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1.
Int J Oral Maxillofac Surg ; 51(6): 724-731, 2022 Jun.
Article in English | MEDLINE | ID: mdl-34535350

ABSTRACT

Midline and paramedian mandibulotomies both have distinct anatomical and surgical strengths. A retrospective study was performed at Chang Gung Memorial Hospital, Linkou Branch between 2014 and 2019 to investigate how the osteotomy site (midline (n = 221) or paramedian (n = 44)) and type (straight, notched, or stair-stepped) affect postoperative and post-radiotherapy complications in patients undergoing wide excision of tongue cancer with flap reconstruction. Midline mandibulotomies were predominantly of the straight osteotomy type, while paramedian mandibulotomies were mostly notched type (P < 0.001). Comparably low elective tooth extraction rates were found in both approaches (P = 0.556). Paramedian mandibulotomy showed a higher osteoradionecrosis rate (P = 0.026), but there was no significance in the sub-analysis of individual types. Paramedian sites were associated with more early infection (P = 0.036) and plate exposure (P = 0.036) than midline sites with the straight osteotomy type, but complication rates did not differ significantly for the notched and stair-stepped types. Paramedian sites (P = 0.020) and notched types (P = 0.006) were associated with higher odds of osteoradionecrosis in the univariable logistic regression analysis, but only the notched type remained significant in the multivariable analysis (P = 0.048). In conclusion, paramedian sites increased the rate of osteoradionecrosis, and correlation with the osteotomy type resulted in more osteoradionecrosis in notched types and more complications in straight paramedian mandibulotomies.


Subject(s)
Osteoradionecrosis , Tongue Neoplasms , Humans , Mandible/surgery , Mandibular Osteotomy , Osteoradionecrosis/surgery , Postoperative Complications , Retrospective Studies , Tongue Neoplasms/surgery
3.
Psychoneuroendocrinology ; 109: 104382, 2019 11.
Article in English | MEDLINE | ID: mdl-31374371

ABSTRACT

Depressive and anxiety disorders substantially contribute to the global burden of disease, particularly in poor countries. Higher prevalence rates for both disorders among women indicate sex hormones may be integrated in the pathophysiology of these disorders. The Kshetriya Gramin Financial Services study surveyed a random sample of 4160 households across 876 villages in rural Tamil Nadu, India. An interviewer-administered questionnaire was conducted to quantify depressive (K6-D) and anxiety (K6-A) symptoms. Alongside, hair samples for sex hormone profiling were collected from a subsample of 2105 women aged 18-85 years. Importantly, 5.9%, 14.8%, and 46.3% of samples contained non-detectable hormone levels for dehydroepiandrosterone, progesterone, and testosterone, respectively. Our primary analysis imputes values for the non-detectable sample and we check robustness of results when non-detectable values are dropped. In this cohort of women from rural India, higher depressive symptomatology is associated with lower levels of dehydroepiandrosterone and higher depressive and anxiety symptoms are associated with higher levels of testosterone. Progesterone shows no clear association with either depressive or anxiety symptoms. These results support a potential protective effect of higher endogenous dehydroepiandrosterone levels. An important caveat on the potential negative effect of hair testosterone levels on women's mental health is that the testosterone analysis is sensitive to how non-detectable values are treated.


Subject(s)
Anxiety/metabolism , Depression/metabolism , Gonadal Steroid Hormones/analysis , Adult , Aged , Aged, 80 and over , Androgens/analysis , Anxiety Disorders/metabolism , Cohort Studies , Dehydroepiandrosterone/analysis , Dehydroepiandrosterone Sulfate/analysis , Depression/epidemiology , Depressive Disorder/metabolism , Estradiol/analysis , Female , Hair/chemistry , Humans , Middle Aged , Progesterone/analysis , Rural Population , Sex Hormone-Binding Globulin/analysis , Testosterone/analysis , Women's Health
4.
Transplant Proc ; 50(9): 2738-2741, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30401387

