Defective T-cell response to COVID-19 vaccination in acute myeloid leukaemia and myelodysplastic syndromes.

Limited data exist on COVID-19 vaccination efficacy in patients with acute myeloid leukemia and myelodysplasia with excess blasts (AML/MDS-EB2). We report results from a prospective study, PACE (Patients with AML and COVID-19 Epidemiology). 93 patients provided samples post-vaccine 2 or 3 (PV2, PV3). Antibodies against SARS-COV-2 spike antigen were detectable in all samples. Neutralization of the omicron variant was poorer than ancestral variants but improved PV3. In contrast, adequate T-cell reactivity to SARS-COV-2 spike protein was seen in only 16/47 (34%) patients PV2 and 23/52 (44%) PV3. Using regression models, disease response (not in CR/Cri), and increasing age predicted poor T cell response.

Association Between Oral Corticosteroid Bursts and Severe Adverse Events : A Nationwide Population-Based Cohort Study.

BACKGROUND: Long-term use of oral corticosteroids has known adverse effects, but the risk from brief oral steroid bursts (≤14 days) is largely unknown. OBJECTIVE: To examine the associations between steroid bursts and severe adverse events, specifically gastrointestinal (GI) bleeding, sepsis, and heart failure. DESIGN: Self-controlled case series. SETTING: Entire National Health Insurance Research Database of medical claims records in Taiwan. PARTICIPANTS: Adults aged 20 to 64 years with continuous enrollment in the National Health Insurance program from 1 January 2013 to 31 December 2015. MEASUREMENTS: Incidence rates of severe adverse events in steroid burst users and non-steroid users, as well as incidence rate ratios (IRRs) for severe adverse events within 5 to 30 and 31 to 90 days after initiation of steroid therapy. RESULTS: Of 15 859 129 adult participants, 2 623 327 who received a single steroid burst were included. The most common indications were skin disorders and respiratory tract infections. The incidence rates per 1000 person-years in steroid bursts were 27.1 (95% CI, 26.7 to 27.5) for GI bleeding, 1.5 (CI, 1.4 to 1.6) for sepsis, and 1.3 (CI, 1.2 to 1.4) for heart failure. Rates of GI bleeding (IRR, 1.80 [CI, 1.75 to 1.84]), sepsis (IRR, 1.99 [CI, 1.70 to 2.32]), and heart failure (IRR, 2.37 [CI, 2.13 to 2.63]) significantly increased within 5 to 30 days after steroid therapy initiation and attenuated during the subsequent 31 to 90 days. LIMITATION: Persons younger than 20 years or older than 64 years were not included. CONCLUSION: Oral corticosteroid bursts are frequently prescribed in the general adult population in Taiwan. The highest rates of GI bleeding, sepsis, and heart failure occurred within the first month after initiation of steroid therapy. PRIMARY FUNDING SOURCE: National Health Research Institutes, Ministry of Science and Technology of Taiwan, Chang Gung Medical Foundation, and Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Association between nonsteroidal anti-inflammatory drugs and atrial fibrillation among a middle-aged population: a nationwide population-based cohort.

AIMS: It remains inconclusive whether the use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of atrial fibrillation (AF), especially in middle-aged Asian populations. In this study, we evaluated the association between NSAID use and the risk of AF in a nationwide population-based study of middle-aged individuals in Taiwan. METHODS: A nested case-control study was conducted using the National Health Insurance Research Database (NHIRD) in Taiwan. We identified the cases with a diagnosis of AF (ICD-9-CM codes: 427.31) and the matched controls from three independent Longitudinal Health Insurance Databases (LHIDs) derived from the NHIRD from data collected from 2001 to 2013. Conditional logistic regression models with covariate adjustment were performed to evaluate the association between NSAID use and the risk of AF. RESULTS: A total of 57 058 participants (28 529 AF cases and 28 529 matched controls) were included. Participants with NSAID use had an elevated risk of AF compared to non-users [adjusted odds ratio (AOR) = 1.18, 95% confidence interval (CI): 1.14-1.23]. When further assessing the effects of different classes of NSAIDs on the risk of AF, the results showed that participants who used non-selective NSAIDs had a significantly elevated risk of AF (AOR = 1.18, 95% CI: 1.13-1.23), as did participants with a combined use of selective and non-selective NSAIDs (AOR = 1.30, 95% CI: 1.21-1.39). CONCLUSIONS: NSAID use was associated with an increased risk of AF occurrence among the participants included in our study cohort. Closely monitoring the adverse effects of NSAID treatment on the risk of AF will be important, particularly among individuals at high risk.

