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Introduction Sleep disturbance is a prevalent problem among HIV-infected persons. The recognition of comorbid sleep disorders in patients with HIV is currently hampered by limited knowledge of sleep-related symptoms, sleep architecture, and types of sleep disorders. We aimed to compare the differences in sleep-related symptoms and polysomnography-based sleep disorders between HIV-infected persons and controls. Methods The study included 170 men with a Pittsburgh sleep quality index (PSQI) greater than 5, composed of 44 HIV-infected men and 126 male controls who were frequency-matched by sex, age (-/+ 3.0 years) and BMI (-/+ 3.0 kg/m2). For all participants an overnight sleep study using a Somte V1 monitor was conducted. Differences in sleep-related symptoms and sleep disorders between HIV-infected patients and controls were examined using t-tests or Chi-square tests. Results HIV-infected persons with sleep disturbances more often had psychological disturbances (72.7% vs. 40.5%, p Conclusion Psychological disturbances and SDB can be the possible explanations of sleep disturbances in HIV-infected persons, in which suspected RBD is notable. Further studies are warranted to examine underlying factors of suspected RBD among HIV-infected persons with sleep disturbances. Support This work was supported by the Ministry of Science and Technology, Executive Yuan of Taiwan [MOST 105-3011-E-006-002], and National Cheng Kung University Hospital [NCKUH-10702022]

A novel tree-based optical add/drop multiplexer (TOADM) that realises the flexible migration of embedding legacy passive optical networks (PONs) and point-to-point networks to next-generation PON 2 (NGPON2) is proposed. The TOADM comprises two four-port optical circulators (OCs), one three-port OC and two fibre Bragg gratings (FBGs). Such a passive component can be placed at any selected location along the trunk fibre of a tree-topology PON to multiplex/demultiplex optical wavelengths dynamically. Experimental results reveal that the insertion losses of the proposed device are smaller than those caused by a 1 × 2 optical splitter in downstream and upstream directions. Unlike the traditional OADM, the novel TOADM is developed to multiplex/demultiplex optical wavelengths for tree-topology networks instead of ring-topology networks. The wavelength routing function of the novel TOADM is more flexible than that of the commercial array waveguide grating or interleaver because the system manager can dynamically readjust the wavelength plan of a PON by modifying the FBG function of preinstalled TOADMs or embedding an extra TOADM in the proper location of the PON.

Background Patients with end stage renal disease have a high all-cause and cardiovascular mortality. Secondary hyperparathyroidism and vitamin D deficiency are considered part of the mechanism for the excess mortality observed. We aimed to evaluate the relationship between vitamin D use and all-cause mortality. Methods In this retrospective cohort study, we included all incident patients who started hemodialysis in Taiwan between 2001 and 2009. Patients were followed from landmark time, i.e., the 360th day from hemodialysis initiation, through the end of 2010 or death. We evaluated the association between activated vitamin D use or not before landmark time and all-cause mortality using conditional landmark analysis with Cox regression. We used group-based trajectory model to categorize high-dose versus average-dose users to evaluate dose-response relationships. Results During the median follow-up of 1019 days from landmark time, vitamin D users had a lower crude mortality rate than non-users (8.98 versus 12.93 per 100 person-years). Compared with non-users, vitamin D users was associated with a lower risk of death in multivariate Cox model (HR 0.91 [95% CI, 0.87–0.95]) and after propensity score matching (HR 0.94 [95% CI, 0.90–0.98]). High-dose vitamin D users had a lower risk of death than conventional-dose users, HR 0.75 [95% CI, 0.63–0.89]. The association of vitamin D treatment with reduced mortality did not alter when we re-defined landmark time as the 180th day or repeated analyses in patients who underwent hemodialysis in the hospital setting. Conclusions Our findings supported the survival benefits of activated vitamin D among incident hemodialysis patients. Electronic supplementary material The online version of this article (10.1186/s12882-018-1111-2) contains supplementary material, which is available to authorized users.

In this study, a 24-GHz horizontally-polarized $1\times 8$ patch antenna array was developed for automotive radar applications. The proposed antenna array offers the advantages of wide fan beam and high gain. The driven patch is loaded with parasitic mushroom-like elements (PMLEs). The PMLEs are 180° out of phase to their corresponding driven patch. The cancellation effect can be properly managed to slightly sacrifice the gain of the array in return for a wider beamwidth in the E- plane. The proposed design exhibits a wide beamwidth of 150° and a high gain of 11.1 dBi.

In this paper, a new control method for a interleaved voltage-doubler boost converter is proposed to extend the operating range of duty ratio. Firstly, the analysis of the current-sharing mechanism is presented. Then, the averaging method is adopted to construct an average-behavior circuit model. After that, the modulation signal for current-sharing is particularly designed by amp-second balance. Besides, the average state-space equation of the voltage-doubler can be obtained. The open-loop transfer function can be derived from the small-signal analysis, and the proportional-integral (PI-type) controller parameters can be selected by Bode plots. All the algorithms are implemented in a Field Programmable Gate Array (FPGA) chip. The simulation and experimental results validate the inductor current-sharing capability of the proposed method.

ObjectivesTo illuminate the association between interferon-based therapy (IBT) and the risk of rheumatoid arthritis (RA) in patients infected with hepatitis C virus (HCV).Design, setting, participants and interventionsThis retrospective cohort study used Taiwan’s Longitudinal Health Insurance Database 2005 that included 18 971 patients with HCV infection between 1 January 1997 and 31 December 2012. We identified 1966 patients with HCV infection who received IBT (treated cohort) and used 1:4 propensity score-matching to select 7864 counterpart controls who did not receive IBT (untreated cohort).Outcome measuresAll study participants were followed until the end of 2012 to calculate the incidence rate and risk of incident RA.ResultsDuring the study period, 305 RA events (3.1%) occurred. The incidence rate of RA was significantly lower in the treated cohort than the untreated cohort (4.0 compared with 5.5 per 1000 person-years, pConclusionsThis study demonstrates that IBT may reduce the risk of RA and contributes to growing evidence that HCV infection may lead to development of RA.