ABSTRACT

BACKGROUND: Ensuring careful selection of heart transplant recipients with pretransplant malignancies (PTM) has been suggested in several retrospective studies. However, cancer survival rates continue to increase and we still lack outcomes data on PTM patients who have undergone heart transplantation (HT) within the Asian region. Herein we report pretransplant characteristics and outcomes among PTM patients with HT. METHODS: A total of 354 patients underwent HT from January 2004 to January 2016. Eight of these patients had a history malignancy that was being treated before transplantation. Posttransplant outcomes and clinical characteristics were collected and possible prognostic factors analyzed. RESULTS: The median age of the patients with a preexisting malignancy was 60 years. The PTM group included 5 males and 3 females, with a median duration of follow-up of 43 months. In this group there were 2 patients with lymphoma after chemotherapy, 1 with colon cancer postoperatively, and 1 was on chemotherapy. In the other 4 patients, nasopharyngeal cancer, thyroid cancer, breast cancer, and endometrial cancer were identified, and each had undergone treatment. Only 1 premalignancy patient, with nasopharyngeal cancer, had disease recurrence. The 5-year overall survival of these patients was 50.0 ± 17.7%, but 5-year survival for those without PTM was 68.7 ± 2.0%. CONCLUSION: PTM was 2.3% in our cohort. PTM is associated with an increased risk of all-cause mortality. Thus, our findings suggest careful consideration when selecting PTM patients for HT.


Subject(s)
Heart Transplantation/mortality , Neoplasms/complications , Neoplasms/mortality , Adult , Aged , Child , Cohort Studies , Comorbidity , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Survival Rate
5.
Transplant Proc ; 50(9): 2747-2750, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30401389

ABSTRACT

OBJECTIVES: An oversized cardiac allograft may have a negative impact on survival outcomes according to previous studies; however, due to the shortage of pediatric donor hearts, the use of oversized cardiac allografts is sometimes inevitable. In this study, we reported the survival outcomes of pediatric patients in relation with the donor-recipient weight ratio. METHODS: Twenty-eight children, aged 3 months to 17 years, with dilated cardiomyopathy underwent primary cardiac transplantation at the National Taiwan University Hospital between 1995 and 2012. We analyzed these patients according to the donor-recipient weight ratio: group 1 (n = 19) with donor-recipient weight ratio <2.5 (median 1.1, interquartile range 1.0-1.6), and group 2 (n = 9) with donor-recipient weight ratio ≥2.5 (median 3.0, inter-quartile range 2.87-3.5). RESULTS: The 30-day survival rate was 100% for both group 1 and group 2 (P = 1). The survival rates for group 1 and group 2 were 95% vs 100% at 1 year, 84% vs 89% at 5 years, and 73% vs 61% at 10 years. The median survival was 14.4 years vs 12.9 years (P = .6313). CONCLUSION: In this cohort, the use of oversized cardiac allograft in pediatric patients for dilated cardiomyopathy did not have a negative effect on short-term and long-term survival.


Subject(s)
Allografts/anatomy & histology , Cardiomyopathy, Dilated/surgery , Heart Transplantation/mortality , Heart Transplantation/methods , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Male , Reoperation , Survival Rate , Taiwan , Tissue Donors
6.
Transplant Proc ; 50(9): 2751-2755, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30401390

ABSTRACT

Renal function after heart transplantation (HTx) typically follows a biphasic pattern and an initial decay within 1 to 2 years. Trajectory of renal function after HTx is less reported, especially in Asia. The aims of this cohort study were to describe the changes in HTx recipients' serum creatinine and estimated glomerular filtration rate (eGFR) levels 5 years following HTx in Taiwan. METHODS: We retrospectively reviewed 5 years of 440 consecutive adult patients (≥ 18 years) who underwent first HTx from June 1987 to December 2014 at the National Taiwan University Hospital. RESULTS: Among 422 participants, they received induction therapy consisting of intravenous rabbit antithymocyte globulin. Here, we illustrated the trends over the years by dividing the subjects into 2 groups based on their immunosuppressive regimen of transplantation (1987-2002 and 2003-2014) The pretransplantation median serum creatinine concentration level was 1.2 mg/dL, rose to 1.4 mg/dL at 3 months after surgery, and remained steady over 5 years after HTx. Pretransplant median eGFR was 67 mL/min/1.73 m2.The median serum creatinine concentration level and eGFR at baseline were all significantly difference than pretransplantation (P > .05). This result has showed that an initial steep decline within 3 months after transplant remained stable 5 years after HTx. CONCLUSION: As renal function deteriorates after HTx, we observed a steep decline in serum creatinine level and glomerular filtration rate within the 3 months after HTx, followed by a slow rate of deterioration over the following months. We found a time-related progressive deterioration in renal function during the 5 years after HTx.