First-time fathers' health status during the perinatal period.

BACKGROUND: For first-time fathers, the perinatal period is a critical period of stress and imbalance. Marital intimacy and social support may affect their stress and health status while they change their roles. AIM: This study was to explore the changes of and correlations among marital intimacy, social support, and health status and predictors of first-time fathers' health status during the perinatal period. METHODS: With a repeated measures study design, a total of 217 first-time fathers whose spouses were in the third trimester of pregnancy were recruited for the study. The Chinese Health Questionnaire, Marital Intimacy Scale, and Social Support Scale were employed to collect data at a medical center in the 36th week of pregnancy and the 1st and 4th weeks after childbirth. RESULTS: The levels of marital intimacy and social support of first-time fathers during the perinatal period increased significantly with time. Meanwhile, the period of the first week after childbirth was a predictor of first-time father's health status. CONCLUSIONS: This study only tracked the first-time fathers' health status in the 36th week of pregnancy and the 1st and 4th weeks after childbirth. Future studies could track them until one year after childbirth in order to explore the impact of the perinatal period on the couples and their babies. During the perinatal period, health care providers shall assess and provide needed interventions to first-time fathers as soon as possible to facilitate the first-time fathers to get ready for the role transition and to promote their health status.

Utilization of Psychopharmacological Treatment Among Patients With Newly Diagnosed Bipolar Disorder From 2001 to 2010.

OBJECTIVE: The aim of the study was to examine utilization and patterns of psychopharmacological treatment during a 1-year follow-up period among patients with newly diagnosed bipolar disorder from 2001 to 2010. METHODS: Patients with newly diagnosed bipolar disorder from 2001 to 2010 were identified from the National Health Insurance Research Database in Taiwan. We assessed prescription records related to 4 kinds of psychopharmacological medication, including antipsychotics (APs), antidepressants, mood stabilizers, and benzodiazepines, as well as health care utilization in a 1-year follow-up period among the study subjects. In addition, logistic regressions were applied to test the trends for utilization of psychopharmacological treatment during the 10-year study period. RESULTS: A total of 2703 patients newly diagnosed with bipolar disorder were enrolled. The ratio of good adherence, defined as medications possession ratio greater than 0.8, for use of the examined psychopharmacological medication was relatively low during the study period. The use of first-generation APs, selective serotonin reuptake inhibitors, tricyclic antidepressants, lithium, carbamazepine, and benzodiazepines has declined; however, the use of second-generation APs, serotonin and norepinephrine reuptake inhibitors, lamotrigine, and valproate has risen markedly during the 10-year period. CONCLUSIONS: This study presents patterns of pharmacological treatment in patients with newly diagnosed bipolar disorder in Taiwan for a 10-year study period. It would be of importance to further investigate causes and outcomes for polytherapy and nonadherence to psychotropic medications among patients with bipolar disorder.

Longitudinal pattern of multiplexed immunoglobulin E sensitization from prenatal stage to the first year of life.

