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Background The prevalence rate of reflux esophagitis (RE) in Asia, including Taiwan, has increased dramatically in recent years. However, few studies have discussed on its relationship with metabolic syndrome (MetS). This study aimed to evaluate the correlation between RE and MetS and its components. Methods We conducted a cross-sectional study during 2013 to 2014 in Taiwan. A total of 4895 subjects who completed upper gastrointestinal endoscopy at the Health Examination Center of Changhua Christian Hospital were enrolled. RE was defined according to the upper gastrointestinal endoscopic findings and MetS was defined according to the Taiwanese criteria. Univariate and multivariate logistic regression analyses were applied to calculate odds ratios and 95% confidence intervals for each variable to assess the associated features for RE. We analyzed the relationship between the number of MetS components and the severity of RE using the chi-square test for trend. Results The prevalence rates of MetS and RE were respectively 28.5 and 59.6%. According to univariate logistic regression analysis, MetS was significantly associated with RE and remained a positive association in multivariate logistic regression analysis (adjusted ORß = 1.251; 95% CI = 1.071–1.462; p = 0.005). Furthermore, among the five MetS components, elevated blood pressure (adjusted ORγ = 1.163; 95% CI = 1.023–1.323; p = 0.021), abdominal obesity (adjusted ORγ = 1.173; 95% CI = 1.020–1.349; p = 0.026) and hyperglycemia (adjusted ORγ = 1.306; 95% CI = 1.142–1.495; p

This study was undertaken to assess the effect of blood glucose on BMD and interactions with age, sex, and BMI in a Taiwanese population. Both obese and non-obese people with type 2 diabetes (T2DM) had higher BMD, at lumbar spine and femoral neck, compared with healthy subjects. In addition, the prevalence of osteoporosis significantly decreased with blood sugar and HbA1c. This study was undertaken to assess the effect of blood glucose on BMD and possible interactions with age, sex, and BMI in a Taiwanese population. This study was a retrospective cross-sectional study using data from the Health Examination Database of Changhua Christian Hospital. Data on BMD of the lumbar spine and femoral neck were obtained by dual X-ray absorptiometry (DXA), and other relevant clinical and laboratory data were recorded. The type 2 diabetes (T2DM) group had a higher BMD than the controls. When comparing the prevalence of osteoporosis between subjects by glucose and HbA1c level, the prevalence of osteoporosis significantly decreased with blood glucose and HbA1c. In addition, the BMD of the lumbar spine and femoral neck was higher in the T2DM group than in the controls. Osteoporosis was negatively associated with DM, BMI, and drinking, but positively associated with age, female gender, previous fracture history, and other diseases of the musculoskeletal system and connective tissue. The association between diabetes and osteoporosis remained statistically significant after adjusting for the above factors. T2DM was associated with lower odds of osteoporosis in both obese (OR = 0.77) and non-obese (OR = 0.63) (p for interaction = 0.555). Both obese and non-obese people with T2DM had higher BMD, at lumbar spine and femoral neck, compared with healthy subjects. In addition, the prevalence of osteoporosis significantly decreased with blood glucose and HbA1c.

Hypercalcaemia and leucocytosis are common in our patients with progressive oral squamous cell carcinoma (SCC). However, the precise incidence, prognostic value, and correlation with the condition of the tumour remain obscure. A total of 618 patients with oral SCC who were treated primarily between 2007 and 2012 and had serum calcium concentrations and white blood cell count (WCC) measured postoperatively were included in the study. Primary TNM stage, pathological features, and the presence of locoregional recurrence or distant metastasis after comprehensive surgical treatment were recorded. The incidence of hypercalcaemia was 9.1% and that of leucocytosis 7.2%. Hypercalcaemia correlated significantly with size of primary tumour (T status), nodal involvement (N status), TNM stage, perineural invasion, lymphovascular permeation, and recurrence or metastasis of disease. Leucocytosis, however, correlated only with T status, lymphovascular permeation, and recurrence or metastasis. In multivariate analysis of survival, recurrence, metastasis, hypercalcaemia, and leucocytosis were strong independent prognostic factors. Median survival was low if the patient had hypercalcaemia or leucocytosis (179 (range 3–73) days if the patient had distant metastasis, and 43 (range 3–102) days if the patient had locoregional recurrence). The incidence of hypercalcaemia and leucocytosis was high during the course of the disease, and both conditions have an adverse impact on survival from oral SCC. Periodic evaluation of serum calcium concentrations and WCC should be routine during the postoperative period.