Background Synovitis, acne, palmoplantarpustulosis, hyperostosis and osteitis syndrome (SAPHO) is a rare syndrome that affects the skin, bones and joints.1 SAPHO syndrome shares a variety of features with the seronegative spondyloarthropathies (SpAs), such as psoriatic arthritis (PsA).1 While the extra-articular manifestations of PsA are well defined, the systemic involvements of SAPHO syndrome are only reported occasionally.2 Previous cases of accompanied pleural effusion3, 4 and organising pneumonia(5were reported. In clinical work, we observed that pulmonary lesions progressed when diseases aggravated. However, the relationship between pulmonary manifestations and diseases activity remains unclear. Objectives This study is to explore the pulmonary comorbidity with SAPHO syndrome. Methods Pulmonary HRCT images were reconstructed from whole-spine CT images in 67 SAPHO patientsHRCT images of 58 healthy controls were obtained and reviewed. Pneumonia and tuberculosis were excluded. We investigated the presence of different HRCT images findings with detailed examinations. Results In detailed HRCT evaluations, abnormalities were identified in 45 of all patients. We found stripe in 29 (43.3%) cases, patchy shadows in 22 (32.8%), ground-glass opacity in 11 (16.4%), pleural thickening in 9 (13.4%), solitary nodule in 6 (9%), bronchiectasis in 3 (4.5%), pulmonary bulla in 2 (3%), multiple nodules in 1 (1.5%), and interstitial change in 1 (1.5%). Compared with healthy controls, SAPHO patients have significantly higher rate of patchy shadows while significantly lower percentage of nodules (especially multiple nodules), although the overall rates of abnormal HRCT findings are similar. Conclusions Our study was the first to study HRCT pulmonary changes in SAPHO patients. SAPHO patients have significantly higher percentage of patchy shadows and significantly lower rate of pulmonary nodules than healthy controls. BASDAI and age are possible good predictors for abnormal HRCT pulmonary findings. References [1] Nguyen MT, Borchers A, Selmi C, et al. The SAPHO syndrome. Semin Arthritis Rheum2012;42(3):254–65. [2] Rozin AP, Hasin T, Toledano K, et al. Seronegative polyarthritis as severe systemic disease. Neth J Med2010;68(6):236–41. [3] Fernandez-Campillo J, Garcia-Pachon E. Pleural effusion associated with the SAPHO syndrome. Chest. 2001;120(5):1752. [4] Hasegawa S, Yabe H, Kaneko N, et al. Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) Syndrome with Significant Bilateral Pleural Effusions. Intern Med2017;56(20):2779–83. [5] Hameed F, Steer H. A case of bronchiolitis obliterans organising pneumonia associated with SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome. BMJ Case Rep2017;2017. Disclosure of Interest None declared

Objective The Advisory Committee on Immunization Practices in 2012 recommended the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults with high risk of pneumonia. However, its effectiveness in cancer survivors has not been investigated. Our aim was to investigate the effectiveness of PPSV23 in these patients. Design Population-based matched cohort study. Setting Claim data were obtained from 1 million people registered with the National Health Insurance Research Database in 1996, and followed to 2010. People aged ≥75 years are eligible for receiving PPSV23 vaccination in Taiwan since 2007. Participants Among the 30 249 patients with cancer, 6784 patients were 75 years or older eligible for PPSV23 vaccination. Among them, 1887 survived 5 or more years (ie, cancer survivors) after cancer diagnosis. We identified 377 cancer survivors who received PPSV23. A total of 754 propensity score matched unvaccinated patients were randomly selected. Intervention PPSV23 vaccination. Primary outcome measures The primary outcome was pneumonia hospitalisation. Potential confounders include influenza vaccination, vaccination period, cancer treatment modalities, comorbidities and sociodemographic variables. Results After 2 years of follow-up, vaccinated patients had a significantly lower incidence rate of pneumonia hospitalisation at 73.66 per 1000 person-years (PYs), compared with 117.82 per 1000 PYs for unvaccinated patients. Additionally, the prevalence for pneumonia hospitalisation frequency of >0–1,>1–2,>2–3 and >3 times per PY was all consistently lower in the vaccinated group (6.63% vs 9.28%, 1.86% vs 2.52%, 0.80% vs 1.59% and 0.27% vs 0.53%, respectively). After adjustment for covariates, PPSV23 vaccine was significantly associated with reduced pneumonia hospitalisation risk, with an adjusted incidence rate ratio of 0.695 (p=0.030). While the cumulative pneumonia incidence was also significantly lower in the vaccinated patients (p=0.027), the overall survival time was similar (p=0.136). Conclusions PPSV23 vaccination was associated with a significantly reduced rate of pneumonia hospitalisation in long-term cancer survivors.

A 25-Gbps underwater wireless optical communication (UWOC) system with a two-stage injection-locked 680-nm vertical-cavity surface-emitting laser (VCSEL) transmitter to enhance the frequency response and an afocal scheme to expand the collimated beam diameter over a 5-m highly turbid harbor water link is proposed and practically demonstrated. Given that the overall attenuation coefficient at 680 nm is smaller than that at 520 nm and 450 nm, a 680-nm redlight VCSEL transmitter is adopted in this proposed 5 m/25 Gbps UWOC system rather than a 450-nm blue-light laser diode (LD) transmitter or a 520-nm green-light LD transmitter. Satisfactory bit error rate performance (3×10−9) and clear eye diagram are acquired in real-time. This proposed UWOC system with a two-stage injection-locked 680 nm VCSEL transmitter and an afocal scheme brings important improvements in the scenario characterized by high turbidity.

AIMS To conduct a population-based study comparing age- and sex-specific risk estimates of heart failure (HF) between people with type 2 diabetes and people without diabetes, and to investigate the risks of HF in association with type 2 diabetes in people with various coronary heart diseases (CHDs). MATERIALS AND METHODS We used a nationally representative sample (one million people) selected from Taiwan's National Health Insurance (NHI) system. A total of 34 291 patients with type 2 diabetes were identified from ambulatory care claims in 2000, and the same number of age- and sex-matched controls were randomly selected from the registry of NHI beneficiaries in the same year. All study subjects were linked to inpatient claims (2000-2013) to identify the possible admissions for HF. Using a Cox proportional hazard regression model, we compared the relative hazards of HF in relation to type 2 diabetes according to various age and sex stratifications. We also compared the relative hazard of HF between type 2 diabetes and controls, with and without histories of various CHDs and coronary revascularization procedures. RESULTS Compared with absence of diabetes (control group), type 2 diabetes was significantly associated with an increased hazard of HF (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.40-1.54]. In both sexes, those with type 2 diabetes aged

Molecular markers are important in guiding treatment and predicting outcome in the genomic era. Meta-analysis of molecular markers in myelofibrosis through a search of PubMed and Medline through October 31, 2017 was performed. Markers with more than 3 studies that compared overall survival (OS) and leukemia-free survival (LFS) were analyzed. A total of 16 studies were included. Hazard ratios (HRs) for OS were as follows: IDH 2.65 (95% confidence interval [CI], 1.66-4.21), SRSF2 2.12 (95% CI, 1.18-3.79), high-risk myeloma 2.11 (95% CI, 1.70-2.61), ASXL1 1.92 (95% CI, 1.60-2.32), EZH2 1.88 (95% CI, 1.32-2.67), JAK2 1.41 (95% CI, 1.04-1.93) in the univariate analysis and 1.49 (95% CI, 0.42-5.30) in the multivariate analysis. LFS of JAK2 and SRSF2 had HRs of 1.81 (95% CI, 0.42-5.30) and 0.36 (95% CI, 0.02-6.48), respectively. In conclusion, mutations in IDH, SRSF2, and ASXL1 had worse prognosis in OS with HRs around 2. JAK2 and SRSF2 mutation were not associated with increased leukemia transformation. The adverse effect of triple-negative, which was often compared with CALR mutation, needs to be explored.