BACKGROUND: The longitudinal pattern of allergen-specific IgE levels from the prenatal stage to early life has remained largely unexplored. METHODS: One-hundred and three mother-infant pairs, which were part of an ongoing population-based prospective birth cohort study of early childhood allergic diseases in Tainan, Taiwan, were included in this study. We examined the relationship of 20 allergen-specific IgE levels with blood samples of mothers, cord blood, and infants at 12 months of age using Spearman rank correlation, Kenal τ and McNemar test, respectively. RESULTS: Certain degree of IgE sensitization against most 20 examined specific allergens was observed in blood samples of mothers, cord blood, and infants at 12 months of age. When we further examined the association between allergy-related risk factors and atopy in infants at the first year of life, we found positive association between colic pain and atopy in infants at 12 months of age [adjusted odds ratios (AOR) = 3.51; 95% confidence interval (CI): 1.13-10.96; p = 0.03], and borderline significance between wheezing and atopy in infants at 12 months of age (AOR = 4.58; 95% CI: 0.89-23.50; p = 0.07). CONCLUSION: The findings from this study suggest that influence of maternal allergen-specific IgE levels on infant immune response might occur at birth and then wane in infants at 12 months of age. Positive association of colic pain and wheezing with atopy in infants at 12 months of age provides supportive evidence for the 'Allergy March' theory of allergy development in an Asian birth cohort.

Mesopores provide an amorphous state suitable for studying biomolecular structures at cryogenic temperatures.

In nano-confinements, aqueous solutions can be found to remain in a liquid state at subfreezing temperatures. The finding provides a means of entering into previously inaccessible temperature regions for studying the dynamics and structure of bulk liquid. Here we show that studying biomolecular structures in nano-confinements improves the accuracy of cryostructures and provides better insight into the relationship between hydration water and biomolecules. Synthetic prion protein peptides are studied in two experimental conditions: (i) in confined nanochannels within mesoporous materials, and (ii) in vitrified bulk solvents, with a temperature range of 50-275 K, using cw/pulse ESR techniques. A large inhomogeneous lineshape broadening is only observed for the spectra from the vitrified bulk solvent below 70 K, suggesting a possible peptide clustering in the solution. The spin-counting and distance measurements by DEER-ESR provide further evidence that peptides are dispersed homogeneously in mesopores but heterogeneously in vitrified solvents wherein the biomolecular structure is disturbed due to heterogeneity in the bulk solvent structure. Our study demonstrates that the nanospace within mesoporous materials provides an amorphous environment that is better than vitrified bulk solvent for studying biostructures at cryogenic temperatures.

Associations of early retirement and mortality risk: a population-based study in Taiwan.

BACKGROUND: Early retirement is highly prevalent in Taiwan. This study assesses the association between early retirement and all-cause and cause-specific mortality risks while exploring the modifying effect of sociodemographic factors. METHODS: Using Taiwan's National Health Insurance Research Database between 2009 and 2019, 1 762 621 early retirees aged 45-64 and an equal number of employed comparators were included. The date and cause of death were identified using the National Death Registry. Cox regression models were used to estimate HRs of early retirement for all-cause mortality and cause-specific mortality. To explore modifying effects, we conducted subgroup analyses based on age groups, sexes, occupation types and general health status (Charlson Comorbid Index score). RESULTS: The analysis revealed that early retirees, compared with their concurrently employed counterparts, had a higher mortality risk (adjusted HR (aHR) 1.69, 95% CI (1.67 to 1.71)). Specifically, younger individuals (aged 45-54) (aHR 2.74 (95% CI 2.68 to 2.80)), males (aHR 1.78 (95% CI 1.76 to 1.81)), those in farming or fishing occupations (aHR 2.13 (95% CI 2.06 to 2.21)) or the private sector (aHR 1.92 (95% CI 1.89 to 1.96)), and those with the poorest health conditions (aHR 1.79 (95% CI 1.76 to 1.83)) had higher mortality risks of early retirement. Regarding specific causes of death, the top three highest risks were associated with gastrointestinal disorders, followed by suicide and neurological disorders. CONCLUSIONS: This study underscores the substantial mortality risk increase linked to early retirement, emphasising the importance of policy considerations, particularly regarding vulnerable populations and specific causes of death potentially linked to unhealthy lifestyles.