Subject(s)
Heart Transplantation/adverse effects , Renal Insufficiency/etiology , Adult , Cohort Studies , Creatinine/blood , Female , Glomerular Filtration Rate , Humans , Kidney/physiopathology , Male , Middle Aged , Renal Insufficiency/epidemiology , Retrospective Studies , Taiwan
7.
Transplant Proc ; 50(9): 2756-2758, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30401391

ABSTRACT

Everolimus (EVR) can be used with calcineurin inhibitors to reduce the risk of renal dysfunction, with similar immunosuppressive effect. In this study, we compared renal function after heart transplantation (HT) under EVR with cyclosporine (CSA) or tacrolimus (TAC). Between 2004 and 2014, EVR with CSA or TAC was used in 117 HT at the National Taiwan University Hospital. After HT, all patients received corticosteroid, EVR (C0 target 3-8 ng/mL) and CSA (C0 blood level 100-200 ng/mL), or TAC (Co blood level 5-10 ng/mL). Renal function was evaluated before HT, every month after HT for up to 1 year, and then every 3 months for up to 2 years. Blood-drug levels of EVR, CSA, and TAC were also monitored simultaneously with renal function. The estimated mean glomerular filtration rate (eGFR) was 76.5 mL/min/1.73 m2 before HT. After HT, the eGFR was 64 mL/min/1.73 m2 at the third month, and 64 mL/min/1.73 m2 at the end of first year. The difference was significant between pre-HT and post-HT (P = .00) during the first year. No significant differences were noted between the CSA and TAC groups. Careful monitoring of blood-drug level and renal function is crucial after heart transplantation. It is concluded that under close monitoring blood-drug level and renal function, it is possible to reach acceptable postoperative renal function with no difference of renal function between EVR plus CSA and EVR plus TAC.


Subject(s)
Cyclosporine/adverse effects , Everolimus/adverse effects , Heart Transplantation/methods , Immunosuppressive Agents/adverse effects , Renal Insufficiency/chemically induced , Tacrolimus/adverse effects , Adult , Calcineurin Inhibitors/adverse effects , Drug Therapy, Combination , Female , Glomerular Filtration Rate/drug effects , Humans , Male , Middle Aged , Renal Insufficiency/epidemiology , Taiwan
8.
Transplant Proc ; 50(9): 2889-2890, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30401418

ABSTRACT

We report a heart transplantation in a patient with no heart. A 60-year-old man suffered from severe infective endocarditis, and due to extensive involvement of the myocardium, only minimal myocardium was left after debridement of the necrotic myocardium and aortic annulus. We finally excised the entire heart to eradicate the infection source and employed 2 extracorporeal membrane oxygenations for full life support. The infection was controlled with strong antibiotics. The patient underwent successful heart transplantation 16 days following the excision and the patient fully recovered without any complications.


Subject(s)
Extracorporeal Membrane Oxygenation/methods , Heart Transplantation/methods , Anti-Bacterial Agents/therapeutic use , Cardiac Surgical Procedures , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/surgery , Humans , Male , Middle Aged
9.
Eur Cell Mater ; 35: 350-364, 2018 06 21.
Article in English | MEDLINE | ID: mdl-29926464