Objective The purpose of our study was to determine the association of type 1 diabetes mellitus (T1DM) and the risk of herpes zoster (HZ). Methods In this cohort study, we selected 4736 patients with T1DM registered in the Catastrophic Illness Patient Database who received insulin therapy before 2003 and 18944 participants without DM who were selected by frequency matched based on sex and age. Cox proportional hazard regression analysis was used to measure the hazard ratios (HRs) of HZ in the T1DM group compared with that in the non-T1DM group. Results Cox proportional hazard regression analysis showed that the adjusted HR of HZ was 2.38 times higher for patients in the T1DM group (95% CI = 1.77–3.19) than for those in the non-T1DM group. According to diabetes severity, mild and serious T1DM patients were associated with a higher risk of HZ (adjusted HR = 2.26, 95% CI = 1.67–3.05; and adjusted HR = 5.08, 95% CI = 2.66–9.71, respectively) than subjects without T1DM. Conclusion Patients with T1DM are at a higher risk of HZ than those without T1DM.

Traumatic intracranial hemorrhage (ICH) is prevalent worldwide with long-term consequences, including disabilities. However, studies on the association of traumatic ICH with coronary artery disease (CAD) are scant. Therefore, this study explored the aforementioned association in a large-scale, population-based cohort. A total of 128,997 patients with newly diagnosed traumatic ICH and 257,994 age- and sex-matched patients without traumatic ICH from 2000 to 2010 were identified from Taiwan's National Health Insurance Research Database. The Kaplan–Meier method was used for measuring the cumulative incidence of CAD in each cohort. Cox proportional regression models were used for evaluating the risk of CAD in patients with and without traumatic ICH and for comparing the risk between the 2 cohorts. The Kaplan–Meier analysis revealed that the cumulative incidence curves of CAD were significantly higher in patients with traumatic ICH than in those without ICH (log-rank test, P

Patients with end-stage head and neck cancer suffer from many physical and psychological symptoms, however, there have been relatively few studies looking at end-of-life symptoms in the head and neck cancer population. The objective of this study was to describe the symptom patterns of patients with terminal head and neck cancer in the palliative care unit.A retrospective chart review of 94 patients with terminal head and neck cancer admitted to a palliative care unit between May 2006 and December 2008 was performed. Demographic data, performance status, primary tumor site, time from diagnosis to first hospice admission, survival time after admission, medication for pain control, and main symptoms at the time of admission were examined.The mean time from diagnosis to first hospice admission was 33.1 ± 51.6 months. The mean survival time in the hospice was 21.9 ± 18.9 days. In this study, the most common symptom experienced was weight loss, followed by pain, cough, dysphagia, feeding difficulties, and communication difficulties. A statistically significant association of communication difficulties was found with presence or absence of a tracheostomy (p 0.001). Change of morphine dosage after hospice care is related to the site location of head and neck cancer. Levels of education seem to be related to the increasing use of morphine (p = 0.025). Change of morphine dosage was statistically correlated with survival time after hospice admission (p 0.001)Numerous symptoms at the end of life highlight the complexity of head and neck cancer patients that may necessitate early hospice referral for symptom control.

The association between the hepatitis C virus (HCV) infection and the risk of myocardial infarction (MI) and stroke has been previously investigated. However, the association between the HCV infection and the risk of venous thromboembolism (VTE) has not been extensively discussed. Using the Longitudinal Health Insurance Database 2000 (LHID2000), we selected 3686 patients with newly diagnosed HCV infection. We randomly selected 14,744 people with no HCV or hepatitis B virus (HBV) infection as comparison group and frequency matched them with patients with HCV infection according to their age, sex, and index year. The incidence density rates and hazard ratios (HRs) of deep vein thrombosis (DVT) and pulmonary embolism (PE) were calculated until the end of 2011. The mean follow-up duration of 5.14 years for the HCV cohort and 5.61 years for the non-HCV cohort, the overall incidence density rates of DVT were 7.92 and 3.51 per 10,000 person-years in the non-HCV group, and the HCV groups, respectively (crude HR = 2.25; 95% confidence interval [CI] = 1.21–4.21). After adjusted for age, sex, and comorbidities, the risk of DVT remained significantly higher in the HCV group than in the non-HCV group (adjusted HR = 1.96; 95% CI = 1.03–3.73). The overall incidence density rates of PE in the HCV and non-HCV groups were not significantly different (crude HR = 2.20; 95% CI = 0.94–5.14). HCV infection is associated with the risk of DVT in a long-term follow-up period.

