A highly efficient liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for etomidate and etomidate acid in urine, liver and kidney.

Etomidate (ETO) is a highly-efficient drug that can induce anesthesia with increasing doses, thus subject to strict regulation. However, an accurate and efficient method for ETO intake detection is currently lacking. Therefore, this study developed a straightforward sample preparation method using LC-MS/MS to analyze ETO and its primary metabolite, etomidate acid (ETA), in urine, liver, and kidney samples. Snap frozen pig liver and kidney samples were ground into a fine powder. Then, all the biological samples, including human urine, pig liver and kidney tissues, were deproteinized using acetonitrile and filtered for analysis. The separation was achieved in 9.01 min with gradient elution. The calibration curves ranged from 0.5 to 50 ng/mL for ETO in urine and 0.5 to 50 ng/g in liver and kidney, while the curves ranged from 1 to 100 ng/mL for ETA in urine and 1 to 100 ng/g in liver and kidney. The correlation coefficients (R2) were greater than 0.9957. The Limit of detection (LOD) and limit of quantitation (LOQ) for ETO were 0.2 and 0.5 ng/mL in urine samples and 0.2 and 0.5 ng/g in liver and kidney samples, respectively. For ETA, the LOD and LOQ were 0.5 and 1 ng/mL in urine samples and 0.5 and 1 ng/g in liver and kidney samples. This method was assessed by validation parameters, including selectivity, intra- and inter-day precision and accuracy, recovery, matrix effect, dilution integrity and stability. It was successfully applied to a practical case, revealing ETO and ETA concentrations in urine of 1.01 and 5.58 µg/mL, in liver samples of 12.30 and 1.13 µg/g, and in kidney samples of 6.95 and 4.23 µg/g. This suggests that the method is suitable for routine forensic detection of illicit ETO abuse.

The development and transcriptome regulation of the secondary trunk of Ginkgo biloba L.

Secondary trunk Ginkgo biloba is one of the specific germplasms of G. biloba. In this study, paraffin sectioning, high-performance liquid chromatography and transcriptome sequencing technology were used to study the development of the secondary trunk of G. biloba from the morphological, physiological and molecular levels. The results showed that the secondary trunk of G. biloba originated from the latent buds in the stem cortex at the junction of the root and stem of the main trunk. The development process of secondary trunk was divided into 4 periods: the dormancy period of the secondary trunk buds, the differentiation period, the formation period of transport tissue, and the budding period. Transcriptome sequencing was performed by comparing the germination period and elongation growth period of the secondary trunk with the normal parts of the same period where no secondary trunks occurred. Differential genes involved in phytohormone signal transduction, phenylpropane biosynthesis, phenylalanine metabolism, glycolysis and other pathways can regulate not only the inhibition of early dormant buds but also the later development of the secondary trunk. Genes related to IAA synthesis are upregulated and indole-3-acetic acid content is increased, leading to the up-regulated expression of IAA intracellular vector genes. The IAA response gene (SAUR) receives and responds to IAA signals to promote the development of the secondary trunk. Through the enrichment of differential genes and functional annotations, a key regulatory pathway map for the occurrence of the secondary trunk of G. biloba was sorted out.

XGBG: A Novel Method for Identifying Ovarian Carcinoma Susceptible Genes Based on Deep Learning.

Ovarian carcinomas (OCs) represent a heterogeneous group of neoplasms consisting of several entities with pathogenesis, molecular profiles, multiple risk factors, and outcomes. OC has been regarded as the most lethal cancer among women all around the world. There are at least five main types of OCs classified by the fifth edition of the World Health Organization of tumors: high-/low-grade serous carcinoma, mucinous carcinoma, clear cell carcinoma, and endometrioid carcinoma. With the improved knowledge of genome-wide association study (GWAS) and expression quantitative trait locus (eQTL) analyses, the knowledge of genomic landscape of complex diseases has been uncovered in large measure. Moreover, pathway analyses also play an important role in exploring the underlying mechanism of complex diseases by providing curated pathway models and information about molecular dynamics and cellular processes. To investigate OCs deeper, we introduced a novel disease susceptible gene prediction method, XGBG, which could be used in identifying OC-related genes based on different omics data and deep learning methods. We first employed the graph convolutional network (GCN) to reconstruct the gene features based on both gene feature and network topological structure. Then, a boosting method is utilized to predict OC susceptible genes. As a result, our model achieved a high AUC of 0.7541 and an AUPR of 0.8051, which indicates the effectiveness of the XGPG. Based on the newly predicted OC susceptible genes, we gathered and researched related literatures to provide strong support to the results, which may help in understanding the pathogenesis and mechanisms of the disease.