Limited access to or receipt of liver transplantation (LT) may jeopardize survival of patients with end-stage liver diseases. Taiwan launched its National Health Insurance (NHI) program in 1995, which essentially removes financial barriers to health care. This study aims to investigate where there are still demographic and urbanization disparities of LT after 15 years of NHI program implementation. Data analyzed in this study were retrieved from Taiwan’s NHI inpatient claims. A total of 3020 people aged ≥18 years received LT between 2000 and 2013. We calculated crude and adjusted prevalence rate of LT according to secular year, age, sex, and urbanization. The multiple Poisson regression model was further employed to assess the independent effects of demographics and urbanization on prevalence of LT. The biennial number of people receiving LT substantially increased from 56 in 2000–2001 to 880 in 2012–2013, representing a prevalence rate of 1.63 and 18.58 per 106, respectively. Such increasing secular trend was independent of sex. The prevalence was consistently higher in men than in women. The prevalence also increased with age in people

Table S1. The frequency in incident hemodialysis patients according to first-time prescription of activated vitamin D. Table S2. Events of death and crude mortality rates by status of vitamin D use on the landmark time in the entire cohort and subgroup of patients in hospital-based hemodialysis setting. Table S3. Cumulative and average dosage units of vitamin D use in each 120-day period of the first 360Â days of hemodialysis initiation. Appendix S1. Details of diagnostic codes to retrieve comorbidity information from baseline period. Appendix S2. Details of prescribed medication during baseline period. Appendix S3. Details of procedure codes of vascular access type. Appendix S4. Details of trajectory model for vitamin D dosage category. Figures S1 and S2. The distribution of propensity score across vitamin D users and non-users before and after propensity score matching (DOCX 86 kb)

A bidirectional fiber-FSO/wireless convergence is proposed and demonstrated. One optical sideband (y-polarization) is transmitted to effectively reduce fiber dispersion due to a span of 40-km SMF and distortion due to the beating among multiple sidebands.

A high-speed 24 Gb/s PAM4 optical-based underwater communication (OBUC) with afocal scheme for reducing/expanding collimated beam diameter is demonstrated. Such proposed OBUC link is better than existing OBUC given its practicability for high-speed underwater link.

A 84 Gb/s VSB-PAM8 VCSEL-based fiber-FSO convergence with injection locking scheme and linear equalizer is demonstrated. Such proposed VSB-PAM8 VCSEL-based fiber-FSO convergence is a notable option with good transmission performances for providing high transmission rate.

Literature about the risk of secondary cancer after radiation therapy (RT) of prostate and rectal cancer reveals contradictory results. We conducted a meta-analysis to examine whether the RT induces secondary rectal or prostate cancer in patients, respectively, with prostate or rectal cancer. All studies published in Medline or Pubmed up to March 3, 2015, containing RT of primary rectal or prostate cancer, and providing risk estimates of secondary prostate or rectal cancer were considered as eligible. Relative risk (RR) and standardized incidence ratios (SIR) were calculated using the random-effects model. Twenty studies met the inclusion criteria. 12 of them were from the Surveillance, Epidemiology, and End Results (SEER) database. For prostate cancer patients, pooled adjusted RRs or SIRs did not show an effect on the risk of secondary rectal cancer. However, notwithstanding the limitations of SEER-based studies, the subgroup of prostate cancer patients receiving external beam radiation therapy (EBRT) showed an increased risk of rectal cancer. For rectal cancer patients, pooled adjusted RR of prostate cancer was 1.12 (95 % CI, 0.44-2.8) and SIR was 0.40 (95 % CI, 0.29-0.55). All studies included in the SIR analysis of rectal cancer were derived from the SEER data source. Based on current evidence, RT for prostate cancer patients had no effect on rectal cancer incidence, except for patients who received EBRT therapy. However, compared with the general population, RT for rectal cancer is associated with a decreased prostate cancer risk as found in SEER-based studies.

Purpose Confounding by disease severity has been viewed as an intractable problem in claims-based studies. A novel 7-variable stroke severity index (SSI) was designed for estimating stroke severity by using claims data. This study compared the performance of mortality models with various proxy measures of stroke severity, including the SSI, in patients hospitalized for acute ischemic stroke (AIS). Methods Data from the Taiwan National Health Insurance Research Database (NHIRD) were analyzed. Three proxy measures of stroke severity were evaluated: Measure 1, the SSI; Measure 2, intensive care unit admission and length of stay; and Measure 3, surgical operation, mechanical ventilation, hemiplegia or hemiparesis, and residual neurological deficits. We performed logistic regression by including age, sex, vascular risk factors, Charlson comorbidity index, and one of the proxy measures as covariates to predict 30-day and 1-year mortality after AIS. Model discrimination was evaluated using the area under the receiver-operating characteristic curve (AUC). Results We identified 7551 adult patients with AIS. Models using the SSI (Measure 1) outperformed models using the other proxy measures in predicting 30-day mortality (AUC 0.892 vs 0.851, p

An innovative free-space optical (FSO) link using laser light propagation to achieve transmission rate of 40 Gb/s at a wavelength of 1550 nm is proposed and experimentally demonstrated. Over a 20-m free-space link, brilliant bit-error-rate performance and clear eye diagram are obtained in the proposed 1550-nm distributed feedback (DFB) laser diode (LD)-based FSO links. As far as we know, it is the first time that a 1550-nm externally modulated laser transmitter cascaded with an erbium-doped fiber amplifier and a pair of fiber collimators to successfully set up a 20-m/40-Gb/s FSO link has been employed. Compared with the 680-nm vertical-cavity surface-emitting laser-based FSO link, this proposed 1550-nm DFB LD-based FSO link is attractive not only because it has longer free-space transmission distance but because it supplies higher bandwidth operation as well. Such a 1550-nm DFB LD-based FSO link provides the benefits of optical wireless communications for longer transmission distance and higher transmission rate, which is thoroughly helpful for optical wireless network applications.

To compare risk of developing coronary artery disease (CAD) between diabetic patients receiving Traditional Chinese Medicine (TCM) therapy and those treated by Western medicine (WM).This prospective cohort study included 13,655 diabetic patients receiving solely TCM and 435,165 patients treated exclusively by WM. Study patients were identified from Taiwan's National Health Insurance (NHI) ambulatory claims in 2000-2001. These patients were then linked to the 2000-2008 NHI inpatient claims, searching for possible new onset of hospitalization for CAD. A Cox proportional hazard model and logistic regression model were used to assess the hazard ratio of CAD admission and odds ratio (OR) of higher rates of admission for CAD in relation to TCM.During 9 years of follow-up, 2607 diabetic patients with TCM were hospitalized for CAD, representing a cumulative incidence rate of 19.1% and an incidence density of 50.5 per 1000 person-years. The corresponding figures for patients treated by WM were 24.1% and 72.7 per 1000 person-years. Compared with the patients treated by WM, those treated by TCM were associated with a slightly reduced, but insignificantly, adjusted OR of CAD admission (0.96; 95% confidence interval, 0.92-1.01). Moreover, the adjusted OR for a higher rate (≥0.212 admission per person-year) of CAD admission for the patients with TCM was also insignificantly decreased at 0.97.After adjustment for prior co-morbidity score, risk or rate of CAD admission did not significantly differ between diabetic patients receiving TCM therapy and those treated by WM, suggesting that TCM is as efficacious as WM in preventing diabetes from being complicated with CAD.

