Background: The surgeon and physician's decision-making may be influenced by many factors. Th... more Background: The surgeon and physician's decision-making may be influenced by many factors. The clinical practice guideline suggested that watchful waiting for 3 months should be the initial management for pediatric otitis media with effusion. The waiting time of ventilation tube insertion for pediatric patients is a proper measurement for physician decision-making. This study investigated factors influencing the waiting time for pediatric ventilation tube insertion and to explore factors influencing physician decision-making. Methods: Information associated with all patients under 18 years of age who received ventilation tube insertions from July 1, 2000 to December 31, 2009 were retrieved and analyzed from a nationwide, population-based administrative database. The waiting time before ventilation tube insertions from the time of diagnosis of otitis media with effusion was recorded. Certain factors that would influence the waiting time were identified. At the same time, how thes...
Background Chronic low-grade inflammation is considered one of the major mechanisms for the progr... more Background Chronic low-grade inflammation is considered one of the major mechanisms for the progression of diabetic kidney disease. We investigated the prognostic value of circulating soluble tumor necrosis factor receptor 2 (sTNFR2) for early nephropathy in patients with type 2 diabetes. Materials and methods A total of 364 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 were followed up for a median of 4 years. Renal outcomes were defined as a composite of either or both a >30% decline in the eGFR and/or albuminuria stage progression determined with consecutive tests. Results Seventy-three patients developed renal composite events. Serum concentrations of sTNFR2 were strongly associated with the risk of renal function decline and progressive changes in albuminuria. Through a receiver operating characteristic curve analysis, a serum sTNFR2 level of 1.608 ng/mL was adopted as the discriminator value for predicting renal outcomes ...
BackgroundWhether microalbuminuria predicts renal outcomes in patients with type 2 diabetes melli... more BackgroundWhether microalbuminuria predicts renal outcomes in patients with type 2 diabetes mellitus (T2DM) is argued. Fibroblast growth factor 21 (FGF-21) levels were elevated by the pathogenic process of diabetic kidney disease. The purpose of the study was to evaluate the associations of FGF-21 and renal outcomes in subjects with T2DM.MethodsChinese patients with T2DM were enrolled and then observed prospectively, and FGF-21 levels at baseline were measured. The associations of FGF-21 levels and renal composite events, defined by a drop > 30% of eGFR or worsening category of albuminuria, were evaluated using Cox analysis. The appropriate cut-off value of FGF-21 was mapped by the receiver operating characteristic (ROC) curve.ResultsAmong 312 subjects, higher FGF-21 levels were associated with higher risks of renal events in Cox analysis. The area under the curve of FGF-21 levels in the ROC curve was optimal (0.67, p < 0.001), and the cut-off value of 1.40 pg/dl exhibited the...
BACKGROUND Transgender individuals often require gender-affirming interventions, such as endogeno... more BACKGROUND Transgender individuals often require gender-affirming interventions, such as endogenous sex hormone inhibition or gender affirming hormone therapy while there is discordance between their body and gender identity. However, a recent study found that the incidence of cardiovascular events is higher in transgender patients receiving cross-sex hormone therapy. The aim of this study was to investigate the metabolic effects of an altered sex hormone profile. METHODS This retrospective study, conducted in a referral center in Northern Taiwan, analyzed metabolic changes over time in 65 trans masculine and 45 trans feminine persons. The transgender individuals were examined at four time points: before the gender affirming hormone therapy, as well as three, six, and twelve months following treatment. RESULTS Compared to baseline measurements, the trans masculine patients showed significant increases in body mass index (22.6±0.3 vs. 23.3±0.4 kg/m2; p<0.001; t=3M), low-density lipoprotein cholesterol (124.3±3.7 vs. 131.3±3.9 mg/dL; p=0.03; t=12M), creatinine (0.75±0.01 vs. 0.83±0.14 mg/dL; p<0.001; t=12M), and hemoglobin (13.5±0.7 vs. 15.2±0.2 g/dL; p<0.001; t=12M), as well as decreased high-density lipoprotein cholesterol (57±2.1 vs. 51±2.0 mg/dL; p<0.001; t=12M). The trans feminine patients had reduced low-density lipoprotein cholesterol (104.2±3.2 vs. 100.8±3.5 mg/dL; p=0.05; t=3M), hemoglobin (14.0±0.1 vs. 13.5±0.1 g/dL; p=0.008; t=12M), and creatinine (0.82±0.01 vs. 0.79±0.14 mg/dL; p<0.001; t=3M) compared to baseline data. In addition, most of these metabolic effects persisted during the follow-up period. CONCLUSION This observational, retrospective study revealed that gender affirming hormone therapy increased the relative cardiovascular risk in trans masculine individuals.
