Background: The COVID-19 pandemic, which broke out in Wuhan, China, in 2019, was declared an inte... more Background: The COVID-19 pandemic, which broke out in Wuhan, China, in 2019, was declared an international public health emergency by the World Health Organization on January 31, 2020. The outbreak on the Diamond Princess cruise ship had appeared first as a cluster infection outside China during the early pandemic. The incident occurred on February 1, 2020, involved an 80-year-old Hong Kong man who was diagnosed with COVID-19. The cruise ship docked in Yokohama, Japan, for 14 days of onboard quarantine; however, cluster infection outbroke rapidly. Methods: We constructed a SIR mathematical model and conducted an epidemiological study of the COVID-19 outbreak on the Diamond Princess cruise ship, covering the period from February 5 (start of quarantine) to February 20 (completion of 14-day quarantine). We estimated the basic reproduction number (R0) using a novel method of nonlinear least-squares curve fitting under Microsoft Excel Solver. The 95% confidence interval (CI) values were ...
METHODS: We prospectively measured plasma ADPN, CRP and other biochemical parameters in 238 ESRD ... more METHODS: We prospectively measured plasma ADPN, CRP and other biochemical parameters in 238 ESRD patients on maintenance PD≥ 3 months. Body composition was measured using the dual energy X-ray absorptiometry (DEXA) scan. Patients were followed prospectively for a median duration of 48 months. RESULTS: The plasma ADPN was 24.6 (13.9, 39.8) and 23.0 (13.9, 32.7) µg/ml for men and women, respectively (P= 0.42). Multiple linear regression analysis showed that log-transformed ADPN was significantly negatively ...
Background: Patients with diabetic kidney disease (DKD) are at an increased risk of frailty. The ... more Background: Patients with diabetic kidney disease (DKD) are at an increased risk of frailty. The exposure to muscle relaxants frequently leads to adverse effects despite their modest therapeutic efficacy, but whether muscle relaxants predispose users to frailty remains unclear. Methods: Patients with DKD from a population-based cohort, the Longitudinal Cohort of Diabetes Patients, were identified between 2004 and 2011 ( N = 840,000). Muscle relaxant users were propensity score-matched to never-users in a 1:1 ratio based on demographic features, comorbidities, outcome-relevant medications, and prior major interventions. Incident frailty, the study endpoint, was measured according to a modified FRAIL scale. We used Kaplan–Meier analyses and Cox proportional hazard regression to analyze the association between cumulative muscle relaxant use (⩾ 28 days) and the risk of incident frailty. Results: Totally, 11,637 users and matched never-users were enrolled, without significant differences...
Clinical and investigative medicine. Medecine clinique et experimentale, Jun 26, 2017
Few studies have addressed health-related quality of life (QoL) in patients who chose conservativ... more Few studies have addressed health-related quality of life (QoL) in patients who chose conservative management over dialysis. This systematic review aims to better define the role of conservative management in improving health-related QoL in patients with end-stage renal disease (ESRD). Medline, Cochrane and EMBASE were searched for prospective or retrospective studies published until June 30, 2016, that examined QoL of ESRD patients. The primary outcome was health-related QoL. Four studies were included (405 patients received dialysis and 332 received conservative management). Two studies that used the Short Form-36 Survey (SF-36) showed that the dialysis group had higher physical component scores, but the conservative management group had similar, or better, mental component scores at the end of intervention. Another study using the SF-36 showed that the physical and mental component scores of the dialysis group did not significantly change after intervention. In the conservative m...
Diagnostic discrepancy, defined as different admission and discharge diagnoses, could be a potent... more Diagnostic discrepancy, defined as different admission and discharge diagnoses, could be a potential source of diagnostic error. We evaluated whether acute kidney injury (AKI) in the elderly affected their risk for diagnostic discrepancy. Patients aged ≥60 years from the general medical wards were prospectively enrolled and divided according to AKI status upon admission, using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We compared their discharge and admission diagnoses and identified patients with a diagnostic discrepancy, using multiple logistic regression analysis to evaluate the relationship between initial AKI and the presence of a diagnostic discrepancy. A total of 188 participants (mean age, 77.9 years) were recruited. Regression analysis showed that initial AKI on admission was associated with a higher risk of diagnostic discrepancy upon discharge (odds ratio [OR] 3.3; p < 0.01). In contrast, higher AKI severity was also associated with an increased ri...