Adjuvant radiotherapy did not increase the risk of coronary heart disease in patients with non-metastatic breast cancer.

OBJECTIVE: Adjuvant radiotherapy (RT) in patients with breast cancer can adversely cause the heart to receive some radiation doses, which may lead to cardiovascular diseases. The results of previous research regarding this issue are not consistent. Therefore, we conducted a nationwide population-based study in Taiwan to evaluate whether adjuvant RT for breast cancer patients increased the risk of developing coronary heart disease (CHD). METHODS: This retrospective cohort study examined data from the National Health Insurance Research Database, Registry for Catastrophic Illness Patients, and Taiwan Cancer Registry Database. We identified 83,733 patients with breast cancer between 1 January 2000 and 31 December 2017. Individuals without breast cancer from the general population were frequency-matched by age and index year with individuals with breast cancer. Participants were followed until the occurrence of a CHD event, the end of follow-up, or patient record removal due to death or withdrawal from the NHI. A Cox proportional hazards regression analysis was conducted to compare the risk of CHD in breast cancer patients with that in patients in the comparison cohort. RESULTS: Compared to breast cancer patients without RT, those who underwent RT had a similar risk of subsequently developing CHD (adjusted hazard ratio, 0.94; 95% confidence interval, 0.87-1.02). Similar results were observed in a subgroup of patients with left-sided breast cancer. However, among patients who received adjuvant RT, those with left-sided breast cancer had a significantly higher risk of CHD than did those with right-sided breast cancer (adjusted hazard ratio, 1.17; 95% confidence interval, 1.04-1.30). Patients who received RT in 2010 or later had a significantly lower risk of CHD compared with those who received RT before 2010 (adjusted hazard ratio, 0.64; 95% confidence interval, 0.45-0.91). Higher prescribed doses of RT to the left-sided breast did not correspond to a higher risk of CHD. CONCLUSION: This large, nationwide cohort study suggests that adjuvant RT in patients with breast cancer did not increase the risk of CHD.

Oral vaccination with attenuated Salmonella encoding the Trichinella spiralis 43-kDa protein elicits protective immunity in BALB/c mice.

A vaccine against Trichinella spiralis infection is urgently needed to interrupt its transmission from domestic animals to humans. However, no vaccine against T. spiralis is currently available. Our previous study demonstrated that the use of the 43-kDa glycoprotein present in excretory-secretory (ES) proteins of muscle larvae (ML) as an intramuscular DNA vaccine led to a 52.1% protection rate against T. spiralis infection. Attenuated Salmonella strains have the advantage of eliciting mucosal immunity, which is important for controlling T. spiralis infections at the intestinal stage and can be provided as vaccines via oral or intranasal routes. Therefore, in this study, complete 43-kDa glycoprotein (Ts43) sequences of T. spiralis were cloned into the vector pYA3681, and the recombinant plasmid pYA3681-Ts43 was transformed into the attenuated Salmonella typhimurium strain χ11802. The results showed that oral vaccination of mice with attenuated Salmonella carrying the recombinant plasmid pYA3681-Ts43 induced an evident elevation of the local intestinal mucosal sIgA and serum IgG antibody responses. The flow cytometry results showed that the percentages of CD4+ T cells and secreted IFN-γ, IL-4, and IL-17A in CD4+ T cells were significantly increased in the spleen and mesenteric lymph node (MLN) lymphocytes of the vaccinated groups. In addition, increased levels of the IFN-γ, IL-4, and IL-17A cytokines were also observed in the serum of the immunized groups. The above immune response results in the immunized groups demonstrated that protective immunity was elicited in this study. Finally, vaccinated mice demonstrated a significant 45.9% reduction in ML burden after infection with T. spiralis. This study demonstrated that oral vaccination with Ts43 delivered by attenuated Salmonella elicited local and systemic concurrent Th1/Th2/Th17 immune responses and provided partial protection against T. spiralis infection in BALB/c mice. This is a prospective strategy for the prevention and control of trichinellosis.

