sixty-four patients (19.0%) had a positive bone scan result. Patients with positive bone scan results had a significantly lower BMI ($23.3{\pm}3.5$ vs. $24.8{\pm}3.3$; p=0.003), a higher Gleason score ($8.5{\pm}1.1$ vs. $7.1{\pm}1.5$; p < 0.001), and a higher PSA level ($1071.3{\pm}2337.1$ vs. $69.4{\pm}235.5$; p < 0.001) than those without bone metastasis. Multivariate logistic regression analysis employing the above independent predictors demonstrated that a Gleason score of ${\geq}7$, clinical stage ${\geq}T3$, $BMI{\leq}22kg/m^2$, and an initial PSA level of ${\geq}20ng/mL$ were all independent predictors of bone metastasis. Conclusions: A bone scan might be necessary in newly diagnosed PCa patients with any of the following criteria: clinical stage T3 or higher, a Gleason score of 7 or higher, BMI equal to or less than 22, and a PSA level of 20 or higher.