Spin-label ESR with nanochannels to improve the study of backbone dynamics and structural conformations of polypeptides.

Nanochannels of mesoporous silica materials were previously found useful for reducing the tumbling motion of encapsulated biomolecules while leaving the biomolecular structure undisturbed. Here we show that experiments of cw-ESR distance measurement in nano-confinement can benefit immediately from the above mentioned features of sufficiently slow molecular tumbling, enabling more accurate determination of interspin distances throughout the temperature range, from 200 to 300 K. A 26-residue prion protein peptide, which can fold into either a helical or hairpin structure, as well as its variants, are studied by using ESR. By comparing the spectra obtained in vitrified bulk solutions vs. mesopores, the spectra from the latter display typical slow-motional lineshapes, thereby enabling dipolar anisotropy to be unambiguously revealed throughout the temperature range, whereas the spectra from the former are dominated by the disordering of the side chain and the rotational tumbling of the peptide. The spectral changes regarding the two secondary structures in nano-confinement are found to show a strong correlation with the dynamic properties of the backbones. The effect of viscosity agent perturbation on the motion of an R1 nitroxide side chain, a commonly employed probe, could be substantial in a bulk solution condition, though it is absolutely absent in nanochannels. Under nano-confinement, the probe is proven sufficiently sensitive to the backbone motions. Overall, the distance distributions determined from the mesopore studies not only describe the conformational structures (by average distances), but also the backbone dynamics (by distribution widths) of the spin-labeled peptides.

Predictors of Self-Efficacy in Administering Insulin Injection.

This study aimed to identify the predictors of self-efficacy in administering insulin injection among patients with type 2 diabetes. Using a cross-sectional survey, data were collected via purposive sampling from a metabolic ward of a medical center in Southern Taiwan. Participants were 72 patients with type 2 diabetes, who had started using Lantus, Levemir, or Novomix pen injectors. Data were collected from October 2013 to August 2014, using the Diabetes and Insulin Injection Knowledge Scale, Self-Efficacy in Administering Insulin Injection Scale, and photographs illustrating insulin injection skills. The findings indicated that "knowledge of diabetes and insulin injection," "insulin injection skills," "senior high school or above education," and "diabetes duration" were predictors of self-efficacy in administering insulin injection, which explained 41% of the total variance in self-efficacy. Health care professionals can design relevant strategies for improving patient self-efficacy in administering insulin injection, thereby increasing patients' insulin self-injection abilities.

Multisite Evaluation and Validation of a Sensitive Diagnostic and Screening System for Spinal Muscular Atrophy that Reports SMN1 and SMN2 Copy Number, along with Disease Modifier and Gene Duplication Variants.

Spinal muscular atrophy is a severe autosomal recessive disease caused by disruptions in the SMN1 gene. The nearly identical SMN2 gene copy number is associated with disease severity. SMN1 duplication markers, such as c.∗3+80T>G and c.∗211_∗212del, can assess residual carrier risk. An SMN2 disease modifier (c.859G>C) can help inform prognostic outcomes. The emergence of multiple precision gene therapies for spinal muscular atrophy requires accurate and rapid detection of SMN1 and SMN2 copy numbers to enable early treatment and optimal patient outcomes. We developed and evaluated a single-tube PCR/capillary electrophoresis assay system that quantifies SMN1/2 copy numbers and genotypes three additional clinically relevant variants. Analytical validation was performed with human cell lines and whole blood representing varying SMN1/2 copies on four capillary electrophoresis instrument models. In addition, four independent laboratories used the assay to test 468 residual clinical genomic DNA samples. The results were ≥98.3% concordant with consensus SMN1/2 exon 7 copy numbers, determined using multiplex ligation-dependent probe amplification and droplet digital PCR, and were 100% concordant with Sanger sequencing for the three variants. Furthermore, copy number values were 98.6% (SMN1) and 97.1% (SMN2) concordant to each laboratory's own reference results.