Uterine myoma is associated with an increased risk of lung cancer: A nationwide population-based cohort study.

OBJECTIVE: The rate of lung cancer in female patients is increasing, with different features from male patients being displayed. Hormonal factors could play a role. The association between the development of uterine myoma (UM) and female hormones has also been reported. The relationship between female lung cancer and UM may be due to the effect of female hormones. METHODS: Data from 50 711 Taiwanese women with UM were retrieved from the National Health Insurance Research Database between 2000 and 2012. They were propensity-score matched with 50 711 women without UM (control group). A multivariate Cox proportional hazard regression model was used to compare the incidence of lung cancer between groups and to determine the hazard ratio of lung cancer in the UM group. RESULTS: The risk of lung cancer was significantly higher in women with myoma (adjusted hazard ratio: 1.62, 95% confidence ratio = 1.24-2.12). Stratified analyses demonstrated that the significantly increased risk of lung cancer was more likely to be found in certain groups, such as women who (a) are of younger age, (b) have a mid-level income, (c) have the highest urbanisation level, (d) are office workers and (e) with a longer follow-up period of myoma. Furthermore, myomectomy did not affect the risk pattern. CONCLUSION: The results from this nationwide population-based cohort study suggested that UM is associated with a higher risk of developing lung cancer. However, the exact underlying mechanism accounted for this remains unclear, and our findings still need to be verified by further comprehensive studies elsewhere.

Uterine Fibroids Increase the Risk of Thyroid Cancer.

OBJECTIVES: The formation of uterine fibroids (UF) is potentially linked to the development of thyroid cancer through a common factor: female sex hormones. METHODS: We conducted a nationwide population-based cohort study to determine whether Taiwanese women with UF have an increased risk of thyroid cancer. The data of both the UF and control groups were derived from the National Health Insurance Research Database (NHIRD) of Taiwan. Groups were matched by the year of UF diagnosis, age, income, urbanization level, occupation, and comorbidities. A Cox proportional hazard regression model was used to compare the incidence of thyroid cancer between the UF and control groups. In addition, the model was used to determine the hazard ratio of thyroid cancer in the UF group in comparison with the control group. RESULTS: Women with UF had a statistically significantly increased risk of thyroid cancer compared with controls (adjusted hazard ratio (aHR): 1.64, 95% confidence interval (CI): 1.26-2.13). Stratified analyses showed that women with UF who had a significantly increased risk of thyroid cancer were more likely to be middle aged, have middle and higher income levels, and a medium follow-up period (1-5 years) of UF. No other UF patient characteristics and comorbidities showed association with the risk of thyroid cancer. In addition, UF patients had a significantly increased risk of thyroid cancer regardless of whether or not they underwent myomectomy. CONCLUSIONS: The results suggest that women with UF have an increased risk of subsequent thyroid cancer. Further research is needed to explore whether surveillance strategies for the early detection of thyroid cancer using ultrasonography should be implemented among patients with UF.

Suicide attempts in patients with head and neck cancer in Taiwan.

OBJECTIVE: We examined the risk of suicide attempts in patients with head and neck cancer (HNC) in comparison with that in the general population and in patients of other cancers (including all other cancers rather than HNC). METHODS: The definition of suicide attempt here is that an attempt of suicide with or without completed suicide. This retrospective cohort study consisted of 66 931 cases of HNC and individual without HNC from the general population assigned to the control group. Cox's proportion hazard regression analysis was conducted to compare the subsequent suicide attempt risk between patients with HNC and the control group. RESULTS: The suicide attempt rate for HNC and control groups were 7.44 and 1.98 per 10 000 person-year, respectively. A more than three-fold higher risk of suicide attempts was observed in the HNC group than in the control group (adjusted hazard ratio [HR]: 3.72; 95% confidence intervals: 2.85, 4.88). Patients of HNC also had a significantly 1.9-fold higher risk of suicide attempt than patients with other cancers. Subsequent stratified analyses revealed a significantly elevated risk of suicide attempts across every cancer anatomic subsite and almost all categories of various demographics, but the risk was limited to male patients and patients with no comorbidity. The suicide attempt rate was the highest among patients with oropharyngeal cancer, and chemotherapy was associated with an elevated risk of suicide attempt. CONCLUSIONS: Patients with HNC are vulnerable to an increased risk of suicide attempts than the general population and patients with other cancers.

