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// Huan-Cheng Chang 1, 2 , Chuan-Fa Hsieh 3, 4 , Disline Manli Tantoh 5 , Pei-Chieh Ko 5 , Ya-Yu Kung 6 , Mei-Chi Lin 6 , Yi-Ching Liaw 7 and Yung-Po Liaw 5, 8 1 Division of Family Medicine, Department of Community Medicine, Landseed Hospital, Taoyuan, Taiwan 2 Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan 3 Department of Medical Education and Research, Landseed Hospital, Taoyuan, Taiwan 4 Center for General Education, Hsin Sheng College of Medical Care and Management, Taoyuan, Taiwan 5 Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan 6 Division of Health Management, Landseed Hospital, Taoyuan, Taiwan 7 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan 8 Department of Family and Community Medicine, Chung Shan Medical University, Taichung, Taiwan Correspondence to: Yung-Po Liaw, email: Liawyp@csmu.edu.tw Keywords: HDL; menopause; sex; factors; Taiwan Received: January 10, 2018 Accepted: February 27, 2018 Published: March 27, 2018 ABSTRACT Aim: To investigate factors, especially modifiable factors associated with high-density lipoprotein (HDL) in Taiwanese based on sex and menopausal status. Materials and Methods: Participants comprised 2022 men and 2392 women (1267 menopausal and 1125 non-menopausal) aged ≥30 years who resided in Pingzhen district, Taoyuan from 2006-2011. Their data, obtained through questionnaires and measurements were retrieved from the Li-Shin Hospital. Results: Higher HDL was associated with total cholesterol, underweight, and alcohol drinking in both men and women. It was also associated with education, blood group B, and marital status in men as well as with age in women. Moreover, it was associated with total cholesterol, underweight, and age in both menopausal and non-menopausal women. Furthermore, it was associated with marital status in non-menopausal women and alcohol drinking in menopausal women. Lower HDL was associated with triglycerides, low-density lipoprotein (LDL), overweight, obesity, waist-hip ratio (WHR), uric acid, and smoking in both men and women and with coffee drinking in only women. It was also associated with uric acid, triglycerides, LDL, overweight, obesity, WHR, and body fat in both menopausal and non-menopausal women. Moreover, it was associated with coffee drinking in menopausal women. Conclusion: Modifiable factors associated with HDL differ according to sex and menopausal status. Sex and menopausal status should be considered when implementing lifestyle changes to raise HDL. For example, both men and women should maintain a normal weight as well as quit smoking.

Background and aims Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and Results Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR Conclusions After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.

The health impact of osteoporosis on individuals and the population at large is huge and its effect on national economies is negative. The aim of this study was to investigate the association between coffee consumption and osteopenia/osteoporosis in premenopausal and postmenopausal women in Taiwan. Data of 2929 women who completed a questionnaire about their weekly coffee consumption and bone health were retrieved from the Li-Shin Hospital (2006-2011). Coffee consumption was classified into 0, 1-4 and 5-7 cups per week (1 cup was equivalent to 400 mL). Osteoporosis and osteopenia were defined using bone mineral densities measured by quantitative ultrasound (QUS). Multiple logistic regression was used to determine the association between coffee drinking and osteopenia/osteoporosis. After exclusions were made, a total of 2533 participants were included in the final analysis. Adjusted confounders included age, hepatitis B surface antigen (HBsAg), anti-Hepatitis C virus (HCV), waist-hip ratio (WHR), body mass index (BMI), smoking, alcohol, tea, exercise, vegetarian diet, supplements, yogurt, education, and blood type. There were 1336 premenopausal and 1593 postmenopausal women at baseline. Among the premenopausal women, an increase in the weekly coffee consumption significantly decreased the odds for osteoporosis (P-trend = 0.0179). The consumption of 1-4 and 5-7 cups of coffee per week significantly reduced the risk of osteoporosis/osteopenia (OR = 0.677; 95% C.I. = 0.469-0.978) and (OR = 0.607; 95% C.I. = 0.400-0.923), respectively. Among postmenopausal women, however, there was no significant relationship between weekly coffee consumption and osteoporosis/osteopenia. It was concluded that coffee drinking might likely minimize the risk of osteoporosis/osteopenia in premenopausal Taiwanese women.