A hybrid orthogonal frequency-division multiplexing (OFDM) and quadruple-frequency radio-over-fiber (RoF) transport system is developed based on colorless optical polarization beam splitters and an optical polarization-arrangement technique. No optical filter is required to eliminate any specific optical wavelength from the hybrid transport system; the employed optical wavelength and central carrier frequency of the transmitted radio-frequency signal can be dynamically adjusted without alerting the transmission performance of the proposed hybrid transport system. To prove the concept of the quadruple-frequency technique, a 40-GHz millimeter-wave (MMW) signal quadrupled from a 10-GHz signal is experimentally demonstrated in an optical domain. Its advancement is then employed to experimentally accomplish a hybrid OFDM and quadruple-frequency RoF signal transmission over a 25-km span of single-mode fiber. The advancement of the hybrid transport system is evaluated and demonstrated by error-free transmissions and clear eye and constellation diagrams. This proposed system is a great candidate for greatly reducing the cost of simultaneously transmitting OFDM and MMW signals over optical access networks and makes it more practical to be employed.

Summary Background/Introduction Some reports suggest early cholecystectomy for diabetic patients with asymptomatic gallstone disease (GSD) to prevent subsequent serious infection. However, only a few studies have examined the incidence of cholecystectomy in response to GSD in diabetic patients. Our study attempts to elucidate the relationship between GSD and diabetes using the high coverage rate health insurance system of Taiwan and thus evaluate the validity of early cholecystectomy in diabetic patients. Purpose(s)/Aim(s) To investigate the rate of cholecystectomy in diabetic patients with GSD. Methods Diabetic patients without prior treatment for GSD on hospitalization or ambulatory visits were identified and compared with age- and sex-matched controls and were followed up for 8 years. Cholecystectomy incidence density rates were estimated according to the patients' diabetic status. Cox proportional hazards regression models were used to analyze the age- and sex-specific effects of diabetes on the risk of surgery for GSD. Results The incidence rates of patients who developed GSD and underwent cholecystectomy were 18.65% and 17.15% in the diabetic and control groups, respectively; thus, the rate of cholecystectomy was higher in the diabetic group than in the control group. Male sex and old age were associated with a high rate of cholecystectomy, irrespective of the diabetic status. Hypertension, cholangitis, and Caroli disease were associated with an increased risk of cholecystectomy in patients with GSD. Overall, diabetic patients exhibited a higher incidence of cholecystectomy than nondiabetic patients did over an 8-year follow-up period. Conclusion Men with GSD are more likely to undergo cholecystectomy than women, irrespective of the diabetic status; therefore, an aggressive GSD management approach for men must be considered for early identification of these patients before the need for emergency surgery.

Background: The relationship between type 1 diabetes mellitus (T1DM) and cancer incidence remains unclear. We sought to assess the all-cause and site-specific cancer incidence in patients with T1DM. Methods: A retrospective cohort study design was employed, in which 14 619 patients with T1DM were retrieved from Taiwan’s National Health Insurance medical claims between 2000 and 2007. The study subjects were followed to the end of 2008, and cancer incidence was assessed. We calculated age-, sex-, and calendar year-standardized incidence ratios (SIRs) of all-cause cancer incidence and site-specific neoplasm incidence, with reference to the general population. Results: Seven hundred and sixty patients were identified for all-cause cancer over 86 610 person-years, representing an incidence rate of 87.75 cases per 10 000 person-years. The incidence rate was higher in males than in female patients (109.86 vs 69.75 cases per 10 000 person-years). T1DM was associated with a significantly increased SIR of all-cause cancer (1.13; 95% confidence interval [CI], 1.05–1.22). The sex-specific SIR was significantly elevated in female patients (1.19; 95% CI, 1.07–1.33), but the SIR for male patients was insignificantly elevated (1.09; 95% CI, 0.99–1.20). Pancreatic cancer showed the greatest increase in SIR among both male and female patients with T1DM. Male patients experienced significantly increased SIRs for kidney, rectum, liver, and colon neoplasm, and significantly increased SIRs were noted for ovarian, bladder, and colon cancer in female patients. Conclusions: T1DM was associated with a 13% increase in risk of all-cause cancer incidence. Patients with T1DM should be advised to undergo cancer screening for certain types of cancer.

Background: A significant minority of bereaved caregivers experience prolonged grief. However, few longitudinal studies have examined prolonged grief, especially in an Asian context. Aim: We explored longitudinal changes and factors predicting prolonged grief in bereaved caregivers of terminally ill Taiwanese cancer patients. Design: Observational, prospective, and longitudinal. Prolonged grief symptoms were measured with the PG-13 at 6, 13, 18, and 24 months postloss. Setting/participants: A convenience sample of 493 caregivers (83.3% participation rate) of terminally ill cancer patients was recruited from a medical center in Taiwan. Results: The prevalence of prolonged grief decreased significantly over time from the patient’s death (7.73%, 1.80%, 2.49%, and 1.85% at 6, 13, 18, and 24 months postloss, respectively, p Conclusion: Prolonged grief in bereavement diminished over time and was predicted by modifiable factors before, during, and after bereavement. To facilitate bereavement adjustment and avoid prolonged grief, healthcare professionals should develop and provide at-risk caregivers with effective interventions starting when patients are still alive to improve their dying experience, to facilitate preparedness for the patient’s forthcoming death, to alleviate caregivers’ preloss depressive symptoms, and to enhance their perceived postloss social support.

Background: The establishment of the National Health Insurance program in Taiwan in 1995 effectively removed the financial barrier to access health care services of Taiwanese people. This population-based cohort study aimed to determine the independent and joint effects of parental education and area urbanization on the mortality risk among children under the universal health insurance coverage in Taiwan since 1995. Methods: We linked 1,501,620 births from 1996 to 2000 to the Taiwan Death Registry to estimate the neonatal, infant, and under-five mortality rates, according to the levels of parental education and urbanization of residential areas. We used a logistic regression model that considers data clustering to estimate the independent and joint effects. Results: Lower levels of parental education and area urbanization exerted an independent effect of mortality on young children, with a stronger magnitude noted for areas with lower levels of urbanization. Children whose parents had lower levels of education and who were born in areas with lower levels of urbanization experienced the highest risk for neonatal (odds ratio (OR) = 1.60, 95% CI = 1.46–1.76), infant (OR = 1.58, 95% CI = 1.48–1.70), and under-five (OR = 1.71, 95% CI = 1.61–1.82) mortality. Conclusions: Even with universal health insurance coverage, lower levels of area urbanization and parental education still exerted independent and joint effects on mortality in young children. This finding implies the inadequate accessibility to health care resources for children from socially disadvantaged families and less urbanized areas.