ABSTRACT

Tissue engineering has the potential to overcome the limitations of tracheal reconstruction. To tissue-engineer a tracheal cartilage, auricular chondrocytes were encapsulated in a photocurable poly(ethylene glycol)/poly(ε-caprolactone) (PEG/PCL) hydrogel. Chondrogenic genes, including Sox9, Acan and Col2a1, were up-regulated in auricular chondrocytes after 2 weeks of in vitro cultivation in the PEG/PCL hydrogel. Co-cultivation of 70 % auricular chondrocytes and 30 % bone marrow mesenchymal stem cells (BMSCs) accelerated the chondrogenic genes' expression in the PEG/PCL hydrogel. Cartilaginous matrix markers, including proteoglycans and collagen type II, were detected in the chondrocytes-encapsulated PEG/PCL hydrogel after 4 weeks of in vitro cultivation. The higher expression level of cartilaginous matrix markers was observed in the PEG/PCL hydrogel with co-cultivation of 70 % chondrocytes and 30 % BMSCs. After 4 weeks of ectopic cultivation in rabbits, the cylindrical PEG/PCL structure was sustained with the use of a luminal silicon stent. However, without the stent, the construct collapsed under a compression force. No fibrosis or vessel ingrowth were found in the PEG/PCL hydrogel after 4 weeks of ectopic cultivation, whereas the auricular chondrocytes showed proteoglycans' accumulation and collagen type II production. Rabbit auricular chondrocytes could survive and retain chondrogenic ability in the PEG/PCL hydrogel under both in vitro and in vivo conditions. While the PEG/PCL hydrogel did not show sufficient mechanical properties for supporting the cylindrical shape of the construct, the high chondrogenesis level of chondrocytes in the PEG/PCL hydrogel displayed the potential of this material for tracheal tissue engineering.


Subject(s)
Chondrocytes/cytology , Ear Cartilage/cytology , Hydrogels/pharmacology , Polyesters/pharmacology , Polyethylene Glycols/pharmacology , Tissue Engineering/methods , Trachea/physiology , Animals , Cells, Cultured , Chondrogenesis/drug effects , Chondrogenesis/genetics , Collagen/metabolism , Extracellular Matrix/drug effects , Extracellular Matrix/metabolism , Gene Expression Regulation/drug effects , Models, Animal , Platelet Endothelial Cell Adhesion Molecule-1/metabolism , Polyesters/chemistry , Polyethylene Glycols/chemistry , Proteoglycans/metabolism , Rabbits , Vimentin/metabolism
10.
Eur J Clin Microbiol Infect Dis ; 36(5): 813-821, 2017 May.
Article in English | MEDLINE | ID: mdl-28013414

ABSTRACT

This nationwide population-based retrospective cohort study evaluated the risk of developing prostate cancer among patients with gonorrhea. We identified cases of newly diagnosed gonorrhea in men between 2000 and 2010 from the Taiwan National Health Insurance Research Database. Each patient with gonorrhea was matched to four controls, based on age and index year. All subjects were followed up from the index date to December 31, 2010. The Cox proportional hazards regression model was used to assess the risk of prostate cancer. A total of 355 men were included in the study group, and 1,420 age-matched subjects without gonorrhea were included in the control group. After adjusting for age, comorbidities, urbanization level, hospital level, and monthly income, gonorrhea was significantly associated with an increased risk of prostate cancer (adjusted hazard ratio = 5.66, 95% confidence interval = 1.36-23.52). Men aged 45-70 years and those with lower monthly income were more strongly associated with prostate cancer in the study group than the control group. The higher risk for developing prostate cancer were also found in those without syphilis, without genital warts, without diabetes mellitus, without chronic obstructive pulmonary disease, without benign prostatic hypertrophy, without chronic prostatitis, and without alcoholism. The Kaplan-Meier analysis showed the risk of prostate cancer was significantly higher in the study group than in the control group. Gonorrhea may be involved in the development of prostate cancer. More intensive screening and prevention interventions for prostate cancer should be recommended in men with gonorrhea.


Subject(s)
Gonorrhea/complications , Prostatic Neoplasms/epidemiology , Adult , Aged , Asian People , Case-Control Studies , Follow-Up Studies , Humans , Male , Middle Aged , Risk Assessment , Risk Factors , Taiwan/epidemiology , Young Adult
11.
Oncogene ; 36(16): 2202-2214, 2017 04 20.
Article in English | MEDLINE | ID: mdl-27893715