Chinese herbal medicines (CHMs) containing aristolochic acid (AA) are associated with chronic kidney disease (CKD), but some prescribed CHMs have been shown to possess renoprotective effects. We conducted a nationwide retrospective cohort study to delineate the role of prescribed CHMs on the CKD progression. Renoprotective CHM (RPCHM) was defined if a CHM contained dong chong xia cao (Cordyceps sinensis (Berk.) Sacc.), da huang (Rheum palmatum L), huang qi (Astragalus membranaceus), dan shen (Salvia miltiorrhiza Bge.), and dong quai (Angelica sinensis (Oliv.) Diels) or belonged to specific mixture herbal formulations (Yishen capsule, Saireito, or Wen Pi Tang). Subjects who had ever used AA-containing CHMs, had cancer or HIV prior to CKD diagnosis, or died within the first month of CKD diagnosis were excluded. A total of 11,625 patients were eligible subjects. The adjusted hazard ratio (aHR) for all-cause mortality was 0.6 (p < 0.001) and 0.6 (p = 0.013) among subjects receiving RPCHMs containing Angelica sinensis and those receiving other RPCHMs, respectively. For CKD-related mortality, the aHR among subjects receiving RPCHMs containing Angelica sinensis was 0.6 (p = 0.025). The use of specific RPCHMs, especially those that contained Angelica sinensis, was associated with a lower risk of mortality among CKD patients.

Purpose We have previously shown in patients receiving adaptive support ventilation (ASV) that there existed a Transition %MinVol (TMV%) where the patient's work of breathing began to reduce. In this study, we tested the hypothesis that higher TMV% would be associated with poorer outcome in patients with acute respiratory failure. Materials and methods In this prospective observational study, we recruited patients with acute respiratory failure on ASV between December 2012 and September 2013 in a mixed ICU. The TMV% was determined by adjusting % MinVol until mandatory respiratory frequency was between 0 and 1 breath/min. TMV% was measured on the first two days of mechanical ventilation. Results A total of 337 patients (age: 70 ± 16 years) were recruited. In patients whose TMV% increased between Day 1 and Day 2, aOR for mortality was 7.0 (95%CI = 2.7–18.3, p

Taiwan has the highest incidence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. Chinese herbal medicine (CHM) has been linked to CKD/ESRD in Taiwan. The specific effects and frequency of CHM on the risk of CKD are unknown.A hospital-based case-control study was performed from August 2006 through December 2009. The cases were consecutive nephrology outpatients 20years of age or older, with a first-time diagnosis of CKD, and without cancer or pre-existing renal disease. The controls were randomly selected outpatients that did not have CKD and were matched 1:1 to cases for age, gender and date of outpatient visit.Four hundred and twenty-four patients were recruited. Among 212 cases, 23.6% took non-prescribed CHM, compared to 6.6% among the controls (p0.001). Multivariate analysis showed that illiteracy [odds ratio (OR) 6.3, 95% confidence interval (CI) 2.4-16.6], hypertension (OR 5.4, 95% CI 2.9-9.8) and occasional use of non-prescribed CHM (OR 6.2, 95% CI 1.8-21.6) were positively associated with CKD, whereas regular exercise was inversely associated with CKD (OR 0.5, 95% CI 0.3-0.9).Occasional use of non-prescribed CHM was associated with the risk of CKD in Taiwan.