Background/purpose To investigate the mobile phone (MP) use for talking in relation to health symptoms among 2042 children aged 11–15 years in Taiwan. Methods A nationwide, cross-sectional study, using the computer assisted telephone interview (CATI) technique, was conducted in 2009 to collect information on children's utilization of MPs and the perceived health symptoms reported by their parents. Results The overall prevalence of MP use in the past month was estimated at 63.2% [95% confidence interval (CI) = 61.1–65.3%]. MP use was associated with a significantly increased adjusted odds ratio (AOR) for headaches and migraine (1.42, 95% CI = 1.12–1.81) and skin itches (1.84, 95% CI = 1.47–2.29). Children who regularly used MPs were also considered to have a health status worse than it was 1 year ago (β = 0.27, 95% CI = 0.17–0.37). Conclusion Although the cross-sectional design precludes the causal inference for the observed association, our study tended to suggest a need for more cautious use of MPs in children, because children are expected to experience a longer lifetime exposure to radiofrequency electromagnetic fields (RF-EMF) from MPs.

This study aims to investigate whether patients with breast cancer and a history of cardiovascular diseases (CADs) are at an increased incidence of acute coronary syndrome (ACS) after receiving radiation therapy (RT). In Taiwan, 5828 patients who had a history of CAD were newly diagnosed of breast cancer and received mastectomy between 1999 and 2009. Among these patients, 1851 also received RT. The study cohort was prospectively followed to the end of 2010 for estimating the incidence of ACS in association with exposure to RT. A Cox proportional hazard model that was adjusted for covariates was used to estimate the hazard ratio (HR) of ACS. Over the study period, the incident rates of ACS for RT and control patients were estimated at 1.51 and 1.77 per 100 person-years, respectively. Covariate-adjusted regression analysis indicated that the hazard of ACS significantly increased in RT patients at an adjusted HR of 1.48 [95 % confidence interval (CI) 1.18–1.87]. Both hypertension and diabetes significantly increased the hazard of ACS in this patient cohort, with adjusted HRs of 3.31 (95 % CI 1.94–5.66) and 1.50 (95 % CI 1.19–1.89), respectively. This 12-year follow-up study suggested excess of ACS events in association with RT exposure in patients with breast cancer who had a higher cardiovascular risk. In consideration of the benefit associated with RT, intensive cardiac care should be given to patients with breast cancer and high cardiovascular risk.

Background/purpose Anesthesiologists in Taiwan had the heaviest workload compared with other Taiwanese specialists. In a previous study, anesthesia-related mortality was >12 times the rate reported in the USA, UK, and Japan. Nine percent of Taiwanese anesthesiologists left their jobs to work as general practitioners in clinics. This study aims to assess the current working conditions of anesthesiologists in Taiwan and their satisfaction with their occupation, and to identify the factors associated with the intentions of anesthesiologists in Taiwan to leave anesthesia practice. Methods A self-reported questionnaire was completed by 474 attending anesthesiologists in Taiwan. The Chi-square test was used for categorical variables and the t test for continuous variables. Multivariate logistic regression was conducted to identify the factors significantly associated with the willingness of anesthesiologists to continue in anesthesiology. Results The sample anesthesiologists worked 59.9 hours/week, however a reasonable length of time to work is 49.6 hours/week. They simultaneously covered four operating rooms daily, but three rooms is considered reasonable. Surprisingly, 54.9% of them expressed their unwillingness to practice clinical anesthesia. Those anesthesiologists dissatisfied with their overall working conditions had a substantially increased odds ratio (6.96) of deterring continuing to practice in anesthesia. Furthermore, an inability to take care of the family and a low salary significantly decreased the willingness to practice in anesthesia (odds ratio: 0.42 and 0.38, respectively). Conclusion Unfavorable working conditions were considered to lower the satisfaction of anesthesiologists in Taiwan. In particular, an inability to take care of the family and a low salary were major factors in deterring anesthesiologists in Taiwan from continuing in anesthesia.

Background Glucose intolerance in patients with amyotrophic lateral sclerosis (ALS) has been inconsistently reported. Evidence for the association of ALS and diabetes mellitus is limited. We aimed to assess the overall and age- and sex-specific risks of ALS among patients with diabetes in Taiwan. Methods The study cohort included 615 492 diabetic patients and 614 835 age- and sex-matched subjects as a comparison cohort, followed from 2000 to 2008. We estimated the incidence densities of ALS and calculated the relative hazard ratios (HRs) of ALS (ICD-9-CM 335.20) in relation to diabetes using a Cox proportional hazard regression model, with adjustment for potential confounders, including sex, age, geographic area, urbanization status, Charlson Comorbidity Index, frequency of medical visit, and histories of hypertension, hyperlipidemia, and chronic obstructive pulmonary disease. Results Over a 9-year period, 255 diabetic and 201 non-diabetic subjects developed ALS, corresponding to incidence densities of 7.42 and 5.06 per 100 000 person-years, respectively. After adjustment for potential confounders, patients with diabetes experienced a significantly elevated HR of 1.35 (95% confidence interval [CI], 1.10–1.67). A higher covariate adjusted HR was noted in men (HR 1.48; 95% CI, 1.13–1.94) than in women (HR 1.17; 95% CI, 0.84–1.64), while men aged ≤65 years showed the most increased HR of 1.67 (95% CI, 1.18–2.36). Conclusions This study demonstrated a moderate but significant association of diabetes with ALS onset, and such association is not confounded by socio-demographic characteristics or certain ALS-related co-morbidities. Further studies are warranted to examine whether the findings observed in our study can be replicated.

Background To determine the survival of patients with stroke for up to 10 years after a first-time stroke and to investigate whether stroke rehabilitation within the first 3 months reduced long-term mortality in these patients. Methods We used the medical claims data for a random sample of 1 million insured Taiwanese registered in the year 2000. A total of 7767 patients admitted for a first-time stroke between 2000 and 2005; 1285 (16.7%) received rehabilitation within the first 3 months after stroke admission. The other 83.3% of patients served as a comparison cohort. A Cox proportional hazards model was used to estimate the relative risk of mortality in relation to the rehabilitation intervention. Results In all, 181 patients with rehabilitation and 1123 controls died, representing respective mortality rates of 25.0 and 32.7 per 1000 person-years. Rehabilitation was significantly associated with a lower risk of mortality (hazard ratio .68, 95% confidence interval .58-.79). Such a beneficial effect tended to be more obvious as the frequency of rehabilitation increased ( P for the trend Conclusions Stroke rehabilitation initiated in the first 3 months after a stroke admission may significantly reduce the risk of mortality for 10 years after the stroke.