ABSTRACT

The highly homeostasis-resistant nature of cancer cells leads to their escape from treatment and to liver metastasis, which in turn makes pancreatic ductal adenocarcinoma (PDAC) difficult to treat, especially the squamous/epithelial-to-mesenchymal transition (EMT)-like subtype. As the molecular mechanisms underlying tumour heterogeneity remain elusive, we investigated whether epigenetic regulation might explain inter-individual differences in the progression of specific subtypes. DNA methylation profiling performed on cancer tissues prior to chemo/radiotherapy identified one hypermethylated CpG site (CpG6882469) in the VAV1 gene body that was correlated with demethylation of two promoter CpGs (CpG6772370/CpG6772811) in both PDAC and peripheral blood. Transforming growth factor ß treatment induced gene-body hypermethylation, dissociation of DNMT1 from the promoter, and VAV1 expression via SMAD4 and mutant KrasG12D. Pharmacological inhibition of TGFß-VAV1 signalling decreased the squamous/EMT-like cancer cells, promoted nuclear VAV1 localization, and enhanced the efficacy of gemcitabine in prolonging the survival of KPfl/flC mice. Together, the three VAV1 CpGs serve as biomarkers for prognosis and early detection, and the TGFß-VAV1 axis represents a therapeutic target.


Subject(s)
Adenocarcinoma/metabolism , Epigenesis, Genetic , Gene Expression Regulation, Neoplastic , Pancreatic Neoplasms/metabolism , Proto-Oncogene Proteins c-vav/genetics , Transforming Growth Factor beta/metabolism , Adenocarcinoma/drug therapy , Adenocarcinoma/genetics , Animals , Antineoplastic Agents/therapeutic use , Benzamides/therapeutic use , Cell Line, Tumor , DNA (Cytosine-5-)-Methyltransferase 1 , DNA (Cytosine-5-)-Methyltransferases/metabolism , Disease Progression , Humans , Mice , Mice, Transgenic , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/genetics , Promoter Regions, Genetic , Pyrazoles/therapeutic use , Smad4 Protein/metabolism , Transforming Growth Factor beta/antagonists & inhibitors
12.
Transplant Proc ; 48(3): 969-73, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27234781

ABSTRACT

BACKGROUND: With advances in immunosuppressive therapy, heart transplantation is currently recommended as the only established surgical treatment for refractory heart failure. However, chronic immunosuppression increases the risk for malignancy. Everolimus (EVR) is a potent mammalian target of rapamycin inhibitor that is used after transplantation and to treat advanced malignancies, as we have done in Taiwan after heart transplantation since 2004. Mycophenolate mofetil (MMF) and EVR are frequently used as cell-cycle inhibitors to optimize post-transplantation outcomes. METHODS: We retrospectively analyzed the characteristics and outcomes of 454 patients who received either MMF (n = 232) or EVR (n = 222) after heart transplantation at the National Taiwan University Hospital from March 1, 1990, to March 1, 2015. Patient characteristics and Kaplan-Meier survival curves were compared between groups. RESULTS: During a median follow-up of 69.2 months, malignancy was diagnosed in 27 patients receiving MMF (n = 23) or EVR (n = 4). There was a significant difference in malignancy risk between groups (9.91% vs 1.80%, P = .001). The most common malignancies were non-Hodgkin lymphoma, skin cancers, and lung squamous cell carcinoma. The 2-year overall survival after malignancy was 50% in the EVR group and 47% in the MMF group (P = .745). CONCLUSIONS: EVR treatment after heart transplant is associated with a lower risk of malignancy than is MMF treatment. The 2-year survival rate after malignancy was similar between EVR and MMF groups.


Subject(s)
Everolimus/adverse effects , Heart Transplantation/adverse effects , Immunosuppression Therapy/adverse effects , Lymphoma, Non-Hodgkin/chemically induced , Mycophenolic Acid/adverse effects , Postoperative Complications/epidemiology , Skin Neoplasms/chemically induced , Adolescent , Adult , Aged , Animals , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/adverse effects , Incidence , Infant , Kaplan-Meier Estimate , Lymphoma, Non-Hodgkin/epidemiology , Male , Middle Aged , Retrospective Studies , Skin Neoplasms/epidemiology , Survival Rate/trends , Taiwan/epidemiology , Young Adult
13.
Transplant Proc ; 48(3): 951-5, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27234777