Background Chronic low-grade inflammation is considered one of the major mechanisms for the progr... more Background Chronic low-grade inflammation is considered one of the major mechanisms for the progression of diabetic kidney disease. We investigated the prognostic value of circulating soluble tumor necrosis factor receptor 2 (sTNFR2) for early nephropathy in patients with type 2 diabetes. Materials and methods A total of 346 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 were followed up for a median of 4 years. Renal outcomes were defined as a composite of either or both a > 30% decline in the eGFR and/or albuminuria stage progression determined with consecutive tests. Results Sixty-nine patients developed renal composite events. Serum concentrations of sTNFR2 were strongly associated with the risk of renal function decline and progressive changes in albuminuria. Through a receiver operating characteristic curve analysis, a serum sTNFR2 level of 1.608 ng/mL was adopted as the discriminator value for predicting renal outcomes ...
Whether the dimension of the osseous external auditory canal (OEAC) is related to chronic otitis ... more Whether the dimension of the osseous external auditory canal (OEAC) is related to chronic otitis media (COM) remains an important but unresolved issue. In the literature, routine canaloplasty has been suggested to help elucidate this problem. In this study, we intended to investigate the relationship between the diameter or shape of OEAC and COM. We retrospectively reviewed the high-resolution computed tomography (HRCT) images of the temporal bones of 62 patients with unilateral COM who underwent tympanoplasty from January 1, 2011, to December 31, 2013. For comparison, the HRCT images of another 62 patients with normal ears were collected to be the control group. The shape of OEAC was categorized into 5 groups according to Mahboubi’s classification, and the dimension of each patient’s OEAC was measured at 2 defined sections (annular section and isthmus/midcanal section). The most prevalent shape of OEAC for the lesion sides of the ears was cylindrical, followed by conical, and hourg...
Objective: The purpose of this retrospective study was to investigate the difference in treatment... more Objective: The purpose of this retrospective study was to investigate the difference in treatment outcomes for patients with idiopathic sudden sensorineural hearing loss (SSNHL) undergoing concurrent or sequential intravenous (IV) and intratympanic (IT) steroid therapies. Methods: Patients with idiopathic SSNHL admitted to Taipei Veterans Hospital from August 2011 to August 2012 were enrolled. Patients were treated with both IV dexamethasone 5 mg b.i.d. for 5 days, then tapered over 6 days, and IT injections of dexamethasone 5 mg daily. The administration of IV and IT steroids was given either concurrently or sequentially (IV steroid was administered from days 1–5 followed by IT steroid treatment starting on day 4 or day 5). The hearing outcomes of the concurrent and sequential groups were analyzed. Results: Overall, after ≥2 months following treatment, across frequencies ranging from 250 to 8,000 Hz and pure-tone average (PTA) assessments, hearing improvements were similar between ...
Baseline thyroid function testing and regular follow-up of thyroid function under amiodarone usag... more Baseline thyroid function testing and regular follow-up of thyroid function under amiodarone usage was recommended by guidelines. Little is known about the status of amiodarone monitoring in real-world clinical care in Taiwan. The objective was to determine the rate of thyroid monitoring and to assess the clinical and physicians' characteristics associated with adequate monitoring in a tertiary referral centre for arrhythmia. We reviewed the medical records of patients receiving amiodarone during the period 2008-2009 at Taipei Veterans General Hospital. The rate of baseline and follow-up thyroid function monitoring during amiodarone therapy were calculated. Factors associated with guideline adherence to monitoring were analysed. Among the 1319 enrolled cases, 36.4% (n = 480) underwent baseline thyroid function testing and 1.1% (n = 15) received measurement of anti-thyroid peroxidase antibody before amiodarone initiation. Regular follow up of thyroid function under amiodarone usa...