Although chronic kidney disease (CKD) is associated with functional decline, whether proteinuria ... more Although chronic kidney disease (CKD) is associated with functional decline, whether proteinuria alone is associated with functional statuses over the course of acute illnesses independent of CKD is unclear. During 2014, we prospectively enrolled non-dialysis patients aged ≥65 years, and all participants underwent spot dipstick urinalysis on admission, divided into 3 groups according to the results (none, trace to 1 + , and 2 + or higher); functional status was evaluated using the pre-morbid and in-hospital Barthel index (BI) scores. Of 136 community-dwelling elderly patients enrolled (age 80.7 ± 8.2 years, with 19% having CKD), 17%, 57%, and 26% had no, trace to 1 + , or 2 + or higher proteinuria. Overall pre-morbid, on-admission, and on-discharge BI scores were 50.4 ± 41.9, 38.6 ± 31.8, and 38.7 ± 35.3, respectively with significant negative correlations with proteinuric severity on admission. Finally, multivariate linear stepwise regression analysis with backward variable selecti...
Scandinavian journal of trauma, resuscitation and emergency medicine, Jan 10, 2017
Few studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We i... more Few studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We investigated whether thrombocytopenia was a risk factor for AKI in geriatric patients with medical illnesses. A prospective cohort study was conducted, by recruiting elderly (≥65 years) patients who visited the emergency department (ED) for medical illnesses during 2014. They all received hemogram for platelet count determination, and were stratified according to the presence of thrombocytopenia (platelets, <150 K/μL) during their initial ED evaluation. They were prospectively followed up during their ED stay. We analyzed the relationship between the diagnosis of thrombocytopenia and subsequent AKI after ED stay, using Cox proportional hazard modeling, with platelet count as a continuous variable or thrombocytopenia as a categorical variable. Of 136 elderly patients (mean age of 80.7 ± 8.2 years, 40% with chronic kidney disease, and 39% with diabetes) enrolled, 22.8% presented with thr...
Polypharmacy is common in the elderly due to multimorbidity and interventions. However, the tempo... more Polypharmacy is common in the elderly due to multimorbidity and interventions. However, the temporal association between polypharmacy and renal outcomes is rarely addressed and recognized. We investigated the association between cardiovascular (CV) polypharmacy and the risk of acute kidney injury (AKI) in elderly patients.We used the Taiwan National Health Insurance PharmaCloud system to investigate the relationship between cumulative CV medications in the 3 months before admission and risk of AKI in the elderly at their admission to general medical wards in a single center. Community-dwelling elderly patients (>60 years) were prospectively enrolled and classified according to the number of preadmission CV medications. CV polypharmacy was defined as use of 2 or more CV medications.We enrolled 152 patients, 48% with AKI (based upon Kidney Disease Improving Global Outcomes [KDIGO] classification) and 64% with CV polypharmacy. The incidence of AKI was higher in patients taking more ...
Chronic hepatitis C (CHC) remains frequent in dialysis patients.1 Currently, interferon (IFN) mon... more Chronic hepatitis C (CHC) remains frequent in dialysis patients.1 Currently, interferon (IFN) monotherapy is the standard of care for dialysis CHC patients.2 In a previous paper published in the journal, we demonstrated that treatment with weekly pegylated IFNα-2a had a significantly higher sustained virological response (SVR) rate than that with thrice weekly standard IFNα-2a in such patients (48% vs 20%, p = 0.02).3 Although dialysis CHC patients responded better to IFN monotherapy than those with normal renal function, the overall SVR rates are far from satisfactory.4 5 Retreatment with pegylated IFN plus ribavirin in ordinary CHC patients who relapsed from prior standard IFN had an SVR rate of 52%.6 Among these patients, the SVR rates for genotype 1 and 2/3 patients were 47% and 63%, respectively. Although ribavirin is contraindicated in dialysis CHC patients for the risk of …
The COVID-19 pandemic broke out in Wuhan, China, and declared an international public health emer... more The COVID-19 pandemic broke out in Wuhan, China, and declared an international public health emergency by the World Health Organization in 2019. It mainly manifests as symptoms of respiratory infections, and severe cases can cause pneumonia and death. The Diamond Princess cruise ship outbroke cluster infection outside China during the early pandemic. The incident occurred on February 1, 2020, and an 80-year-old Hong Kong man was diagnosed with COVID-19. The cruise docked in Yokohama, Japan, for 14 days on-board quarantine; however, cluster infection outbroke rapidly. The results show that after 14 days of quarantine, 634 (17.1%) cases were diagnosed with a total of 3,711 population, and 328 (51.7%) cases were asymptomatic. As of April 24, 2020, 712 cases have been diagnosed and 14 deaths have occurred. A cumulative mortality rate reaches 1.96%. Using a nonlinear least-squares curve fitting with Microsoft Excel Solver, we obtain the parameters of the SIR mathematical model of infecti...