Use of proton pump inhibitors increased the risk of hip fracture: a population-based case-control study.

PURPOSE: To investigate whether the use of proton pump inhibitor (PPIs) was associated with an increased risk of hip fracture. METHODS: We conducted a population-based case-control study in Taiwan. Data were retrospectively collected from the Taiwan National health Insurance Research Database. Cases included all patients with a newly diagnosed of hip fracture in 2005 and 2006 (n = 1241). The controls were pair matched to cases by age, sex, and index date. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using multiple logistic regression. RESULTS: Having been prescribed more than 28 defined daily dose (DDDs) of PPIs was associated with an increased risk for hip fracture in multivariate analyses (adjustments for matching variables and medication use) (at 29-70 DDDs, OR = 1.67, 95% CI = 1.11-2.51 and at >70 DDDs, OR = 2.51, 95% CI = 1.77-3.55). There was a significant trend toward increasing hip fracture risk with increasing cumulative DDDs of PPIs (p for trend <0.0001). CONCLUSIONS: This study provides evidence that PPIs use is associated with an increased risk of hip fracture in a dose-response manner.

The effect of health education through the internet on university female students' hepatitis B knowledge and cognition.

AIMS AND OBJECTIVES: The purpose of this study was to investigate the effect of internet health education on female university students' knowledge and cognition regarding hepatitis B. BACKGROUND: One of the focal points of preventing hepatitis B is to improve students' knowledge of hepatitis B. The internet is thought to attract learners, ensure privacy and provide channels for help. DESIGN: Cluster sampling was used to select 189 female students from two universities in Kaohsiung City. The participants were divided into 130 participants who agreed to participate in an internet health education program and 59 who did not. METHOD: The participants were administered questionnaires on 'hepatitis B knowledge' and 'hepatitis B cognition' before, two weeks after and four weeks after the health education intervention. The experimental group received an additional 'user satisfaction' survey at two weeks after the health education intervention. RESULTS: Participants in the internet hepatitis B educational program scored significantly higher in knowledge of hepatitis B at two and four weeks post intervention. No significant score differences were found in hepatitis B cognition in either of the groups two and four weeks. Sixty per cent of the experimental group indicated that the program was easy to understand, 67.69% found it helpful, 66.15% were generally satisfied with the content. Almost 67% (66.92%) thought the university should adopt and promote the web site. RELEVANCE TO CLINICAL PRACTICE: This study provides health professionals with a reference for hepatitis B health education programs.

[Influence of Rainfall Intensity on the Nutrient Loading from an Inflowing River in the Plain River Network of the Taihu Catchment].

