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Chia-Lin Chou,1,2 Tzu-Ju Chen,1,3– 5 Wan-Shan Li,1,3,5 Sung-Wei Lee,6 Ching-Chieh Yang,7,8 Yu-Feng Tian,2 Cheng-Yi Lin,9 Hong-Lin He,10 Hung-Chang Wu,8,11 Yow-Ling Shiue,5,12 Chien-Feng Li,12– 14 Yu-Hsuan Kuo5,8,11,12 1Department of Medical Technology, Chung Hwa University of Medical Technology, Tainan, 717, Taiwan; 2Division of Colon and Rectal Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, 710, Taiwan; 3Department of Pathology, Chi Mei Medical Center, Tainan, 710, Taiwan; 4Department of Clinical Pathology, Chi Mei Medical Center, Tainan, 710, Taiwan; 5Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, 804, Taiwan; 6Department of Radiation Oncology, Chi Mei Medical Center, Liouying, 736, Taiwan; 7Department of Radiation Oncology, Chi Mei Medical Center, Tainan, 710, Taiwan; 8College of Pharmacy and Science, Chia Nan University, Tainan, Taiwan; 9Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, 710, Taiwan; 10Department of Pathology, E-DA Hospital & E-DA Cancer Hospital, I-Shou University, Kaohsiung, 82445, Taiwan; 11Division of Hematology and Oncology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan; 12Institute of Precision Medicine, National Sun Yat-Sen University, Kaohsiung, 804, Taiwan; 13Department of Medical Research, Chi Mei Medical Center, Tainan, 710, Taiwan; 14National Institute of Cancer Research, National Health Research Institutes, Miaoli County, 35053, TaiwanCorrespondence: Yu-Hsuan Kuo; Chien-Feng Li, No. 901, Zhonghua Road Yongkang Dist, Tainan City, Taiwan, Tel +886-6-2812811, Fax +886-6-2510218 ; Fax +886-6-2510218, Email beethovan@gmail.com; angelo.p@yahoo.com.twPurpose: For locally advanced rectal cancer, neoadjuvant concurrent chemoradiotherapy (CCRT) allows tumor downstaging and makes curative radical proctectomy possible. However, we lack a genetic biomarker to predict cancer prognosis or treatment response. W

Chia-Lin Chou,1,2 Tzu-Ju Chen,2– 4 Cheng-Yi Lin,5 Sung-Wei Lee,6 Shih-Chang Wang,7 Shou-Sheng Chu,7 Ching-Chieh Yang7,8 1Division of Colon and Rectal Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; 2Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; 3Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan; 4Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan; 5Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 6Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan; 7Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan; 8Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, TaiwanCorrespondence: Ching-Chieh YangDepartment of Radiation Oncology, Chi-Mei Medical Center, No. 901 Zhonghua Road, Yung Kang District, Tainan City 701, TaiwanTel +88662812811-53501Email cleanclear0905@gmail.comBackground: In a data mining search for potential therapeutic targets to improve the outcome of rectal cancer, we identified PCSK1 as the cell–cell signaling gene most significantly associated with poor response to concurrent chemoradiotherapy (CCRT). This study aims to investigate the prognostic value of PCSK1 expression in rectal cancer patients who underwent neoadjuvant CCRT.Methods: Endoscopic biopsy specimens from 172 rectal cancer patients receiving neoadjuvant CCRT followed by curative surgery were assessed immunohistochemically for PCSK1 expression, and H-scores were determined. Expression levels of PCSK1 were further analyzed for correlations with clinicopathologic features, tumor regression grade, metastasis-free survival, disease-specific survival, and recurrence-free survival.Results: PCKS1 overexpression was significantly associated with pretreatment tumor status (T3– 4; p = 0.009), pretreatment nodal status (N1

Vincent Yi-Fong Su,1–3 Han-Fang Liao,4 Diahn-Warng Perng,3,5 Yueh-Ching Chou,4,6,7 Chia-Chen Hsu,6 Chia-Lin Chou,4,6 Yuh-Lih Chang,4,6 Jiin-Cherng Yen,4 Tzeng-Ji Chen,3,8,9 Ting-Chun Chou4,6 1Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan; 2Institute of Clinical Medicine, 3Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 4Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; 5Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 6Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan; 7School of Pharmacy, Taipei Medical University, Taipei, Taiwan; 8Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 9Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan Objective: The effect of antacid therapy for patients with COPD and gastroesophageal reflux disease (GERD) remains unclear.Patients and methods: This nationwide population-based study was conducted using data from Taiwan’s National Health Insurance Research Database, and enrolled COPD patients with or without GERD. Patients with COPD who were not prescribed COPD medications were excluded. Patients with GERD who underwent upper gastrointestinal endoscopy or 24-hour pH monitoring and received at least 1 antacid were enrolled as symptomatic GERD group. The primary endpoint was acute exacerbation and mortality.Results: This study included 3,485 patients with COPD and symptomatic GERD, and 13,938 patients with COPD alone and covered 12,806.57 and 56,809.78 person-years, respectively, from 2000 to 2011. After multivariate adjustment, symptomatic GERD was associated with acute exacerbation (adjusted hazard ratio [HR]: 1.35, 95% CI: 1.23–1.48, p<0.0001) and mortality (HR: 1.42, 95% CI: 1.25–1.61, p<0.0001). In the COPD with symptomat