Background: The surgeon and physician's decision-making may be influenced by many factors. Th... more Background: The surgeon and physician's decision-making may be influenced by many factors. The clinical practice guideline suggested that watchful waiting for 3 months should be the initial management for pediatric otitis media with effusion. The waiting time of ventilation tube insertion for pediatric patients is a proper measurement for physician decision-making. This study investigated factors influencing the waiting time for pediatric ventilation tube insertion and to explore factors influencing physician decision-making. Methods: Information associated with all patients under 18 years of age who received ventilation tube insertions from July 1, 2000 to December 31, 2009 were retrieved and analyzed from a nationwide, population-based administrative database. The waiting time before ventilation tube insertions from the time of diagnosis of otitis media with effusion was recorded. Certain factors that would influence the waiting time were identified. At the same time, how thes...
Background Chronic low-grade inflammation is considered one of the major mechanisms for the progr... more Background Chronic low-grade inflammation is considered one of the major mechanisms for the progression of diabetic kidney disease. We investigated the prognostic value of circulating soluble tumor necrosis factor receptor 2 (sTNFR2) for early nephropathy in patients with type 2 diabetes. Materials and methods A total of 364 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 were followed up for a median of 4 years. Renal outcomes were defined as a composite of either or both a >30% decline in the eGFR and/or albuminuria stage progression determined with consecutive tests. Results Seventy-three patients developed renal composite events. Serum concentrations of sTNFR2 were strongly associated with the risk of renal function decline and progressive changes in albuminuria. Through a receiver operating characteristic curve analysis, a serum sTNFR2 level of 1.608 ng/mL was adopted as the discriminator value for predicting renal outcomes ...
BackgroundWhether microalbuminuria predicts renal outcomes in patients with type 2 diabetes melli... more BackgroundWhether microalbuminuria predicts renal outcomes in patients with type 2 diabetes mellitus (T2DM) is argued. Fibroblast growth factor 21 (FGF-21) levels were elevated by the pathogenic process of diabetic kidney disease. The purpose of the study was to evaluate the associations of FGF-21 and renal outcomes in subjects with T2DM.MethodsChinese patients with T2DM were enrolled and then observed prospectively, and FGF-21 levels at baseline were measured. The associations of FGF-21 levels and renal composite events, defined by a drop > 30% of eGFR or worsening category of albuminuria, were evaluated using Cox analysis. The appropriate cut-off value of FGF-21 was mapped by the receiver operating characteristic (ROC) curve.ResultsAmong 312 subjects, higher FGF-21 levels were associated with higher risks of renal events in Cox analysis. The area under the curve of FGF-21 levels in the ROC curve was optimal (0.67, p < 0.001), and the cut-off value of 1.40 pg/dl exhibited the...
BACKGROUND Transgender individuals often require gender-affirming interventions, such as endogeno... more BACKGROUND Transgender individuals often require gender-affirming interventions, such as endogenous sex hormone inhibition or gender affirming hormone therapy while there is discordance between their body and gender identity. However, a recent study found that the incidence of cardiovascular events is higher in transgender patients receiving cross-sex hormone therapy. The aim of this study was to investigate the metabolic effects of an altered sex hormone profile. METHODS This retrospective study, conducted in a referral center in Northern Taiwan, analyzed metabolic changes over time in 65 trans masculine and 45 trans feminine persons. The transgender individuals were examined at four time points: before the gender affirming hormone therapy, as well as three, six, and twelve months following treatment. RESULTS Compared to baseline measurements, the trans masculine patients showed significant increases in body mass index (22.6±0.3 vs. 23.3±0.4 kg/m2; p<0.001; t=3M), low-density lipoprotein cholesterol (124.3±3.7 vs. 131.3±3.9 mg/dL; p=0.03; t=12M), creatinine (0.75±0.01 vs. 0.83±0.14 mg/dL; p<0.001; t=12M), and hemoglobin (13.5±0.7 vs. 15.2±0.2 g/dL; p<0.001; t=12M), as well as decreased high-density lipoprotein cholesterol (57±2.1 vs. 51±2.0 mg/dL; p<0.001; t=12M). The trans feminine patients had reduced low-density lipoprotein cholesterol (104.2±3.2 vs. 100.8±3.5 mg/dL; p=0.05; t=3M), hemoglobin (14.0±0.1 vs. 13.5±0.1 g/dL; p=0.008; t=12M), and creatinine (0.82±0.01 vs. 0.79±0.14 mg/dL; p<0.001; t=3M) compared to baseline data. In addition, most of these metabolic effects persisted during the follow-up period. CONCLUSION This observational, retrospective study revealed that gender affirming hormone therapy increased the relative cardiovascular risk in trans masculine individuals.