The Performance of Different Artificial Intelligence Models in Predicting Breast Cancer among Individuals Having Type 2 Diabetes Mellitus.

Objective: Early reports indicate that individuals with type 2 diabetes mellitus (T2DM) may have a greater incidence of breast malignancy than patients without T2DM. The aim of this study was to investigate the effectiveness of three different models for predicting risk of breast cancer in patients with T2DM of different characteristics. Study design and methodology: From 2000 to 2012, data on 636,111 newly diagnosed female T2DM patients were available in the Taiwan's National Health Insurance Research Database. By applying their data, a risk prediction model of breast cancer in patients with T2DM was created. We also collected data on potential predictors of breast cancer so that adjustments for their effect could be made in the analysis. Synthetic Minority Oversampling Technology (SMOTE) was utilized to increase data for small population samples. Each datum was randomly assigned based on a ratio of about 39:1 into the training and test sets. Logistic Regression (LR), Artificial Neural Network (ANN) and Random Forest (RF) models were determined using recall, accuracy, F1 score and area under the receiver operating characteristic curve (AUC). Results: The AUC of the LR (0.834), ANN (0.865), and RF (0.959) models were found. The largest AUC among the three models was seen in the RF model. Conclusions: Although the LR, ANN, and RF models all showed high accuracy predicting the risk of breast cancer in Taiwanese with T2DM, the RF model performed best.

Long-Term Use of Tamoxifen Is Associated With a Decreased Subsequent Meningioma Risk in Patients With Breast Cancer: A Nationwide Population-Based Cohort Study.

Background: Earlier studies have indicated a relatively higher risk of occurring meningioma among female breast cancer survivors and have suggested that tamoxifen might decrease this risk. The present study evaluated whether tamoxifen use in breast cancer patients can reduce the risk of meningioma. Methods: We designed a population-based cohort study by using data from the National Health Insurance system of Taiwan to assess this issue. Between January 1, 2000, and December 31, 2008, women with breast cancer and of age ≥20 years were included. They were divided into two groups: those who had not received tamoxifen therapy and those who had. The Cox's proportion hazard regression analysis was conducted to estimate the effects of tamoxifen treatment and the subsequent meningioma risk. Results: We identified a total of 50,442 tamoxifen users and 30,929 non-tamoxifen users. Tamoxifen users had a borderline significantly lower overall risk of meningioma than non-tamoxifen users [adjusted hazard ratio (aHR) = 0.64, 95% confidence interval (95% CI) = 0.40-1.02]. A statistically significant difference was found in those patients with tamoxifen treatment duration longer than 1,500 days (aHR = 0.42, 95% CI = 0.19-0.91) or with cumulative dosage exceeding 26,320 mg (aHR = 0.44, 95% CI = 0.22-0.88). Furthermore, no statistically significant joint effect of aromatase inhibitors and tamoxifen on the occurrence of meningioma among breast cancer patients was seen. Conclusion: Tamoxifen users had a non-significantly (36%) lower risk of developing meningioma than did tamoxifen non-users; however, our data indicated that tamoxifen therapy is associated with a reduced meningioma risk for Taiwanese breast cancer patients receiving long duration or high cumulative dosage treatment with tamoxifen.

Constrained-induced movement therapy promotes motor function recovery by enhancing the remodeling of ipsilesional corticospinal tract in rats after stroke.

Constraint-induced movement therapy (CIMT), which forces the use of the impaired limb by restraining the unaffected limb, has been used extensively for the recovery of limb motor function after stroke. However, the underlying mechanism of CIMT remains unclear. Diffusion tensor imaging (DTI) is a well-known neuroimaging technique that reflects the microstructure of white matter tracts and potential changes associated with different treatments. The aim of this study is to use DTI imaging to determine how corticospinal tract (CST) fibers remodel in ischemic rats with CIMT. In the present study, rats were randomly divided into three groups: a middle cerebral artery occlusion group (MCAO), a therapeutic group (MCAO + CIMT), and a sham-operated group (sham). A plaster cast was used to restrict the unaffected limb of the rats in the MCAO + CIMT group for 14 days. The Catwalk system was used to assess the limb motor function of rats. Fractional anisotropy (FA) and the average diffusion coefficient (ADC) of the CST were quantified through DTI. The expression of the c-Jun-N-terminal kinase signaling pathway (JNK) was examined after 14 days of CIMT. We found that CIMT could accelerate and enhance motor function recovery, and the MCAO + CIMT group showed significantly increased FA values in the ipsilesional posterior limb of internal capsule (PLIC) compared with the MCAO group. In addition, we found no significant difference in the ratio of phosphorylated-JNK/total-JNK among the three groups, whereas the expression of P-JNK decreased significantly in the chronic phase of stroke. In conclusion, CIMT-induced functional recovery following ischemic stroke through facilitation of the remodeling of ipsilesional CST, and restoration after ischemic stroke may be associated with the declining value of the ratio of P-JNK/JNK.