Background: The COVID-19 pandemic, which broke out in Wuhan, China, in 2019, was declared an inte... more Background: The COVID-19 pandemic, which broke out in Wuhan, China, in 2019, was declared an international public health emergency by the World Health Organization on January 31, 2020. The outbreak on the Diamond Princess cruise ship had appeared first as a cluster infection outside China during the early pandemic. The incident occurred on February 1, 2020, involved an 80-year-old Hong Kong man who was diagnosed with COVID-19. The cruise ship docked in Yokohama, Japan, for 14 days of onboard quarantine; however, cluster infection outbroke rapidly. Methods: We constructed a SIR mathematical model and conducted an epidemiological study of the COVID-19 outbreak on the Diamond Princess cruise ship, covering the period from February 5 (start of quarantine) to February 20 (completion of 14-day quarantine). We estimated the basic reproduction number (R0) using a novel method of nonlinear least-squares curve fitting under Microsoft Excel Solver. The 95% confidence interval (CI) values were ...
METHODS: We prospectively measured plasma ADPN, CRP and other biochemical parameters in 238 ESRD ... more METHODS: We prospectively measured plasma ADPN, CRP and other biochemical parameters in 238 ESRD patients on maintenance PD≥ 3 months. Body composition was measured using the dual energy X-ray absorptiometry (DEXA) scan. Patients were followed prospectively for a median duration of 48 months. RESULTS: The plasma ADPN was 24.6 (13.9, 39.8) and 23.0 (13.9, 32.7) µg/ml for men and women, respectively (P= 0.42). Multiple linear regression analysis showed that log-transformed ADPN was significantly negatively ...
Background: Patients with diabetic kidney disease (DKD) are at an increased risk of frailty. The ... more Background: Patients with diabetic kidney disease (DKD) are at an increased risk of frailty. The exposure to muscle relaxants frequently leads to adverse effects despite their modest therapeutic efficacy, but whether muscle relaxants predispose users to frailty remains unclear. Methods: Patients with DKD from a population-based cohort, the Longitudinal Cohort of Diabetes Patients, were identified between 2004 and 2011 ( N = 840,000). Muscle relaxant users were propensity score-matched to never-users in a 1:1 ratio based on demographic features, comorbidities, outcome-relevant medications, and prior major interventions. Incident frailty, the study endpoint, was measured according to a modified FRAIL scale. We used Kaplan–Meier analyses and Cox proportional hazard regression to analyze the association between cumulative muscle relaxant use (⩾ 28 days) and the risk of incident frailty. Results: Totally, 11,637 users and matched never-users were enrolled, without significant differences...
Clinical and investigative medicine. Medecine clinique et experimentale, Jun 26, 2017
Few studies have addressed health-related quality of life (QoL) in patients who chose conservativ... more Few studies have addressed health-related quality of life (QoL) in patients who chose conservative management over dialysis. This systematic review aims to better define the role of conservative management in improving health-related QoL in patients with end-stage renal disease (ESRD). Medline, Cochrane and EMBASE were searched for prospective or retrospective studies published until June 30, 2016, that examined QoL of ESRD patients. The primary outcome was health-related QoL. Four studies were included (405 patients received dialysis and 332 received conservative management). Two studies that used the Short Form-36 Survey (SF-36) showed that the dialysis group had higher physical component scores, but the conservative management group had similar, or better, mental component scores at the end of intervention. Another study using the SF-36 showed that the physical and mental component scores of the dialysis group did not significantly change after intervention. In the conservative m...
Diagnostic discrepancy, defined as different admission and discharge diagnoses, could be a potent... more Diagnostic discrepancy, defined as different admission and discharge diagnoses, could be a potential source of diagnostic error. We evaluated whether acute kidney injury (AKI) in the elderly affected their risk for diagnostic discrepancy. Patients aged ≥60 years from the general medical wards were prospectively enrolled and divided according to AKI status upon admission, using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We compared their discharge and admission diagnoses and identified patients with a diagnostic discrepancy, using multiple logistic regression analysis to evaluate the relationship between initial AKI and the presence of a diagnostic discrepancy. A total of 188 participants (mean age, 77.9 years) were recruited. Regression analysis showed that initial AKI on admission was associated with a higher risk of diagnostic discrepancy upon discharge (odds ratio [OR] 3.3; p < 0.01). In contrast, higher AKI severity was also associated with an increased ri...