To reveal the law of external pollution in the plain river network of the Taihu catchment, we investigated nitrogen, phosphorus, and dissolved organic carbon daily, as well as automatic recording data for flow rate and rainfall in Dapu River from 1st March, 2017 to 28th February, 2018. Dapu River, a typical inflowing river of Lake Taihu, usually has a reciprocating flow. A reciprocating flow is a common condition in the plain river network located in the Yangtze Delta. The response flow rate in the river was relatively slow to different intensities of rainfall. Flow rate significantly increased only when the rainfall intensity reached heavy rain (>25 mm·d-1). The concentrations were statistically non-significant under different rainfall intensities, and the concentrations of total nitrogen averaged 3.00±0.58, 3.34±0.93, 3.55±1.05, and 3.37±1.14 mg·L-1 under heavy rain (>25 mm·d-1), medium rain (10 mm·d-1-25 mm·d-1), light rain (<10 mm·d-1), and no rain. The concentrations of total phosphorus averaged 0.228±0.068, 0.258±0.121, 0.219±0.083, and 0.225±0.121 mg·L-1, respectively. The concentration of dissolved organic carbon and nitrogen in the Dapu River changed little during the 3 typical rainfall processes, but the concentration of phosphorus increased significantly after heavy rain when the duration was 2 days. The concentration of total phosphorus and particulate phosphorus increased significantly after medium rain when the duration was 1 day. The concentration of phosphorus did not show an obvious change after light rain. The concentration of total nitrogen was the highest under light rain, and the concentration of total phosphorus was the highest under medium rain. The daily loadings of total nitrogen from the Dapu River to Lake Taihu were 7.64, 3.19, 3.21, and 2.62 t·d-1 under conditions of heavy rain, medium rain, light rain, and no rain, respectively. The daily loadings of total phosphorus were 0.59, 0.26, 0.22, and 0.20 t·d-1 under conditions of heavy rain, medium rain, light rain, and no rain, respectively. Although the daily loading of nutrients under heavy rain conditions was the highest, the contribution of annual nutrient loading was small during heavy rain days. The reason was that the percentage of heavy rain during the entire year was small. The total nitrogen loading in heavy rain days was 61.11 tons in the observatory year, which was only 5.6% of annual loading. The total phosphorus loading in heavy rain days was 4.72 tons, which was only 5.8% of the annual loading. These low percentages of nutrient loading under heavy rainfall are quite different from situations in mountain catchments. This research showed that the transport processes of nutrients in the plain river network was complicated and its influence on nutrient concentrations and loadings in connected rivers was slow and indirect. The amount of inflow water was an important source of external nutrient loading in the plain river network. These conclusions have reference value for estimating the external loading and deciding non-point control policy of lakes in plain river network of the Taihu catchment.

Trends and prescription patterns of traditional Chinese medicine use among subjects with allergic diseases: A nationwide population-based study.

BACKGROUND: The alarmingly rising prevalence of allergic diseases has led to substantial healthcare and economic burdens worldwide. The integrated use of traditional Chinese medicines (TCM) and Western medicines has been common in treating subjects with allergic diseases in clinical practice in Taiwan. However, limited studies have been conducted to evaluate long-term trends and prescription patterns of TCM use among subjects with allergic diseases. Thus, we conducted a nationwide population-based study to characterize TCM use among subjects with allergic diseases. METHODS: A total of 241,858 subjects with diagnosed atopic dermatitis, asthma or allergic rhinitis in the period of 2003-2012 were identified from the National Health Insurance Research Database (NHIRD) in Taiwan and included in this study. We assessed trends and prescribed patterns related to TCM (both single herbs and herbal formulas) among the study subjects over the 10-year study period. RESULTS: The overall proportions of TCM use were 30.5%, 29.0% and 45.7% in subjects with atopic dermatitis, asthma and allergic rhinitis, respectively. We found increasing trends of TCM use among subjects having atopic dermatitis and asthma, with annual increase of 0.91% and 0.38%, respectively, over the 10-year study period while the proportion remained steadily high (from 46.6% in 2003 to 46.3% in 2012) among subjects having allergic rhinitis. Moreover, the number of hospitalization due to allergic diseases in TCM users was significantly smaller than that in non TCM users for all three allergic diseases. CONCLUSION: A notable proportion (30%-50%) of subjects with allergic diseases in Taiwan has used TCM, with the highest proportion of TCM use found in subjects with allergic rhinitis, whereas increasing trends of TCM use are found among subjects with atopic dermatitis and asthma, respectively. Our results suggest that TCM use may help reduce the severe episodes of allergic diseases necessitating hospitalizations.

Increased expression of the rice C-type cyclin-dependent protein kinase gene, Orysa;CDKC;1, in response to salt stress.