Objective Diabetes is a common diseases and a major problem worldwide. Diabetic osteopathy might be elevated in diabetic patients and is usually caused by bone fracture. Several diabetes medications, such as thiazolidinediones (TZDs), could lead to increased risks of fracture. Methods We used the nationwide database to identified 32466 patients who had developed type 2 diabetes from 2000 to 2010 as the diabetic cohort and, from that group, we selected 3427 diabetic patients who had developed bone fracture to survey the possible risk factors, includng commonly used diabetes medication. Results We found that TZDs might present increased risks for fracture in patients who used it for an extended period (7 to 730 days before the index date), especially in female patients younger than 64 years old, for whom the risk was elevated from a 1.74- to a 2.58-fold odds ratio. Conclusions We recommend that clinics follow up with non-osteoporotic female patients younger than 64 years old who are using TZDs, to avoid the associated risks of fracture.

Supplemental Digital Content is available in the text, The objective of this study was to examine the association of depression, psychotropic medications, and mental illness with cardiovascular disease in a nationwide community-dwelling elderly population in Taiwan. A total of 5664 participants who enrolled in the Healthy Aging Longitudinal Study in Taiwan (HALST) were included in the study. Multiple logistic regression was applied to investigate the association of depression, psychotropic medication use, and mental illness, separately, with cardiovascular disease. The results suggested that cardiovascular disease was significantly associated with various definitions of depression, including: the Center for Epidemiologic Studies-Depression scale (CES-D) ≥ 16, self-reported, and physician-diagnosed for depression (adjusted odds ratio [AOR] = 1.51; 95% confidence interval (CI): 1.14–2.00 for CES-D; AOR = 3.29; 95% CI: 1.99–5.42 for self-reported; and AOR = 2.45; 95% CI: 1.51–3.97 for physician-diagnosed). Additionally, significant associations of cardiovascular disease with the use of antipsychotics (AOR = 2.04; 95% CI: 1.25–3.34), benzodiazepines (BZDs) (AOR = 1.84; 95% CI: 1.52–2.21), and Z-drugs (AOR = 1.41; 95% CI: 1.03–1.93), respectively, were also observed, but not the use of antidepressants. In addition, a significant association of cardiovascular disease with mental illness was found in this study (AOR = 2.33; 95% CI: 1.68–3.24). In line with previous reports, these findings provided supportive evidence that depression and/or mental illness were significantly associated with cardiovascular disease in a community-dwelling elderly population in Taiwan. Moreover, significant associations of cardiovascular disease with the use of antipsychotics, BZDs, and Z-drugs, individually, were found. Further investigation would be of importance to clarify the causal relationship of depression and/or psychotropic medications with cardiovascular disease, especially among elderly populations.

We designed a population-based retrospective cohort study to investigate the association between the event of benzodiazepine (BZD) poisoning and the risk of acute pancreatitis. In the present study, 12,893 patients with BZD poisoning during 2000 to 2011 were enrolled and matched with 4 comparison patients according to mean age and sex. We determined the cumulative incidences and adjusted hazard ratios of acute pancreatitis. A significant association was observed between BZD poisoning and acute pancreatitis. After adjustment for potential risk factors, the patients with BZD poisoning had a 5.33-fold increased risk of acute pancreatitis compared with the controls without BZD poisoning (HR = 5.33, 95% CI = 2.26–12.60). The results revealed that acute pancreatitis in patients with BZD poisoning occurred in a follow-up time of ≤1 month (HR = 50.0, P 1 month (HR = 1.07, P > .05). This population-based study revealed the positive correlation between the event of BZD poisoning and an increased risk of acute pancreatitis. The findings warrant further large-scale and in-depth investigation.