Chen M-M, Chang H-C, Hsieh C-F, Yen M-F, Chen TH. Predictive model for congenital muscular torticollis: analysis of 1021 infants with sonography. Objective To construct a predictive model to foretell congenital muscular torticollis (CMT) on the basis of clinical correlates. Design Correlation study. Setting Regional hospital. Participants A consecutive series of 1021 newborn infants. Interventions Not applicable. Main Outcome Measure Participants underwent portable ultrasonography to diagnose CMT. Significant clinical correlates were identified to construct a predictive model using the logistic regression model. Results Forty of 1021 infants were diagnosed with CMT using ultrasonography, yielding an overall incidence of 3.92%. Birth body length (odds ratio [OR]=1.38; 95% confidence interval [CI], 1.49–2.38), facial asymmetry (OR=21.75; 95% CI, 6.6–71.7), plagiocephaly (OR=22.3; 95% CI, 7.01–70.95), perineal trauma during delivery (OR=4.26; 95% CI, 1.25–14.52), and primiparity (OR=6.32; 95% CI, 2.34–17.04) were significant correlates. A predictive logistic regression model with the incorporation of these 4 correlates was developed. We used cross-validation with a receiver operating characteristic curve to validate the predictive model. Conclusions Our study successfully developed a quantitative predictive model for estimating the risk of CMT on the basis of clinical correlates only. This model has good discriminative ability for classifying CMT and non-CMT by yielding acceptable values of false-negative and false-positive cases.

Background Discharge disposition planning is vital for poststroke patients. We investigated clinical factors associated with discharging patients to nursing homes, using the Taiwan Stroke Registry data collected from 39 major hospitals. Methods We randomly assigned 21,575 stroke inpatients registered from 2006 to 2008 into derivation and validation groups at a 3-to-1 ratio. We used the derivation group to develop a prediction model by measuring cumulative risk scores associated with potential predictors: age, sex, hypertension, diabetes mellitus, heart diseases, stroke history, snoring, main caregivers, stroke types, and National Institutes of Health Stroke Scale (NIHSS). Probability of nursing home care and odds ratio (OR) of nursing home care relative to home care by cumulative risk scores were measured for the prediction. The area under the receiver operating characteristic curve (AUROC) was used to assess the model discrimination against the validation group. Results Except for hypertension, all remaining potential predictors were significant independent predictors associated with stroke patient disposition to nursing home care after discharge from hospitals. The risk sharply increased with age and NIHSS. Patients with a cumulative risk score of 15 or more had an OR of 86.4 for the nursing home disposition. The AUROC plots showed similar areas under curves for the derivation group (.86, 95% confidence interval [CI], .85-.87) and for the validation group (.84, 95% CI, .83-.86). Conclusions The cumulative risk score is an easy-to-estimate tool for preparing stroke patients and their family for disposition on discharge.

Objectives To evaluate the relationship between the use of non-aristolochic acid (AA) prescribed Chinese herbal medicines (CHMs) and the risk of mortality in patients with chronic kidney disease (CKD). Design Nationwide population-based follow-up study. Setting Longitudinal health insurance database sampled from the Taiwan National Health Insurance Research Database. Participants A total of 47 876 patients with CKD were identified. Participants who had ever used AA-containing CHMs, had cancer or HIV prior to the diagnosis of CKD, died within the first month of CKD diagnosis and who were not Taiwanese citizens were excluded. A total of 13 864 participants were eligible for final analysis. Primary and secondary outcome measures All-cause mortality among patients with CKD between 2000 and 2008. Results After controlling for potential confounders, we found that participants who started to receive non-AA prescribed CHMs after the diagnosis of CKD had a lower risk of mortality as compared with non-users of non-AA prescribed CHMs (adjusted HR (aHR) 0.6; 95% CI 0.4 to 0.7, p

Background and Purpose: Intracerebral hemorrhage (ICH) is associated with substantial morbidity and mortality. This study aimed to explore the risk factors associated with mortality and unfavorable outcome of ICH in Taiwan and to compare the predictive power with the existing ICH scores. Methods: Medical records of the ICH patients consecutively admitted to a regional hospital between January 2003 and December 2006 were reviewed retrospectively. The demographics, outcome, clinical and radiological characteristics were also analyzed. Results: A total of 61 among 285 (21.4%) ICH patients died during hospitalization. Diabetes mellitus, lower scores of initial Glasgow Coma Scale, initial ICH volume >30 ml, and intraventricular hematoma were identified as major independent risk factors associated with in-hospital mortality in the logistic regression model. In comparison to the predictive power for mortality and unfavorable outcome, Barthel Index Conclusions: Although these ICH scores developed with various measurements, no significant difference in predicting mortality and unfavorable functional outcomes was found. The results supporting the ICH score by Hemphill may provide a good prediction in acute outcome across ethnic groups.