Li-Jung Lai,1 Chia-Lin Chou,2 H Irene Su,3 Tzeng-Ji Chen,1,4 Li-Fang Chou,5 Yueh-Ching Chou,2,6,7 Shinn-Jang Hwang,1,8 Hann-Chin Yu9,10 1Department of Family Medicine, 2Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan; 3Department of Reproductive Medicine, University of California, San Diego, CA, USA; 4Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, 5Department of Public Finance, National Chengchi University, 6Department and Institute of Pharmacology, National Yang-Ming University, 7College of Pharmacy, Taipei Medical University, 8Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 9Taipei Veterans General Hospital Hsinchu Branch, Hsinchu County, Taiwan; 10Department of Healthcare Management, Yuanpei University, Hsinchu, Taiwan Background: A shortage of gynecologists exists in many countries. Even within an affluent country, gynecological clinics might not be evenly distributed. The purpose of the study was to investigate the disparity in gynecological care between adult women living in towns with and without gynecologists in Taiwan.Methods: Data sources were the cohort datasets of the National Health Insurance Research Database, with claims data of 1 million beneficiaries in 2010. A woman’s residency was operationally inferred from the locations where she had most frequently visited physicians’ clinics or local community hospitals within the year.Results: In Taiwan, 145 (39.4%) of 368 towns had no practicing gynecologist. Of 382,167 women with health care use in the datasets, 21,794 (5.7%) lived in towns without a gynecologist. The overwhelming majority of these towns lay in sparsely populated, rural areas. During the year, 132,702 women (34.7%) had sought medical help for gynecological diseases and 113,698 (29.8%) had visited gynecologists for gynecological diseases. Women in towns without a gynecologist were less likel

Gynecological care is vital to women's health but utilization of gynecological care has been seldom addressed. We applied the population-based "ecology model" to demonstrate the utilization of gynecological care of women, with examples from Taiwan. We analyzed the claims data from the cohort datasets within the National Health Insurance Research Database in Taiwan. Women's utilization of gynecological care in 2009 was computed. Of 1000 women, 319 utilized gynecological care at least once, 277 visited Western medicine clinics, 193 visited physician clinics, 118 visited hospital-based outpatient clinics, 73 visited traditional Chinese medicine clinics, eight were hospitalized, four were hospitalized in an academic medical center, and four visited emergency departments. More than 90% of young and middle-aged women who sought gynecological care visited gynecologist clinics. Elderly women were less likely to utilize gynecological care in all settings of medical care, but were more likely to be attended by non-gynecologists. Young women tended to visit emergency departments. The ecology model highlighted age disparities in women's utilization of gynecological care in various settings of medical care. Since gynecological conditions were common among women, more attention should be paid on the availability of gynecologists and continuing medical education in gynecological care for non-gynecologists to guarantee women's health.

Gynecological care is vital to women's health but utilization of gynecological care has been seldom addressed. We applied the population-based "ecology model" to demonstrate the utilization of gynecological care of women, with examples from Taiwan. We analyzed the claims data from the cohort datasets within the National Health Insurance Research Database in Taiwan. Women's utilization of gynecological care in 2009 was computed. Of 1000 women, 319 utilized gynecological care at least once, 277 visited Western medicine clinics, 193 visited physician clinics, 118 visited hospital-based outpatient clinics, 73 visited traditional Chinese medicine clinics, eight were hospitalized, four were hospitalized in an academic medical center, and four visited emergency departments. More than 90% of young and middle-aged women who sought gynecological care visited gynecologist clinics. Elderly women were less likely to utilize gynecological care in all settings of medical care, but were more likely to be attended by non-gynecologists. Young women tended to visit emergency departments. The ecology model highlighted age disparities in women's utilization of gynecological care in various settings of medical care. Since gynecological conditions were common among women, more attention should be paid on the availability of gynecologists and continuing medical education in gynecological care for non-gynecologists to guarantee women's health.

Bih-Ru Wang,1,2,* Yuh-Lih Chang,1,2,* Tzeng-Ji Chen,3,4 Jen-Hwey Chiu,5,6 Jing Chong Wu,7 Min-Shan Wu,1 Chia-Lin Chou,1 Yueh-Ching Chou1,2,81Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan; 2Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; 3Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 4Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan; 5Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; 6Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 7Traditional Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 8College of Pharmacy, Taipei Medical University, Taipei, Taiwan*These authors contributed equally to this workBackground: Many female breast cancer (FBC) patients take Chinese herbal medicine (CHM) and Western medication (WM) concurrently in Taiwan. Despite the possibility of interactions between the CHM and WM mentioned in previous studies, the pattern of these coprescriptions in FBC patients remains unclear. Hence, the aim of the present study is to investigate the utilization of coprescriptions of CHM and WM among the FBC patients in Taiwan.Methods: The study was a cross-sectional survey using the sampled cohort in 2009 obtained from the National Health Insurance Research Database in Taiwan. There were 3,507 FBC patients identified from the registry for catastrophic illness patients. Ambulatory visit records, corresponding prescriptions, and the data of beneficiaries belonging to the FBC patients were further extracted. A total of 1,086 FBC patients used CHM at least once. CHM and WM prescribed within any overlapping duration were defined as coprescriptions.Results: There were 868 (80.0%) patients simultaneously receiving CHM and WM. A total of 4,927 CHM prescriptions and 6,358 WM prescriptions we