ABSTRACT

BACKGROUND: Acute fulminant myocarditis with intractable cardiogenic shock is a fatal condition; its only therapeutic option is mechanical circulatory support. The use of mechanical circulatory support, either extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD), serves as a bridge to recovery or as a bridge to transplantation. OBJECTIVES: The aim of this research was to advance our understanding of the outcome of heart transplantation under mechanical support for acute myocarditis. Two groups of patients were compared: those recovered without undergoing transplantation and those who underwent transplantation. METHODS: We reviewed 134 patients experiencing acute myocarditis who required mechanical circulatory support (including ECMO and/or VAD) in our institute between 1994 and 2014. Demographic data, clinical characteristics, support duration, and outcome of individuals were retrospectively analyzed. RESULTS: Patients taking part in this study were aged from 1 month to 70 years, with an average age of 28 years. The transplantation-free survival rate in adults was 54%. A total of 6 adult patients receive a heart transplant under ECMO/left VAD; 2 of these patients died of uncontrolled sepsis after the heart transplantation. The duration of mechanical support ranged from 10 to 130 days (average, 41 days). CONCLUSIONS: Mechanical circulatory support in patients with acute myocarditis proved to be effective. Approximately one half of all adult patients in this study experienced myocardium recovery under mechanical support, with only 5% undergoing a successful heart transplantation. In terms of patients who survived after heart transplantation, the mid-term and long-term outcomes are favorable.


Subject(s)
Extracorporeal Membrane Oxygenation/methods , Forecasting , Heart Transplantation/methods , Heart-Assist Devices , Myocarditis/surgery , Shock, Cardiogenic/surgery , Acute Disease , Adult , Female , Humans , Male , Middle Aged , Myocarditis/complications , Retrospective Studies , Shock, Cardiogenic/etiology
14.
Transplant Proc ; 48(3): 974-7, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27234782

ABSTRACT

BACKGROUND: Malignancy is the leading cause of death in Taiwan. The risk of malignancy is higher in heart transplant recipients than in the general population. We reviewed the malignancy incidence among the patients who underwent heart transplantation (HT) at the National Taiwan University Hospital (NTUH) during the past 28 years. We found that the incidence of malignancy is low in Taiwan and that the pattern of malignancy is different from that in the Western population. METHODS: From July 1987 to March 2015, 518 patients underwent HT at NTUH. Forty-four patients who died within 1 month after transplantation were excluded from this study. Thus, a total of 476 patients were enrolled in this study. There were 393 male and 83 female patients, with a mean age of 45 years at transplantation. The major indications for HT were dilated cardiomyopathy (52%) and ischemic cardiomyopathy (33%). After HT, all patients received triple immunosuppressive therapy, including a calcineurin inhibitor (cyclosporine or tacrolimus), cell-cycle inhibitor (azathioprine, mycophenolate mofetil, or everolimus), and steroid. After 1995, induction with rabbit anti-human thymocyte globulin was routinely performed. Survival was estimated by means of the Kaplan-Meier method. RESULTS: Twenty-seven patients without pre-transplantation malignancy developed malignancies after HT. The median survival time (MST) of these 27 HT patients was 76.8 months. After malignancy was diagnosed, the overall MST was 20.7 months. The 3- and 5-year overall survival rates were 44% and 27%, respectively. Twenty-one patients (77.8%) died, 10 of them because of cancer. The most common malignancy was non-Hodgkin lymphoma (n = 6), followed by skin cancer (including 2 keratoacanthomas, 2 squamous cell carcinomas, and 1 basal cell carcinoma; n = 5) and lung squamous cell carcinoma (n = 3). The univariate analysis identified cancer stage (P = .044) and comorbidity (P = .002) as factors associated with poor malignancy survival. In the multivariate analysis, comorbidity was an independent prognostic factor for greater risk of death because of post-transplantation malignancy (P = .002). CONCLUSIONS: In Taiwan, the risk of malignancy after HT is low (5.7%), as is the incidence of skin cancer. The most common malignancy was non-Hodgkin lymphoma, followed by skin cancer and lung cancer. Comorbidity was an independent factor for overall survival in cancer patients who previously underwent HT.


