Epidemiology of anaphylaxis: A retrospective cohort study in Taiwan.

OBJECTIVE: Medication-induced anaphylaxis is a potentially fatal event. Little is known at present about the patterns of medication-induced anaphylaxis in Asian countries. The current study aims to examine the pattern of documented incidences of drug-associated anaphylaxis in Taiwan over a 9-year period. METHODS: Cases of medication-associated anaphylaxis documented in the Taiwan National Health Insurance claims database during a span of 9 years (from January, 1997 to December, 2005) encompassing approximately 23 million person-years were reviewed. The database quantifies the drugs dispensed, clinical diagnoses, and patient demographics. RESULTS: Overall, 92 reports of medication-associated anaphylaxis in 92 patients were identified with potential causative agents documented. In this group, nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics were the main classes of medications most frequently implicated as the causative agent(s) in 89% of the cases. NSAIDs alone were implicated in 28% of cases, whereas antibiotics alone were implicated in another 28% of these cases. The use of multiple medications including either antibiotics or analgesics was documented in an additional one-third of the cases. A number of different NSAIDs including aspirin, diclofenac, ketoprofen, ketorolac, and meperidine were documented as the causative agents. Among the reported cases of antibiotics-induced anaphylaxis, cefazolin was the most frequently reported causative agent with 11 cases, followed by amoxicillin with four cases. CONCLUSION: Antibiotics and NSAIDs were the two main classes of medications most frequently implicated in the reports of anaphylaxis in the Taiwanese population. Although this may be related to the frequent use of these medications in the Taiwanese population, the observation here does advocate for reduced combination of NSAIDs and antibiotics, and more careful patient monitoring when they are combined.

Immunophenotypic features of dedifferentiated endometrial carcinoma - insights from BRG1/INI1-deficient tumours.

AIMS: Dedifferentiated endometrial carcinoma (DDEC) is defined by the presence of an undifferentiated carcinoma together with an endometrioid carcinoma. Inactivation of SMARCA4 (BRG1) and inactivation of SMARCB1 (INI1) were recently described as potential mechanisms underlying the histological dedifferentiation. The aim of this study was to characterize the immunophenotypic features of DDECs, particularly in cases with prototypical histological and molecular features (BRG1/INI1 deficiency). METHODS AND RESULTS: We evaluated PAX8, oestrogen receptor (ER) and p53 immunostaining in the endometrioid and the undifferentiated components of 20 BRG1/INI1-deficient DDECs and 15 BRG1/INI1-intact DDECs, and compared the results with those of 23 grade 3 endometrioid carcinomas. The differentiated endometrioid component was positive for PAX8 and/or ER in 19 of 20 BRG1/INI1-deficient DDECs, whereas the corresponding undifferentiated component of all 20 tumours showed a complete absence of PAX8 and ER staining. All except one of the BRG1/INI1-deficient tumours showed a wild-type p53 staining pattern. PAX8 and ER expression in the undifferentiated component was absent in 67% and 80% of BRG1/INI1-intact DDECs, respectively, whereas 47% of the BRG1/INI1-intact DDECs showed a mutated p53 staining pattern. In comparison, absent PAX8 expression and absent ER expression were each observed in the more solid area of 48% and 48% of grade 3 endometrioid carcinomas. CONCLUSIONS: The consistent absence of PAX8 and ER expression in molecularly defined (BRG1/INI1-deficient) DDECs suggests that the loss of PAX8 and ER expression is a fundamental feature of dedifferentiation. The frequent findings of a mutated p53 staining pattern in BRG1/INI1-intact DDECs indicate that BRG1/INI1-intact DDECs may be biologically different from BRG1/INI1-deficient tumours.

A 12-year ecological study of hip fracture rates among older Taiwanese adults.

Hip fracture rates in Taiwan are among the highest in the world. The aim of this study was to describe the trends of hip fracture hospitalizations among Taiwanese elderly (aged ≥ 65 years) and the trends of antiosteoporosis medication expenditure from 1999 to 2010. We conducted an ecological study using inpatient health care-utilization data from the Department of Health, and medication expenditure data from the IMS Health, Taiwan. The International Classification of Disease, Clinical Modification, 9th version, code 820 was used to identify hip fracture hospitalizations. Medications included alendronate, calcitonin, ibandronate, raloxifene, strontium ranelate, teriparatide, and zoledronic acid. Year 2010 was assigned as the reference point for age-standardized rates, currency exchange (to the US dollar), and discount rates. Over the 12-year study period, age-standardized hip fracture hospitalizations decreased by 2.7 % annually (p for trend < 0.001) for Taiwanese elders. The decline was more obvious among those aged ≥75 years (6.1 %). However, the number of hip fracture hospitalizations increased from 14,342 to 18,023. Total hospitalization costs increased by US$0.6 ± 0.2 million annually (p for trend = 0.002); however, the per capita costs decreased by US$23.0 ± 8.0 (p for trend = 0.017). The total medication expenditure increased 7.2-fold, from US$8.1 million to US$58.9 million, accounting for an increase in the overall pharmaceutical market by fivefold, from 3.4 to 15.9 ‰ (both p for trend < 0.001). From 1999 to 2010, there was a decline in hip fracture rates among elderly Taiwanese adults with a concomitant increase in antiosteoporosis medication expenditure.