Background Chronic low-grade inflammation is considered one of the major mechanisms for the progr... more Background Chronic low-grade inflammation is considered one of the major mechanisms for the progression of diabetic kidney disease. We investigated the prognostic value of circulating soluble tumor necrosis factor receptor 2 (sTNFR2) for early nephropathy in patients with type 2 diabetes. Materials and methods A total of 346 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 were followed up for a median of 4 years. Renal outcomes were defined as a composite of either or both a > 30% decline in the eGFR and/or albuminuria stage progression determined with consecutive tests. Results Sixty-nine patients developed renal composite events. Serum concentrations of sTNFR2 were strongly associated with the risk of renal function decline and progressive changes in albuminuria. Through a receiver operating characteristic curve analysis, a serum sTNFR2 level of 1.608 ng/mL was adopted as the discriminator value for predicting renal outcomes ...
Whether the dimension of the osseous external auditory canal (OEAC) is related to chronic otitis ... more Whether the dimension of the osseous external auditory canal (OEAC) is related to chronic otitis media (COM) remains an important but unresolved issue. In the literature, routine canaloplasty has been suggested to help elucidate this problem. In this study, we intended to investigate the relationship between the diameter or shape of OEAC and COM. We retrospectively reviewed the high-resolution computed tomography (HRCT) images of the temporal bones of 62 patients with unilateral COM who underwent tympanoplasty from January 1, 2011, to December 31, 2013. For comparison, the HRCT images of another 62 patients with normal ears were collected to be the control group. The shape of OEAC was categorized into 5 groups according to Mahboubi’s classification, and the dimension of each patient’s OEAC was measured at 2 defined sections (annular section and isthmus/midcanal section). The most prevalent shape of OEAC for the lesion sides of the ears was cylindrical, followed by conical, and hourg...
Objective: The purpose of this retrospective study was to investigate the difference in treatment... more Objective: The purpose of this retrospective study was to investigate the difference in treatment outcomes for patients with idiopathic sudden sensorineural hearing loss (SSNHL) undergoing concurrent or sequential intravenous (IV) and intratympanic (IT) steroid therapies. Methods: Patients with idiopathic SSNHL admitted to Taipei Veterans Hospital from August 2011 to August 2012 were enrolled. Patients were treated with both IV dexamethasone 5 mg b.i.d. for 5 days, then tapered over 6 days, and IT injections of dexamethasone 5 mg daily. The administration of IV and IT steroids was given either concurrently or sequentially (IV steroid was administered from days 1–5 followed by IT steroid treatment starting on day 4 or day 5). The hearing outcomes of the concurrent and sequential groups were analyzed. Results: Overall, after ≥2 months following treatment, across frequencies ranging from 250 to 8,000 Hz and pure-tone average (PTA) assessments, hearing improvements were similar between ...
Baseline thyroid function testing and regular follow-up of thyroid function under amiodarone usag... more Baseline thyroid function testing and regular follow-up of thyroid function under amiodarone usage was recommended by guidelines. Little is known about the status of amiodarone monitoring in real-world clinical care in Taiwan. The objective was to determine the rate of thyroid monitoring and to assess the clinical and physicians' characteristics associated with adequate monitoring in a tertiary referral centre for arrhythmia. We reviewed the medical records of patients receiving amiodarone during the period 2008-2009 at Taipei Veterans General Hospital. The rate of baseline and follow-up thyroid function monitoring during amiodarone therapy were calculated. Factors associated with guideline adherence to monitoring were analysed. Among the 1319 enrolled cases, 36.4% (n = 480) underwent baseline thyroid function testing and 1.1% (n = 15) received measurement of anti-thyroid peroxidase antibody before amiodarone initiation. Regular follow up of thyroid function under amiodarone usa...
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