Subject(s)
Heart Transplantation/adverse effects , Neoplasms/epidemiology , Adult , Aged , Cause of Death/trends , Female , Humans , Immunosuppression Therapy/adverse effects , Incidence , Male , Middle Aged , Neoplasms/etiology , Survival Rate/trends , Taiwan/epidemiology , Young Adult
15.
Transplant Proc ; 48(3): 978-81, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27234783

ABSTRACT

BACKGROUND: Transplantation and immunosuppressive drugs are major limitations to the success of pregnancy. In 1988, the first pregnancy after a heart transplant was reported, which has given female recipients the hope to give birth. During pregnancy, physiologic changes with increased blood volume and hemodilution may influence blood drug level. CASE REPORT: We reported our experience in monitoring on immunosuppressive drugs for 2 cases. Both of them underwent heart transplantation in 2006 and were 34 and 37 years old at time of pregnancy. For both cases, we frequently monitored the blood level and increased the dosage of immunosuppressive drugs accordingly. Both cases had uneventful pregnancy and delivery to healthy babies at the National Taiwan University Hospital in Taiwan. Their postpartum courses were uneventful as well. CONCLUSIONS: We advocate adjusting the immunosuppressive dosage according to the blood level before pregnancy.


Subject(s)
Graft Rejection/drug therapy , Heart Transplantation , Immunosuppression Therapy/methods , Pregnancy Complications, Cardiovascular , Adult , Female , Humans , Immunosuppressive Agents/therapeutic use , Infant, Newborn , Pregnancy , Pregnancy Outcome
16.
PLoS One ; 11(3): e0151235, 2016.
Article in English | MEDLINE | ID: mdl-27018999

ABSTRACT

Benford's Law is a probability distribution for the first significant digits of numbers, for example, the first significant digits of the numbers 871 and 0.22 are 8 and 2 respectively. The law is particularly remarkable because many types of data are considered to be consistent with Benford's Law and scientists and investigators have applied it in diverse areas, for example, diagnostic tests for mathematical models in Biology, Genomics, Neuroscience, image analysis and fraud detection. In this article we present and compare statistically sound methods for assessing conformance of data with Benford's Law, including discrete versions of Cramér-von Mises (CvM) statistical tests and simultaneous confidence intervals. We demonstrate that the common use of many binomial confidence intervals leads to rejection of Benford too often for truly Benford data. Based on our investigation, we recommend that the CvM statistic Ud(2), Pearson's chi-square statistic and 100(1 - α)% Goodman's simultaneous confidence intervals be computed when assessing conformance with Benford's Law. Visual inspection of the data with simultaneous confidence intervals is useful for understanding departures from Benford and the influence of sample size.


Subject(s)
Models, Theoretical , Confidence Intervals , Databases, Genetic , Genomics , Open Reading Frames/genetics , Probability , Sample Size
17.
Acta Psychiatr Scand ; 133(4): 277-88, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26493376

ABSTRACT

OBJECTIVE: To investigate the association of resting heart rate with suicide in two large cohorts. METHOD: The MJ cohort (Taiwan) included 532 932 adults from a health check-up programme (1994-2008). The HUNT cohort (Norway) included 74 977 adults in the Nord-Trøndelag County study (1984-1986), followed up to 2004. In both cohorts heart rate was measured at baseline, and suicide was ascertained through linkage to cause-of-death registers. Risk of suicide was estimated using Cox proportional hazards models. RESULTS: There were 569 and 188 suicides (average follow-up period of 8.1 and 16.9 years) in the MJ and HUNT cohorts respectively. Sex- and age-adjusted hazard ratio for every 10 beat increase in heart rate per minute was 1.08 (95% Confidence Interval 1.00-1.16) and 1.24 (1.12-1.38) in the MJ and HUNT cohorts, respectively. In the MJ cohort this association was confined to individuals with a history of heart diseases vs. those without such a history (P for interaction = 0.008). In the HUNT cohort the association did not differ by history of heart diseases and was robust to adjustment for health-related life style, medication use, and symptoms of anxiety and depression. CONCLUSION: Elevated resting heart rate may be a marker of increased suicide risk.