The present study was performed to evaluate the 5-year status of immediately placed implants subjected to maxillary sinus elevation without grafting.Implants were placed in 2004 and 2005. A minimum of 3 mm of residual bone height (RBH) was required. All implants were placed with a sinus elevation performed through a lateral approach by the trap-door, open-window method without placement of any grafting material. Regular follow-up included oral hygiene instruction, periodontal charting, panoramic radiographs, and cone beam computed tomographic scans. The gained bone height (GBH) in the sinus, peri-implant sulcus depth, and marginal bone loss were analyzed statistically.Forty-four patients (26 men, 18 women) with an average age of 58 years received 80 implants, which were followed for 5 years after prosthesis delivery. No patients developed sinusitis or other complications leading to implant loss. The average RBH was 5.06 ± 1.51 mm and the average intrasinus implant length was 7.77 ± 1.69 mm. Survival rates for the implants were 100% after 2 and 5 years. Average GBH was 7.24 ± 1.83 mm at 2 years (range, 3 to 12 mm) and 7.44 ± 1.94 mm at 5 years (P.05). The average peri-implant sulcus depths were 2.5 ± 0.4 mm at 2 years and 3.1 ± 0.5 mm at 5 years (P.05). The mean peri-implant marginal bone loss was 1.3 ± 0.3 mm at 2 years and 2.1 ± 0.5 mm at 5 years (P.05).New bone formation in the sinus was confirmed, and good survival of implants with maxillary sinus elevation by the lateral approach without grafting was observed after 5 years. Attention should be focused on oral hygiene maintenance to ensure peri-implant gingival health.

Supplemental Digital Content is available in the text, The current population-based study investigated the onset of neonatal urinary tract infection (UTI) and the associated risks of allergic rhinitis. From 2000 to 2005, 3285 children with neonatal UTI and 13,128 randomly selected controls were enrolled from the National Health Insurance Research Database in Taiwan and frequency matched by gender, urbanization of residential area, parental occupation, and baseline year. We compared the risk of allergic rhinitis between the non-UTI and UTI cohorts by performing multivariable Cox regression analysis. We observed a significant relationship between UTI and allergic rhinitis. This study examined 16,413 patients, among whom 3285 had UTI and 13,128 did not have UTI. The overall incidence rate ratio of allergic rhinitis was 1.41-fold higher in the UTI cohort than in the non-UTI cohort (100.2 vs 70.93 per 1000 person-y). After potential risk factors were adjusted for, the adjusted hazard ratio of allergic rhinitis was 1.32 (95% confidence interval = 1.23–1.41). Regardless of gender, the UTI cohort had a higher risk of allergic rhinitis than that of the non-UTI cohort. The patients with UTI in different follow-up durations were equally susceptible to developing allergic rhinitis compared with those without UTI, especially in follow-up durations shorter than 5 years. Patients with UTI and particular comorbidities such as infections and neonatal jaundice had a significantly increased risk of allergic rhinitis. UTI in newborns is significantly associated with the development of allergic rhinitis in childhood and might be a risk factor for subsequent childhood allergic rhinitis.

Studies have suggested that statin use is related to cancer risk and prostate cancer mortality. We conducted a population-based cohort study to determine whether using statins in prostate cancer patients is associated with reduced all-cause mortality rates. Data were obtained from the Taiwan National Health Insurance Research Database. The study cohort comprised 5179 patients diagnosed with prostate cancer who used statins for at least 6 months between January 1, 1998 and December 31, 2010. To form a comparison group, each patient was randomly frequency-matched (according to age and index date) with a prostate cancer patient who did not use any type of statin-based drugs during the study period. The study endpoint was mortality. The hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox regression models. Among prostate cancer patients, statin use was associated with significantly decreased all-cause mortality (adjusted HR = 0.65; 95% CI = 0.60–0.71). This phenomenon was observed among various types of statin, age groups, and treatment methods. Analyzing the defined daily dose of statins indicated that both low- and high-dose groups exhibited significantly decreased death rates compared with nonusers, suggesting a dose–response relationship. The results of this population-based cohort study suggest that using statins reduces all-cause mortality among prostate cancer patients, and a dose–response relationship may exist.

Background To investigate the association between metabolic syndrome, including its factors, and gallstone disease (GSD) in a Taiwanese population. Methods We conducted a cross-sectional study during 2011 ~ 2012. A total of 12050 subjects who completed a questionnaire and underwent physical examination, laboratory tests and abdominal ultrasonography formed the study population. Results The prevalences of metabolic syndrome and gallstone disease were 24.09% and 6.16%. In an age- and sex-adjusted logistic regression model, metabolic syndrome was associated with gallstone disease (OR = 1.61; P