Development of a prediction model for pancreatic cancer in patients with type 2 diabetes using logistic regression and artificial neural network models.

OBJECTIVES: Patients with type 2 diabetes (T2DM) are suggested to have a higher risk of developing pancreatic cancer. We used two models to predict pancreatic cancer risk among patients with T2DM. METHODS: The original data used for this investigation were retrieved from the National Health Insurance Research Database of Taiwan. The prediction models included the available possible risk factors for pancreatic cancer. The data were split into training and test sets: 97.5% of the data were used as the training set and 2.5% of the data were used as the test set. Logistic regression (LR) and artificial neural network (ANN) models were implemented using Python (Version 3.7.0). The F 1, precision, and recall were compared between the LR and the ANN models. The areas under the receiver operating characteristic (ROC) curves of the prediction models were also compared. RESULTS: The metrics used in this study indicated that the LR model more accurately predicted pancreatic cancer than the ANN model. For the LR model, the area under the ROC curve in the prediction of pancreatic cancer was 0.727, indicating a good fit. CONCLUSION: Using this LR model, our results suggested that we could appropriately predict pancreatic cancer risk in patients with T2DM in Taiwan.

Risk of suicide attempts among colorectal cancer patients: A nationwide population-based matched cohort study.

OBJECTIVE: Patients with colorectal cancer (CRC) have been found to have a higher risk of suicide in limited-number studies. However, data on the actual incidence rate of suicide remain scarce. METHODS: Using Taiwan's National Health Insurance Research Database, we examined whether patients with CRC in Taiwan are at increased risk of suicide attempts. In this retrospective matched cohort study, data of 96 470 cases of CRC during 1 January 2000 to 31 December 2010 were collected. The control group was derived from general population by frequency matching 2 individuals without CRC for each individual with CRC by year of CRC diagnosis, age, and sex. The suicide risk in the CRC group compared with the control group was determined through Cox proportional hazard regression. We also compared the Kaplan-Meier analyses to competing risk cumulative incidence curves using the Aalen-Johansen estimator. RESULTS: A statistically significant 103% higher risk of suicide was observed in the CRC group compared with the control group (adjusted hazard ratio: 2.03; 95% confidence ratio: 1.60-2.56). Additional stratified analyses revealed a significantly elevated risk across almost all demographic groups but limited to rectum location, short follow-up time (<5 years), and without comorbidity. CONCLUSIONS: Our study suggested that patients with CRC in Taiwan have an elevated risk of suicide. Oncologists should pay attention to these patients and should consider referring them for psychological consultation to prevent suicide.

Development of a Prediction Model for Colorectal Cancer among Patients with Type 2 Diabetes Mellitus Using a Deep Neural Network.

OBJECTIVES: Observational studies suggested that patients with type 2 diabetes mellitus (T2DM) presented a higher risk of developing colorectal cancer (CRC). The current study aims to create a deep neural network (DNN) to predict the onset of CRC for patients with T2DM. METHODS: We employed the national health insurance database of Taiwan to create predictive models for detecting an increased risk of subsequent CRC development in T2DM patients in Taiwan. We identified a total of 1,349,640 patients between 2000 and 2012 with newly diagnosed T2DM. All the available possible risk factors for CRC were also included in the analyses. The data were split into training and test sets with 97.5% of the patients in the training set and 2.5% of the patients in the test set. The deep neural network (DNN) model was optimized using Adam with Nesterov's accelerated gradient descent. The recall, precision, F1 values, and the area under the receiver operating characteristic (ROC) curve were used to evaluate predictor performance. RESULTS: The F1, precision, and recall values of the DNN model across all data were 0.931, 0.982, and 0.889, respectively. The area under the ROC curve of the DNN model across all data was 0.738, compared to the ideal value of 1. The metrics indicate that the DNN model appropriately predicted CRC. In contrast, a single variable predictor using adapted the Diabetes Complication Severity Index showed poorer performance compared to the DNN model. CONCLUSIONS: Our results indicated that the DNN model is an appropriate tool to predict CRC risk in patients with T2DM in Taiwan.