Subject(s)
Heart Rate/physiology , Suicide/statistics & numerical data , Adult , Cohort Studies , Female , Humans , Male , Middle Aged , Norway/epidemiology , Proportional Hazards Models , Risk Factors , Taiwan/epidemiology , Young Adult
18.
Andrologia ; 48(4): 363-73, 2016 May.
Article in English | MEDLINE | ID: mdl-26190442

ABSTRACT

This study investigated the effect of resistant maltodextrin (RMD) on reproduction in streptozotocin (STZ)-nicotinamide-induced type 2 diabetic male rats. Forty male rats were induced with diabetes by a single intraperitoneal injection of STZ (50 mg kg(-1)) and nicotinamide (100 mg kg(-1)). Five groups were analysed in total: normal, diabetic rats without RMD, diabetic rats with RMD 1.2 g per 100 g diet (1×), with RMD 2.4 g per 100 g (2×), and with RMD 6.0 g per 100 g (5×). The groups of diabetic rats with the RMD supplement, compared to those without supplement, showed improved plasma glucose control, attenuated insulin resistance and recovery of testosterone level and spermatogenesis stage. The STZ-nicotinamide-induced diabetes mellitus (DM) caused a significant reduction in serum testosterone, testis androgen receptor (AR), steroidogenic acute regulatory protein (StAR) and 3ß-hydroxysteroid dehydrogenase (3ß-HSD) protein, but a statistical recovery in each of these was observed in the 5× group. TUNEL-positive cells were observed in the diabetic without RMD group, and RMD treatment reduced apoptotic germ cells. The expression of Bax/Bcl2 was induced in the diabetic group and also significantly reduced in the 5× group. Dietary RMD may improve metabolic control in STZ-nicotinamide-induced diabetic rats and attenuate hyperglycaemia-related impaired male reproduction and testicular function.


Subject(s)
Diabetes Mellitus, Experimental/complications , Hyperglycemia/complications , Polysaccharides/pharmacology , Spermatogenesis/drug effects , Testis/drug effects , 17-Hydroxysteroid Dehydrogenases/blood , 3-Hydroxysteroid Dehydrogenases/metabolism , Animals , Apoptosis/drug effects , Diabetes Mellitus, Experimental/blood , Diabetes Mellitus, Experimental/chemically induced , Germ Cells/drug effects , Hyperglycemia/blood , In Situ Nick-End Labeling , Injections, Intraperitoneal , Male , Niacinamide/administration & dosage , Niacinamide/toxicity , Phosphoproteins/blood , Polysaccharides/administration & dosage , Rats , Rats, Wistar , Receptors, Androgen/analysis , Streptozocin/administration & dosage , Streptozocin/toxicity , Testis/metabolism , Testosterone/blood
19.
Opt Lett ; 40(18): 4237-40, 2015 Sep 15.
Article in English | MEDLINE | ID: mdl-26371905

ABSTRACT

A symmetrical Fibonacci micro-ring resonator (SFMR) has been presented to avoid the coupled resonator optical waveguide (CROW) bottle, which is a bottle-shaped distribution for high orders in transmission spectra. The SFMR features three advantages that improve filtering quality compared to that provided by traditional periodic micro-ring resonators. First, sharper resonances are obtained by eliminating the CROW bottle from the mini gaps that appear in the major-band region. Second, peaks with perfect transmission are always obtained without a radius and coupling modulation in the mini-band regions and major-band regions. Third, the full width at half-maximum of the band-edge peak decreases with the increasing generation order.

20.
Opt Express ; 23(10): 13613-8, 2015 May 18.
Article in English | MEDLINE | ID: mdl-26074610

ABSTRACT

We present sharp resonances with complete transmission in the Thue-Morse microring resonator. The quasi-periodic structure attains a better quality of filtering than the traditional periodic structure. This includes the following: (i) the high-Q resonances with complete transmission are obtained in the transmission spectra, (ii) the maximum value of transmittance always remains 1 for an arbitrary proportion of two different radiuses in the major-band regions, and (iii) the complete transmission occurs for arbitrary coupling in the mini-band regions. Moreover, we propose an analytical method to predict the occurrences of resonance peaks in the mini-band regions based on the gap map.

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