Cyclin-dependent protein kinases (CDKs) form a conserved superfamily of eukaryotic serine/threonine protein kinases which require binding to a regulatory cyclin for activity. CDKs are organized in several gene families and are involved in different aspects of cell biology, such as gene transcription, cell proliferation and differentiation. In this study, we present the characteristics of the rice C-type CDK gene, Orysa;CDKC;1. The gene was expressed in all organs of the plant and relatively high amounts of its transcript were detected in mature leaves and panicles. This indicated a putative role during later stages of leaf and panicle development. Using yeast two-hybrid analysis, we identified Orysa;CYCT as an interactor with Orysa;CDKC;1. The expression profiles of the new Orysa;CDKC;1 in response to various factors from rice cells were compared with those of previously described Orysa;CDKA;1, and Orysa;CDKB2;1. The Orysa;CDKC;1 transcript was induced by salt stress and ABA treatments, but was unaffected by mannitol. In addition, the MBP kinase activity associated with Orysa;CDKC;1 immunocomplexes was induced under salt stress. We propose that Orysa;CDKC;1 may be involved in developmental programs, as well as in the salt- and ABA-signaling pathway.

Increasing trends of anaphylaxis-related events: an analysis of anaphylaxis using nationwide data in Taiwan, 2001-2013.

BACKGROUND: Anaphylaxis is a severe, potentially fatal, and systemic allergic reaction. Previous studies document increasing trends in incidence rates of anaphylaxis-related events in Western countries, yet little is known about the incidence and trend of anaphylaxis in Asia. In this study, we aimed to determine time trends in incidence rates of anaphylaxis-related events in Taiwan from 2001 through 2013. METHODS: We utilized medical claims data from the National Health Insurance Research Databases in Taiwan. We identified anaphylaxis-related events (ICD-9-CM-codes: 995.0, 995.60-995.69, 999.41-999.42, and 999.49) and calculated incidence rates. Poisson regression models were applied to examine trends and incidence rates. RESULTS: A total of 2496 patients (mean age, 45.11 years; 56% male) with first-time anaphylaxis were identified during 34,430,000 person-years of observation time. The overall incidence of anaphylaxis was 7.25 (95% confidence interval (CI) = 6.97-7.53) per 100,000 person-years, increasing from 4.79 in 2001 to 8.20 in 2013, with an incidence rate ratio (IRR) of 1.05 (95%CI = 1.04-1.06). Over the 13-year period, the increasing trends were found in incident diagnosis of anaphylaxis-related outpatient or emergency department visits (IRR = 1.06, 95%CI = 1.05-1.08) and admissions to intensive care units (IRR = 1.06, 95%CI = 1.03-1.10), whereas the trends in incidence of anaphylaxis-related hospitalizations remained steady. The proportion of patients requiring hospitalizations among all patients with anaphylaxis (p _trend = 0.01), as well as the proportion requiring intensive care treatment among patients who were hospitalized (p _trend = 0.01), both increased with age. CONCLUSION: The incidence rate of anaphylaxis in Taiwan has increased at an average rate of 5% annually since 2001, paralleling the rising trends in several Western countries.

Association between Nonsteroidal Anti-Inflammatory Drugs and Colorectal Cancer: A Population-Based Case-Control Study.

Background: COX-2 overexpression may contribute to colorectal cancer occurrence. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce colorectal cancer recurrence, but the efficacy of primary prevention in Asian populations is still elusive. Thus, we examined the primary preventive efficacy of aspirin and NSAIDs on colorectal cancer incidence in Taiwan.Methods: A nested case-control study was conducted using the National Health Insurance Research Database (NHIRD) in Taiwan. We identified patients with diagnosis of colorectal cancer from 2005 to 2013 in the Registry of Catastrophic Illness Patient Database. We selected patients without colorectal cancer from the Longitudinal Health Insurance Database as the controls and matched them with cases. NSAID exposure was defined as at least two prescriptions 13 to 48 months prior to the index date. Conditional logistic regression models were performed to evaluate the association between NSAID use and colorectal cancer.Results: A total of 65,208 colorectal cancer cases and 65,208 matched controls were identified. Patients with aspirin use had a lower risk of colorectal cancer compared with nonusers [adjusted OR (AOR) = 0.94, 95% confidence interval (CI) = 0.90-0.99]. NSAID use was associated with lower incidence of colorectal cancer (AOR = 0.96; 95% CI = 0.92-1.00). When examining colon or rectal cancer, similar decreased risks were observed. Patients taking more cumulative days of NSAIDs use tended to experience a more protective effect on colorectal cancer, but no dose-response effects were noted.Conclusions: Aspirin and NSAIDs were associated with a reduced risk of colorectal cancer development among a study cohort in an Asian population.Impact: This study provided a possible chemoprevention for colorectal cancer in an Asian population. Cancer Epidemiol Biomarkers Prev; 27(7); 737-45. ©2018 AACR.