Aim The prevalence of end-stage renal disease in Taiwan is among the highest in the world. Treatment reimbursement for haemodialysis was capped in 1996 in order to contain costs. This study evaluated temporal changes in the costs and utilization of medical care and mortality in patients receiving haemodialysis following capped reimbursement. Methods Using insurance claims data in Taiwan between 1998 to 2009, we established eight annual subcohorts of patients with incident haemodialysis, increasing from 6099 in 1998 to 7745 in 2005. With a 4-year follow-up paradigm for each subcohort, we evaluated resources use and costs of medical services, as well as mortality trends. Results The annual mean cost for each haemodialysis patient increased from US $431 to $737 for emergency visits, US $9007 to $13 280 for hospitalizations and US $79 141 to $92 416 (16.8% increase) for total costs, from the initial to final subcohorts, respectively. Compared to the 1998 subcohort, the adjusted hazard ratio of deaths declined from 0.97 (95% CI 0.91 to 1.02) for the 1999 subcohort to 0.86 (95% CI 0.82 to 0.91) for the 2005 subcohort (P for trend

Sleep disorders could be associated with neurodegenerative diseases. This study aimed to determine the risk of Parkinson's disease in patients with obstructive sleep apnea. The incident cases of newly diagnosed obstructive sleep apnea were identified between 2000 and 2009 from the medical claims database of National Health Institute of Taiwan. The risk of Parkinson's disease onset at least 1 year after the diagnosis of obstructive sleep apnea was measured during and up to 11 years of period, compared to that of age- and gender-matched controls estimated in the same period. A total of 5864 patients with newly diagnosed obstructive sleep apnea and 23,269 subjects without obstructive sleep apnea were identified for data analysis. The study reported that the incidence of Parkinson's disease in the obstructive sleep apnea cohort was approximately two times higher than that in the control cohort (2.57 versus 1.32 per 1000 person-years), with an adjusted hazard ratio of 1.84. Furthermore, the risk of Parkinson's disease was particularly greater for the obstructive sleep apnea with insomnia subgroup (adjusted hazard ratio = 1.97, 95% confidence interval = 1.44-2.69) than for the control cohort. The sex-age-specific analysis further discovered that the most elevated risk of Parkinson's disease onset was noted in female obstructive sleep apnea patients aged 50-69 years (adjusted hazard ratio = 2.82). This population-based study indicated that patients with obstructive sleep apnea, especially those who suffered from insomnia, are at an increased risk of Parkinson's disease onset.

This letter proposes and experimentally demonstrates a hybrid cable television (CATV)/16-quadrature amplitude modulation (QAM)-orthogonal frequency-division multiplexing (OFDM) in-house network over a combined 40 km single-mode fiber, 1.43 km photonic crystal fiber, and 30 m graded index-plastic optical fiber/5 m visible light communication transport. Good performances of carrier-to-noise ratio, composite second-order, and composite triple-beat are obtained for the CATV signal. A low bit error rate value is achieved for the 16-QAM-OFDM signal.

A 20-km/60-Gb/s two-way passive optical network (PON) based on directly modulated two-stage injection-locked 1.55-μm vertical-cavity surface-emitting laser (VCSEL) transmitters and negative dispersion fibers (NDFs) is proposed and demonstrated. A one-stage injection-locked technique has been confirmed as an effective approach for increasing the frequency response of a VCSEL. A two-stage injection-locked technique, which can further increase the frequency response of a VCSEL, is thereby expected to have excellent transmission performance in a two-way PON. To be the first to employ directly modulated two-stage injection-locked 1.55-μm VCSEL transmitters in a two-way PON, brilliant bit-error-rate performance and a clear eye diagram are obtained over a 20-km NDF transport. A directly modulated VCSEL has a positive chirp, whereas an NDF has a negative dispersion property in the transmission fiber; this negative dispersion property compensates the laser positive chirp and results in systems with better transmission performance. Such an innovative two-way PON provides the advantage of a communication link for high data rates, which is an attractive feature that is useful for broadband network applications.

This paper proposes and validates a bidirectional hybrid lightwave transport system based on fiber-invisible laser light communication (IVLLC) and fiber-visible laser light communication (VLLC) convergences with light injection and optoelectronic feedback techniques. This paper is also the first to employ light injection and optoelectronic feedback techniques in a bidirectional lightwave transport system based on fiber-IVLLC and fiber-VLLC integration. Light is successfully modulated directly with cable television (CATV), 16-quadrature amplitude modulation (QAM), and 16-QAM-orthogonal frequency-division multiplexing (OFDM) signals. Good carrier-to-noise ratio, composite second order, composite triple beat, and bit error rate (BER) are obtained for CATV, 16-QAM, and 16-QAM-OFDM signal transmissions over a combined 40-km single-mode fiber, a 1.43-km photonic crystal fiber, and 6-m free-space transmission. The proposed bidirectional hybrid lightwave transport system exhibits significant potential in providing broadband integrated services, such as CATV, Internet, and telecommunication, via optical fiber and free-space indoor networks.

The association of psychosocial stress with cardiovascular disease (CVD) is still inconclusive. The aim of this study was to examine the relationships between arteriosclerosis and various work-related conditions among medical employees with various job titles.A total of 576 medical employees of a regional hospital in Taiwan with a mean age of 43 years and female gender dominance (85%) were enrolled. Arteriosclerosis was evaluated by brachial-ankle pulse wave velocity (baPWV). Workrelated conditions included job demands, job control, social support, shift work, work hours, sleep duration, and mental health. The crude relationship between each of the selected covariates and baPWV was indicated by Spearman correlation coefficients. A multiple linear regression model was further employed to estimate the adjusted associations of selected covariates with arteriosclerosis.The mean baPWV of participants was 11.4 ± 2.2 m/s, with the value for males being significantly higher than that for females. The baPWV was associated with gender, age, medical profession, work hours, work type, depression, body mass index, systolic and diastolic blood pressures, fasting glucose, and cholesterol. After being fully adjusted by these factors, only sleep duration of less than 6 hours and weekly work hours longer than 60 hours were significantly associated with increased risk of arteriosclerosis. The conditions of job demands, job control, social support, shift work, and depression showed no significant association with baPWV.Longer work hours and shorter sleep durations were associated with an increased risk of arteriosclerosis. These findings should make it easier for the employer or government to stipulate rational work hours in order to avoid the development of cardiovascular disease among their employees.

A progressive bidirectional cable television (CATV)/wireless-over-fiber lightwave transmission system based on one broadband light source (BLS), one arrayed waveguide grating, two intensity modulators, and one phase modulator is proposed and experimentally demonstrated. A continuous amplified spontaneous emission BLS is split into eight channels in the C-band with 50-GHz spacing. The multiple equal-space optical spectra exhibit a high optical signal-to-noise ratio (≥ 55 dB) and good flatness (≤ 5 dB). A high-quality comb multicarrier provides a single wavelength and twin millimeter-wave bands for baseband CATV and wireless transport systems. Several measured values (carrier-to-noise ratio ≥ 64 dB, composite second order ≥ 62 dB, composite triple beat ≥ 63 dB, and bit error rate $\leq 10^{-9} $) can be obtained from distortion-reduced and noise-free performance. Moreover, downstream and upstream high-bit-rate wireless transmissions exhibit an interference-eliminating property. Thus, the proposed system does not only offer a future for progressive fiber backbone and CATV/wireless hybrid networks, but also provides a full-duplex interference-free for high-data-rate mobile communication and in-home CATV access networks as well.