Explore the effects of Huang-Lian-Jie-Du-Tang on Alzheimer's disease by UPLC-QTOF/MS-based plasma metabolomics study.

Alzheimer's disease (AD) is a progressive neurodegenerative disease with neither definitive pathogenesis nor effective treatment method so far. Huang-Lian-Jie-Du-Tang (HLJDT) is a classic formula of traditional Chinese medicine (TCM) proven to have ameliorative effects on learning and memory deficits of dementia. Morris water maze (MWM) test and pathology analysis have demonstrated that HLJDT could ameliorate learning and memory deficits in AD mouse model, which may act via its anti-neuroinflammation properties. According to our previous studies, an UPLC-QTOF/MS-based metabolomics approach was performed to explore the potential mechanisms of HLJDT on preventing AD. As a result, a total of 23 potential metabolites (VIP >1, |Pcorr| >0.58, CUFjk excludes 0, P < 0.05) contributing to AD progress were identified. The metabolic pathway analysis with MetPA revealed that glycerophospholipid metabolism, sphingolipid metabolism, arachidonic acid metabolism, linoleic acid metabolism and tryptophan metabolism were disturbed in mouse model of AD. After HLJDT treatment, 14 metabolites were restored back to the control-like levels.

Cancer risk in patients with candidiasis: a nationwide population-based cohort study.

BACKGROUND: Candidiasis and certain types of cancer are related to immunocompromised status. This study aimed to evaluate whether Candida infection (CI) is associated with subsequent cancer risk in Taiwan. METHODS: Data from the National Health Insurance system of Taiwan were used to evaluate the association between CI and cancer risk. The CI cohort comprised 34,829 patients. Each patient was randomly frequency matched with one person from the general population without CI on the basis of age, sex, year of index date of CI diagnosis, and other characteristics to generate the control group. We used Cox's proportional hazard regression analysis to estimate the effects of CI on subsequent cancer risk. RESULTS: Compared with the control group, patients with CI had a significantly higher risk of overall cancer (adjusted hazard ratio = 1.19, 95% confidence interval = 1.09-1.30). For subsite analysis, the risks of hematologic malignancy and head and neck, pancreatic, skin, and thyroid cancers were significantly higher in the CI group. Stratified analyses by sex, age, and follow-up time revealed different patterns. CONCLUSION: Our study suggested that CI can significantly increase overall and some individual cancer risks, which is partially compatible with previous findings.

Risk of mood disorders in patients with colorectal cancer.

BACKGROUND: To assess the risk of mood disorders among patients with colorectal cancer (CRC), a population-based cohort study was performed using the Taiwanese National Health Insurance Research Database. METHODS: The study cohort included 27242 patients diagnosed with CRC between January 1, 2000 and December 31, 2010. Four insurants from the general population without CRC were frequency matched to each case by age, sex, and index year/month to create the control group. Cox's proportional hazard regression model with hazard ratios (HRs) and 95% confidence intervals (CIs) was conducted to estimate the impact of CRC on the risk of mood disorders. RESULTS: Patients with CRC exhibited a significantly higher risk of developing mood disorders (adjusted HR=3.05, 95% CI=2.89-3.20) compared with the control group. This phenomenon was also observed for each type of mood disorder (depression, bipolar disease and anxiety), as well as across different subgroups by patient characteristics. However, a follow-up time longer than 1 year was more likely to have significantly increased risks, and we unexpectedly found that some treatments in CRC patients tended to have a decreased risk of anxiety compared to their counterparts. CONCLUSION: The findings of this population-based cohort study suggest that patients with CRC are at a higher risk of mood disorders, especially when follow-up time is longer than 1 year, but various treatments may inversely affect this association.

Cancer risk in patients with osteoporosis: a population-based cohort study.