Psychotropic use and risk of stroke among patients with bipolar disorders: 10-year nationwide population based study.

OBJECTIVES: To investigate the association between psychotropic agents (including antipsychotics, antidepressants and mood stabilizers) and risk of stroke among patients with bipolar disorders. METHODS: We conducted a disease risk score-matched nested case-control study and identified patients with bipolar disorders (ICD-9 codes: 296.0x, 296.1x, 296.4x, 296.5x, 296.6x, 296.7x, 296.80, 296.81 or 296.89) from the National Health Insurance Research Database in Taiwan. Among them, we identified 1232 cases (981 were ischemic stroke and 251 were hemorrhagic stroke) and 5314 disease risk score-matched controls. Conditional logistic regression model equations were applied to determine the effect of psychotropic agents on stroke risk among patients with bipolar disorders. RESULTS: The results indicated that overall use of psychotropic agents was associated with an increased risk of stroke (adjusted odds ratio [AOR] = 1.82; 95% confidence interval [CI]: 1.56-2.13). When classifying psychotropic agents into antipsychotics, antidepressants and mood stabilizers, respectively, a significant positive association was found for users of antipsychotics (AOR = 1.98; 95% CI = 1.53-2.56), antidepressants (AOR = 1.44; 95% CI = 1.16-1.79), and mood stabilizers (AOR = 1.89; 95% CI = 1.22-2.93). Combined use of psychotropic agents was associated with higher risk of stroke than monotherapy (AOR = 2.62; 95% CI = 1.98-3.45). DISCUSSIONS: The results support our hypothesis that psychotropic use is associated with increased risk of stroke among patients with bipolar disorders. The stroke risks are higher among patients with polypharmacy than those with monotherapy. These findings warrant further investigation to confirm and replicate the findings using different methodologies and populations, and to mitigate residual confounding.

Use of antidepressants and risk of hospitalization for acute myocardial infarction: A nationwide case-crossover study.

BACKGROUND: We aimed to investigate the association between antidepressant use and the risk of hospitalization for acute myocardial infarction (AMI). METHODS: A case-crossover study was conducted using a nationwide population-based sample from Taiwan's National Health Insurance Research Database. A total of 18,631 patients with incident AMI were included in this study. The effects of antidepressant use as well as that of various classes (including tricyclic or tetracyclic antidepressants; selective serotonin reuptake inhibitors; or serotonin norepinephrine reuptake inhibitors), doses, and receptor-binding profiles of the antidepressants on AMI were assessed. Conditional logistic regression models with adjustment for potential confounding factors were applied to determine the effects of antidepressant use on the risk of AMI during case and control time periods of 15, 30, and 60 days, respectively. The modifiable effects of age, gender, and comorbidity were evaluated by stratified analysis. RESULTS: Antidepressant use was not associated with the risk of AMI (adjusted odds ratio [AOR] = 1.04; 95% confidence interval (CI): 0.88-1.24). Likewise, neither the class, dose, nor the binding affinity of serotonin transporter or norepinephrine transporter was associated with AMI risks, and there was no modifying effect of age, gender, or comorbid medical condition on the association between antidepressant use and AMI. CONCLUSIONS: Use of antidepressant drugs was not associated with the risk of AMI.