Efficacy of intrathecal drug delivery system for refractory cancer pain patients: a single tertiary medical center experience.

BACKGROUND/PURPOSE: Between 10% and 20% of cancer pain patients fail to obtain adequate pain relief despite comprehensive medical management. The totally implantable programmable intrathecal drug delivery system (IDDS) is an attractive option for managing refractory cancer pain. In suitable patients, IDDS can provide reliable long-term analgesia without any permanent nerve or plexus destruction. IDDS can also allow patient care on an outpatient basis. In Taiwan, however, the experience of using IDDS in terminally ill cancer patients is very limited. METHODS: This retrospective study, describes experience of managing totally implantable programmable IDDS in 6 refractory cancer pain patients including patient selection, intraspinal morphine trial, surgical techniques, complications, and drug adjustment. Pain scores and functional status were compared before and after IDDS. RESULTS: By delivering liberal dose of intrathecal morphine, patients' pain scores decreased from 10 to 3.5. Due to much better pain control and improved quality of life, Eastern Cooperative Oncology Group performance status also improved in 4/6 patients. During the mean 5 ± 4.1 months of follow-up, two patients experienced pocket seroma, and resolved spontaneously after short-term abdominal binder compression. Otherwise, no serious complication was noted. CONCLUSION: Intrathecal morphine delivery by using totally implantable programmable IDDS is an effective method to relieve refractory cancer pain.

The utility and limitation of single nucleotide polymorphism analysis on whole genome amplified mesenchymal tumour DNA in formalin fixed tumour samples.

AIMS: In the study of tumour genetics, formalin fixed, paraffin embedded (FFPE) tumours are the most readily available tissue samples and DNA derived from FFPE tissue has been validated for array comparative genomic hybridisation (aCGH) and single nucleotide polymorphism (SNP) array analysis. Furthermore, in the study of tumour precursor genetics, whole genome amplification (WGA) has been used to produce a sufficient amount of DNA for aCGH. However, it is unclear whether the same approach can be extended to high-resolution SNP analysis. METHODS: In this study, we examined the utility and limitations of genotyping platforms performed on WGA DNA from FFPE mesenchymal tumour samples for both copy number and SNP analyses. We analysed the results obtained using DNA derived from matched FFPE and frozen tissue samples on the Affymetrix 250K Nsp SNP array. Two widely used WGA methods, Qiagen (isothermal protocol) and Sigma (thermocycling protocol) were employed to determine how WGA methods affect the results. RESULTS: We found that the use of WGA DNA derived from FFPE mesenchymal tumours for high-resolution SNP array application can produce a significant amount of false positive and false negative findings. While some of these misinterpretations appear to cluster in genomic regions with high or low GC contents, the majority appears to occur randomly. Only large scale chromosome loss of heterozygosity (LOH) (>10 Mb) can be reliably detected from WGA FFPE tumour DNA samples but not smaller LOH or copy number alterations. CONCLUSIONS: Our findings here indicate a need for caution in SNP array data interpretation when using WGA FFPE tumour-derived DNA in determining genomic alterations less than 10 Mb.

Serum selenium concentration is associated with metabolic factors in the elderly: a cross-sectional study.

BACKGROUND: Selenium is an essential micronutrient known for its antioxidant function. However, the association of serum selenium with lipid profiles and fasting glucose are inconsistent in populations with average intake of selenium. Furthermore, there were few studies conducted specifically for the elderly. This study examined the relationship of serum selenium concentration with serum lipids and fasting glucose in the Taiwanese elderly population. METHODS: This was a cross-sectional study of 200 males and females aged 65-85 years (mean 71.5 +/- 4.6 years) from Taipei, Taiwan. Serum selenium was measured by inductively coupled plasma-mass spectrometer. The association between serum selenium and metabolic factors was examined using a multivariate linear regression analysis after controlling several confounders. RESULTS: The mean serum selenium concentration was 1.14 mumol/L, without significant difference between sexes. Total cholesterol, triglycerides, and LDL cholesterol increased significantly with serum selenium concentration (P < 0.001, P < 0.05 and P < 0.001, respectively) after adjusting for age, gender, anthropometric indices, lifestyle factors, and cardio-vascular risk factors in several linear regression models. Furthermore, there was a significantly positive association between serum selenium and serum fasting glucose concentrations (P < 0.05). CONCLUSIONS: Total cholesterol, triglycerides, and LDL cholesterol, and fasting serum glucose concentrations increased significantly with serum selenium concentration in the Taiwanese elderly. The underlying mechanism warrants further research.