BACKGROUND: Osteoporosis has been associated with cancer development. We conducted a nationwide population-based cohort study in Taiwan to evaluate this possible association of osteoporosis with subsequent cancer development. METHODS: A total of 35,979 patients diagnosed with osteoporosis between 2000 and 2010 identified from the National Health Insurance Research Database comprised the osteoporosis cohort, and each patient was randomly frequency matched with one individual from the general population (without osteoporosis) based on age, sex, and year of osteoporosis diagnosis to form the non-osteoporosis (control) cohort. Cox proportional hazard regression analysis was used to calculate adjusted hazard ratios and 95% confidence intervals and determine the effect of osteoporosis on cancer risk. RESULTS: Patients with osteoporosis showed a significantly higher risk of developing liver and thyroid cancers and lower risk of colorectal cancer than did individuals without osteoporosis. Male patients with osteoporosis had a significantly increased risk for liver cancer, whereas female patients with osteoporosis had a significantly increased risk for thyroid cancer, but a significantly decreased risk for overall and colorectal cancers. In addition, more significant findings were observed when age ≤64 years or the follow-up duration was ≤5 years; however, a significantly lower risk for colorectal cancer was observed when follow-up duration was >5 years. Study limits including lack of data for some health-related behaviors, inclusion criteria of osteoporosis and potential selection bias have been discussed. CONCLUSION: Patients with osteoporosis showed a higher risk for liver and thyroid cancers and a lower risk for colorectal cancer than did control individuals. Stratified analyses by sex, age, and follow-up duration showed various patterns in different cancers.

Evaluating the consistency of location of the most severe acute skin reaction and highest skin dose measured by thermoluminescent dosimeter during radiotherapy for breast cancer.

We conducted this prospective study to evaluate whether the location of the most severe acute skin reaction matches the highest skin dose measured by thermoluminescent dosimeter (TLD) during adjuvant radiotherapy (RT) for patients with breast cancer after breast conservative surgery. To determine whether TLD measurement can reflect the location of the most severe acute skin reaction, 80 consecutive patients were enrolled in this prospective study. We divided the irradiated field into breast, axillary, inframammary fold, and areola/nipple areas. In 1 treatment session when obvious skin reaction occurred, we placed the TLD chips onto the 4 areas and measured the skin dose. We determined whether the highest measured skin dose area is consistent with the location of the most severe skin reaction. The McNemar test revealed that the clinical skin reaction and TLD measurement are more consistent when the most severe skin reaction occurred at the axillary area, and the p = 0.0108. On the contrary, TLD measurement of skin dose is less likely consistent with clinical observation when the most severe skin reaction occurred at the inframammary fold, breast, and areola/nipple areas (all the p > 0.05). Considering the common site of severe skin reaction over the axillary area, TLD measurement may be an appropriate way to predict skin reaction during RT.

Infective Endocarditis and Cancer Risk: A Population-Based Cohort Study.

This study investigated the possible relationship between endocarditis and overall and individual cancer risk among study participants in Taiwan.We used data from the National Health Insurance program of Taiwan to conduct a population-based, observational, and retrospective cohort study. The case group consisted of 14,534 patients who were diagnosed with endocarditis between January 1, 2000 and December 31, 2010. For the control group, 4 patients without endocarditis were frequency matched to each endocarditis patient according to age, sex, and index year. Competing risks regression analysis was conducted to determine the effect of endocarditis on cancer risk.A large difference was noted in Charlson comorbidity index between endocarditis and nonendocarditis patients. In patients with endocarditis, the risk for developing overall cancer was significant and 119% higher than in patients without endocarditis (adjusted subhazard ratio = 2.19, 95% confidence interval = 1.98-2.42). Regarding individual cancers, in addition to head and neck, uterus, female breast and hematological malignancies, the risks of developing colorectal cancer, and some digestive tract cancers were significantly higher. Additional analyses determined that the association of cancer with endocarditis is stronger within the 1st 5 years after endocarditis diagnosis.This population-based cohort study found that patients with endocarditis are at a higher risk for colorectal cancer and other cancers in Taiwan. The risk was even higher within the 1st 5 years after endocarditis diagnosis. It suggested that endocarditis is an early marker of colorectal cancer and other cancers. The underlying mechanisms must still be explored and may account for a shared risk factor of infection in both endocarditis and malignancy.