AIMS: The aim of this study was to investigate the putative link between dipeptidyl peptidase‐4 inhibitor (DPP‐4i) use and the risk of fracture in patients with type 2 diabetes. METHODS: This propensity‐score‐matched population‐based cohort study was performed between 2009 and 2013 on patients with type 2 diabetes who were stable metformin users. A total of 3996 patients with type 2 diabetes used DPP‐4i as a second‐line antidiabetic drug. The same number of matched non‐DPP‐4i users were followed up until fracture occurrence, health insurance policy termination, or the end of 2013. The incidence rates of overall and cause‐specific fractures were estimated based on the Poisson assumption. A multiple Cox proportional hazard model was used to estimate the covariate‐adjusted hazard ratio (HR) and 95% confidence interval (CI) to determine the association between DPP‐4i use and overall and cause‐specific fractures stratified by age and sex. RESULTS: Over a maximum follow‐up period of 5 years, 340 DPP‐4i users and 419 non‐DPP‐4i users were newly diagnosed with fractures, yielding incidence rates of 28.03 and 32.04 per 1000 people per year, respectively. The Cox proportional hazard model revealed that DPP‐4i use significantly reduced the risk of all‐cause fractures and upper extremity fractures, with adjusted HRs of 0.86 (95% CI: 0.74–0.99) and 0.75 (95% CI: 0.59–0.95), respectively. The aforementioned associations of DDP‐4i use with fracture were sustained across sex and age stratifications. CONCLUSIONS: The results of this study supported the premise that DPP‐4i usage is associated with a reduced risk of all‐cause fractures and upper extremity fractures in patients with type 2 diabetes.

Background: The risk of dementia increases by 15–28% in patients with type 2 diabetes mellitus (DM). However, studies on dementia risk in type 1 DM have been neither comprehensive nor conclusive. Methods: We carried out a cohort study involving 1,077 patients registered to have type 1 DM from 1998 to 2009 and 32,310 matched non-DM controls who were selected from Taiwan National Health Insurance Claims. These participants were followed up from their first clinical appearance for type 1 DM treatment in 1998–2009 to the date of dementia diagnosis or the last day of 2011. The Cox proportional hazard model was employed to estimate the hazard ratio (HR) of dementia incidence. Results: The incidence rates of dementia reached 42.8 and 13.1 per 104 person-years for the type 1 DM and control groups respectively. The adjusted HR of dementia in patients with type 1 DM was estimated at 3.01 (95% CI 2.18–4.14) after adjustment for demographics, comorbidity, urbanization, monthly income, and annual frequency of ambulatory care visits. No significant difference in sex-specific HR was observed. Conclusions: The relative risk of developing dementia (118–314%) in patients with type 1 DM was much higher than the ­previously reported relative risk (15–28%) associated with type 2 DM.

One key issue in proton beam therapy is to ensure precise delivery of the concentrated radiation dose to the target. A promising method that is under active study and development is the use of position emission tomography (PET) for range verification or monitoring. In this work, we test the use of a digital PET system developed on the basis of a Plug-and-Imaging architecture for a proton therapy system. We analyze technical features of the proposed PET technology and experimentally demonstrate the possibility to imaging positron decays in a phantom immediately after proton irradiation. The experiment results agree with the expectation according to the physical properties of proton beam interaction with hydrocarbons.

INTRODUCTION This study assesses whether demographic and rural-urban variations in dental care service utilization still exist in Taiwan after 15 years of the implementation of universal health insurance coverage, which largely reduces financial barriers to dental care. METHODS The data analysed in this cohort study were based on a random sample of one million beneficiaries retrieved from Taiwan's National Health Insurance Research Database (NHIRD) in 2005. The follow-up was made between 2005 and 2010. Poisson regression models were used to explore the associations of dental service utilization rates with urbanization and demographic characteristics. RESULTS The highest and lowest rates of preventive dental care were obtained in people aged 55-64 years (579.2/1000 person-years) and

A 16 Gb/s four-level pulse amplitude modulation (PAM4) underwater wireless optical communication (UWOC) system based on 488-nm laser diode (LD) with light injection and optoelectronic feedback techniques is proposed and successfully demonstrated. Experimental results show that such a 1.8-GHz 488-nm blue light LD with light injection and optoelectronic feedback techniques is enough forceful for a 16 Gb/s PAM4 signal underwater link. To the authors’ knowledge, this study is the first to successfully adopt a 488-nm LD transmitter with light injection and optoelectronic feedback techniques in a PAM4 UWOC system. By adopting a 488-nm LD transmitter with light injection and optoelectronic feedback techniques, good bit error rate performance (offline processed by Matlab) and clear eye diagrams (measured in real-time) are achieved over a 10-m underwater link. The proposed system has the potential to play a vital role in the future UWOC infrastructure by effectively providing high transmission rate (16 Gb/s) and long underwater transmission distance (10 m).

Objective To determine the relation between rehabilitation intensity and poststroke mortality. Design Retrospective cohort study. Setting Nationwide claims data. Participants From Taiwan's National Health Insurance claims databases, patients (N=6737; mean age, 66.9y; 40.3% women) hospitalized between 2001 and 2013 for a first-ever stroke who had mild to moderate stroke and survived the first 90 days of stroke were enrolled. Interventions The intensity of rehabilitation therapy within 90 days after stroke was categorized into low, medium, or high based on the tertile distribution of the number of rehabilitation sessions. Main Outcome Measures Long-term all-cause mortality. The Cox proportional hazard models with Bonferroni correction were used to assess the association between rehabilitation intensity and mortality, adjusting for age, comorbidities, stroke severity, and other covariates. Results Patients in the high-intensity group were younger but had a higher burden of comorbidities and greater stroke severity. During follow-up, the high-intensity group was associated with a significantly lower adjusted risk (hazard ratio [HR], .73; 95% confidence interval [CI], .63–.84) of mortality than the low-intensity group, whereas the medium-intensity group carried a similar risk of mortality (HR, 0.94; 95% CI, 0.84–1.06) compared with the low-intensity group. This association was not modified by stroke severity. Conclusions Among patients with mild to moderate stroke severity, high-intensity rehabilitation therapy within the first 90 days was associated with a lower mortality risk than low-intensity therapy. Efforts to promote high-intensity rehabilitation therapy for this group of patients with stroke should be encouraged.

A bidirectional fiber-IVLLC and fiber-wireless convergence system based on two orthogonally polarized optical sidebands for hybrid CATV/MMW/BB signal transmission is proposed and demonstrated. Two orthogonally polarized optical sidebands are transmitted over a 40-km SMF transport to effectively reduce the fiber dispersion and the distortion. The approach presented in this work signifies the advancements in the convergence of SMF-based backbone and optical/RF wireless-based feeder.

Objective To estimate the incidence densities and cumulative incidence of diabetes-related complications in patients with type 1 diabetes for a maximum of 15-year follow-up. The estimations were further stratified by gender and age at diagnosis (ie, early onset: 0–12 years, late onset:≥13 years). Design A population-based retrospective longitudinal cohort study. Setting Taiwan’s National Health Insurance medical claims. Participants 4007 patients newly diagnosed with type 1 diabetes were identified during 1999–2012. Outcome measures Acute complications included diabetic ketoacidosis (DKA) and hypoglycaemia. Chronic complications were cardiovascular diseases (CVD), retinopathy, neuropathy and nephropathy. Results The incidence density of retinopathy was greatest (97.74 per 1000 person-years), followed by those of nephropathy (31.36), neuropathy (23.93) and CVD (4.39). Among acute complications, the incidence density of DKA was greatest (121.11 per 1000 person-years). The cumulative incidences of acute complications after 12 years following diagnosis were estimated to be 52.1%, 36.1% and 4.1% for DKA, outpatient hypoglycaemia and hospitalised hypoglycaemia, respectively. For chronic complications, the cumulative incidence of retinopathy after 12 years following diagnosis was greatest (65.2%), followed by those of nephropathy (30.2%), neuropathy (23.7%) and CVD (4.1%). Females with late-onset diabetes were greatly affected by advanced retinopathy (ie, sight-threatening diabetic retinopathy) and hospitalised hypoglycaemia, whereas those with early-onset diabetes were more vulnerable to DKA. Chronic complications were more commonly seen in late-onset diabetes, whereas early-onset diabetes were most affected by acute complications. Conclusions Ethnic Chinese patients with type 1 diabetes were greatly affected by DKA and retinopathy. The incidence of diabetes-related complications differed by age at diagnosis and sex.