Although chronic kidney disease (CKD) is associated with functional decline, whether proteinuria ... more Although chronic kidney disease (CKD) is associated with functional decline, whether proteinuria alone is associated with functional statuses over the course of acute illnesses independent of CKD is unclear. During 2014, we prospectively enrolled non-dialysis patients aged ≥65 years, and all participants underwent spot dipstick urinalysis on admission, divided into 3 groups according to the results (none, trace to 1 + , and 2 + or higher); functional status was evaluated using the pre-morbid and in-hospital Barthel index (BI) scores. Of 136 community-dwelling elderly patients enrolled (age 80.7 ± 8.2 years, with 19% having CKD), 17%, 57%, and 26% had no, trace to 1 + , or 2 + or higher proteinuria. Overall pre-morbid, on-admission, and on-discharge BI scores were 50.4 ± 41.9, 38.6 ± 31.8, and 38.7 ± 35.3, respectively with significant negative correlations with proteinuric severity on admission. Finally, multivariate linear stepwise regression analysis with backward variable selecti...
Scandinavian journal of trauma, resuscitation and emergency medicine, Jan 10, 2017
Few studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We i... more Few studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We investigated whether thrombocytopenia was a risk factor for AKI in geriatric patients with medical illnesses. A prospective cohort study was conducted, by recruiting elderly (≥65 years) patients who visited the emergency department (ED) for medical illnesses during 2014. They all received hemogram for platelet count determination, and were stratified according to the presence of thrombocytopenia (platelets, <150 K/μL) during their initial ED evaluation. They were prospectively followed up during their ED stay. We analyzed the relationship between the diagnosis of thrombocytopenia and subsequent AKI after ED stay, using Cox proportional hazard modeling, with platelet count as a continuous variable or thrombocytopenia as a categorical variable. Of 136 elderly patients (mean age of 80.7 ± 8.2 years, 40% with chronic kidney disease, and 39% with diabetes) enrolled, 22.8% presented with thr...
Polypharmacy is common in the elderly due to multimorbidity and interventions. However, the tempo... more Polypharmacy is common in the elderly due to multimorbidity and interventions. However, the temporal association between polypharmacy and renal outcomes is rarely addressed and recognized. We investigated the association between cardiovascular (CV) polypharmacy and the risk of acute kidney injury (AKI) in elderly patients.We used the Taiwan National Health Insurance PharmaCloud system to investigate the relationship between cumulative CV medications in the 3 months before admission and risk of AKI in the elderly at their admission to general medical wards in a single center. Community-dwelling elderly patients (>60 years) were prospectively enrolled and classified according to the number of preadmission CV medications. CV polypharmacy was defined as use of 2 or more CV medications.We enrolled 152 patients, 48% with AKI (based upon Kidney Disease Improving Global Outcomes [KDIGO] classification) and 64% with CV polypharmacy. The incidence of AKI was higher in patients taking more ...
Chronic hepatitis C (CHC) remains frequent in dialysis patients.1 Currently, interferon (IFN) mon... more Chronic hepatitis C (CHC) remains frequent in dialysis patients.1 Currently, interferon (IFN) monotherapy is the standard of care for dialysis CHC patients.2 In a previous paper published in the journal, we demonstrated that treatment with weekly pegylated IFNα-2a had a significantly higher sustained virological response (SVR) rate than that with thrice weekly standard IFNα-2a in such patients (48% vs 20%, p = 0.02).3 Although dialysis CHC patients responded better to IFN monotherapy than those with normal renal function, the overall SVR rates are far from satisfactory.4 5 Retreatment with pegylated IFN plus ribavirin in ordinary CHC patients who relapsed from prior standard IFN had an SVR rate of 52%.6 Among these patients, the SVR rates for genotype 1 and 2/3 patients were 47% and 63%, respectively. Although ribavirin is contraindicated in dialysis CHC patients for the risk of …
The COVID-19 pandemic broke out in Wuhan, China, and declared an international public health emer... more The COVID-19 pandemic broke out in Wuhan, China, and declared an international public health emergency by the World Health Organization in 2019. It mainly manifests as symptoms of respiratory infections, and severe cases can cause pneumonia and death. The Diamond Princess cruise ship outbroke cluster infection outside China during the early pandemic. The incident occurred on February 1, 2020, and an 80-year-old Hong Kong man was diagnosed with COVID-19. The cruise docked in Yokohama, Japan, for 14 days on-board quarantine; however, cluster infection outbroke rapidly. The results show that after 14 days of quarantine, 634 (17.1%) cases were diagnosed with a total of 3,711 population, and 328 (51.7%) cases were asymptomatic. As of April 24, 2020, 712 cases have been diagnosed and 14 deaths have occurred. A cumulative mortality rate reaches 1.96%. Using a nonlinear least-squares curve fitting with Microsoft Excel Solver, we obtain the parameters of the SIR mathematical model of infecti...
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