We compared the effects of two types of basal insulin: long-acting insulin analogues vs. intermediate/long-acting human insulin, on diabetes-related complications in type 1 diabetes.A total of 1188 patients with type 1 diabetes who had recently started on long-acting insulin analogues or intermediate/long-acting human insulin were identified in 2004-2008 and followed until death or the end of 2013. Clinical outcomes included acute (i.e. hyperglycaemia, hypoglycaemia) and chronic (i.e. nephropathy, retinopathy, neuropathy, cardiovascular diseases) complications. Diabetes-related complications were measured as a composite outcome which included acute and chronic complications. Cox proportional hazards models were used to assess the time to event hazard ratio. Three propensity score (PS) methods were applied to adjust for baseline imbalances between basal insulin groups, including the PS-matching approach (as the main analysis), standardized mortality ratio weighting (SMRW) and inverse probability of treatment weighting (IPTW).Long-acting insulin analogues vs. intermediate/long-acting human insulin had a lower risk for a composite of diabetes-related complications {adjusted hazards ratios [aHRs] [95% confidence interval (CI)] 0.782 [0.639, 0.956], 0.743 [0.598, 0.924] and 0.699 [0.577, 0.846] according to the PS-matching approach, SMRW and IPTW, respectively}. Compared with intermediate/long-acting human insulin, using long-acting insulin analogues had a lower hypoglycaemia risk: aHRs (95% CI) 0.681 (0.498, 0.930), 0.662 (0.466, 0.943) and 0.639 (0.471, 0.867) from the PS-matching approach, SMRW and IPTW, respectively. No statistical differences were found between two types of insulin on individual chronic complications.A trend of lower diabetes-related complications associated with long-acting insulin analogues vs. intermediate/long-acting human insulin was observed. A reduced hypoglycaemia risk with long-acting insulin analogues was confirmed in this 'real-world' study.

A bidirectional fiber-invisible laser light communication (IVLLC) and fiber-wireless convergence system with two orthogonally polarized optical sidebands for hybrid cable television (CATV)/millimeter-wave (MMW)/baseband (BB) signal transmission is proposed and experimentally demonstrated. Two optical sidebands generated by a 60-GHz MMW signal are orthogonally polarized and separated into different polarizations. These orthogonally polarized optical sidebands are delivered over a 40-km single-mode fiber (SMF) transport to effectually reduce the fiber dispersion induced by a 40-km SMF transmission and the distortion caused by the parallel polarized optical sidebands. To the best of our knowledge, this work is the first to adopt two orthogonally polarized optical sidebands in a bidirectional fiber-IVLLC and fiber-wireless convergence system to reduce fiber dispersion and distortion effectually. Good carrier-to-noise ratio, composite second order, composite triple beat, and bit error rate (BER) are achieved for downlink transmission at a 40-km SMF operation and a 100-m free-space optical (FSO) link/3-m RF wireless transmission. For up-link transmission, good BER performance is acquired over a 40-km SMF transport and a 100-m FSO link. The approach presented in this work signifies the advancements in the convergence of SMF-based backbone and optical/RF wireless-based feeder.

Dysfunction of degradation machineries causes cancers, including hepatocellular carcinoma (HCC). Overexpression of cyclin D1 in HCC has been reported. We previously reported that autophagy preferentially recruits and degrades the oncogenic microRNA (miR)-224 to prevent HCC. Therefore, in the present study, we attempted to clarify whether cyclin D1 is another oncogenic factor selectively regulated by autophagy in HCC tumorigenesis. Initially, we found an inverse correlation between low autophagic activity and high cyclin D1 expression in tumors of 147 HCC patients and three murine models, and these results taken together revealed a correlation with poor overall survival of HCC patients, indicating the importance of these two events in HCC development. We found that increased autophagic activity leads to cyclin D1 ubiquitination and selective recruitment to the autophagosome (AP) mediated by a specific receptor, sequestosome 1 (SQSTM1), followed by fusion with lysosome and degradation. Autophagy-selective degradation of ubiquitinated cyclin D1 through SQSTM1 was confirmed using cyclin D1/ubiquitin binding site (K33-238 R) and phosphorylation site (T286A) mutants, lentivirus-mediated silencing autophagy-related 5 (ATG5), autophagy-related 7 (ATG7), and Sqstm1 knockout cells. Functional studies revealed that autophagy-selective degradation of cyclin D1 plays suppressive roles in cell proliferation, colony, and liver tumor formation. Notably, an increase of autophagic activity by pharmacological inducers (amiodarone and rapamycin) significantly suppressed tumor growth in both the orthotopic liver tumor and subcutaneous tumor xenograft models. Our findings provide evidence of the underlying mechanism involved in the regulation of cyclin D1 by selective autophagy to prevent tumor formation. Conclusion Taken together, our data demonstrate that autophagic degradation machinery and the cell-cycle regulator, cyclin D1, are linked to HCC tumorigenesis. We believe these findings may be of value in the development of alternative therapeutics for HCC patients. (Hepatology 2018;68:141-154).

Introduction The volume-outcome relationships in failed root canal treatments (RCTs) are rarely studied. Thus, we aimed to examine the association of failed RCTs with dentist and institutional volumes. Methods Ambulatory dental claims (2005–2010) of 1 million beneficiaries randomly selected from the National Health Insurance Research Database of Taiwan were used. This study is a population-based cohort study using a marginal Cox proportional hazards regression model in which the outcome variables cluster around individual patients. A total of 458,557 teeth that received first-ever RCT from 2005 to 2010 and were followed up until the end of 2010 were identified as the tooth cohort. These teeth were aggregated to 244,368 patients, 10,901 dentists, and 7122 institutions for analysis. Results Dentists in the second, third, and highest quartiles all showed a significantly lower hazard ratio of failed RCTs than those with the lowest case volume, and their adjusted hazard ratios (aHRs) were 0.93, 0.92, and 0.90, respectively. Medical institutions in the second, third, and highest quartiles also showed a significantly lower hazard ratio of failed RCTs than those with the lowest case volume, and their aHRs were 0.93, 0.89, and 0.81, respectively. Teeth with a history of periodontitis also exhibited a significantly higher aHR of failure events. The use of rubber dams significantly reduced the rates of failed RCTs. Conclusions Dentists and institutions with high care volumes tended to show good RCT outcomes. Such an effect was prominent and robust among dental institutions.