Pei-Ying Lin

Association Between Parkinson Disease and Risk of Cancer in Taiwan

IMPORTANCEnParkinson disease (PD) has been reported to be associated with a general reduced risk of cancer. These studies were mainly carried out in Western populations and little was known about associations in East Asians.nnnOBJECTIVEnTo analyze the association between PD and risk of cancer.nnnDESIGN, SETTING, AND PARTICIPANTSnIn this cohort study, the data were obtained from the Taiwan National Health Insurance Research Database, which contained information on approximately 24.7 million insured individuals. The cohort included individuals with newly diagnosed as having PD between 2004 and 2010. An age- and sex-matched systematic random-sampling method was used for subject selection in the reference non-PD cohort. Multivariate Cox proportional hazard regression analysis was used to determine the effects of PD on the risks of cancer, as shown by hazard ratios (HRs) with 95% CIs.nnnMAIN OUTCOMES AND MEASURESnThe Taiwan Population Census and National Cancer Registry Databases were used to identify patients with cancer. The last follow-up date was December 31, 2012.nnnRESULTSnIn 62u202f023 patients with PD, the HR for all subsequent cancers combined was 1.58 (95% CI, 1.50-1.65). Of the 19 types of cancer, Parkinson disease was not associated with breast, ovarian, or thyroid cancers. Increased HRs were found in the remaining 16 cancers, including malignant brain tumors (HR, 3.42; 95% CI, 1.84-6.38), gastrointestinal tract cancers (esophageal [HR, 1.81; 95% CI, 1.28-2.57], stomach [HR, 1.59; 95% CI, 1.30-1.94], colorectal [HR, 1.47; 95% CI, 1.31-1.65], liver [HR, 1.89; 95% CI, 1.67-2.14]; gallbladder [HR, 1.73; 95% CI, 1.16-2.57], and pancreas [HR, 1.48; 95% CI, 1.09-2.02]) (Pu2009<u2009.05 for all comparisons), lung cancers (HR, 1.56; 95% CI, 1.38-1.76), some hormone-related cancers (uterine [HR, 1.83; 95% CI, 1.12-3.01], cervical [HR, 1.36; 95% CI, 1.05-1.76], and prostate [HR, 1.80; 95% CI, 1.52-2.13; Pu2009<u2009.05 for all comparisons), urinary tract cancers (kidney and bladder cancers; HRs, 1.59 and 1.99, respectively; Pu2009<u2009.001 for both comparisons), lymphoma and/or leukemia (HR, 1.62; 95% CI, 1.31-2.01), melanoma (HR, 2.75; 95% CI, 1.35-5.59), and other skin cancers (HR, 1.81; 95% CI, 1.46-2.23). For hepatocellular carcinoma, the highest HR resided in the 50- to 59-year-old group (HR, 2.57; 95% CI, 1.7-3.89).nnnCONCLUSIONS AND RELEVANCEnOur study concludes that PD is is associated with most cancers in Taiwan. Further studies are needed to clarify whether our findings can be applied to other East Asian populations. The differences between our study and most previous cohorts suggest the importance of ethnicity and environmental exposures in disease pathogenesis.

Circulating miRNA signature for early diagnosis of lung cancer

Non‐small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide. Despite the numerous recent studies on NSCLC genomics, molecular mechanisms of disease and the development of targeted therapies, which improve treatment responses to a certain extent, the overall 5‐year survival rate is only around 10–15%. The main reason for such a low 5‐year survival rate has long been attributed to late diagnosis of the disease in three quarters of patients, resulting in advanced and inoperable diseases. Lung cancer studies for decades have attempted to develop screening modalities that allow early diagnosis. However, in contrast to the success in prognostic and predictive biomarker research during the past 10 years, the progress in early lung cancer screening is still limited and restricted to imaging studies.nnChest radiography and sputum cytology screening programs in the 1970s had failed to reduce cancer mortality. Low‐dose spiral chest computed tomography (LDCT) screening trials carried out in the 2000s generally resulted in a significant increase in the number of early‐stage lung cancer diagnoses, but without apparent reduction in development of advanced cancers or cancer mortality (Pastorino, 2010). The first successful large LDCT screening trial reported is the National Lung Screening Trial (NSLT). It demonstrates a 20% reduction of cancer mortality in the LDCT screening arm compared to the chest radiography arm (http://www.cancer.gov).nnThe results from these LDCT screening studies highlight several issues worth noticing. First, LDCT leads to over‐diagnosis of benign/indolent pulmonary lesions and cause significant increase of unnecessary surgical intervention (Bach, 2008 …

Invasive Infections of Aggregatibacter (Actinobacillus) Actinomycetemcomitans

BACKGROUND/PURPOSEnAggregatibacter (Actinobacillus) actinomycetemcomitans, part of the normal flora of the mouth, is frequently found in human periodontal cultures and is an important pathogen causing various invasive infections, particularly infective endocarditis. In this study, we describe the clinical course and outcome of patients with A. actinomycetemcomitans infection.nnnMETHODSnAll patients suffering invasive A. actinomycetemcomitans infections at the National Taiwan University Hospital from January 1985 to December 2004 were included in this study. Relevant data regarding clinical presentation, antimicrobial treatment and outcome of these patients were analyzed.nnnRESULTSnDuring the study period, there were 11 patients with invasive A. actinomycetemcomitans infections, including eight patients with infective endocarditis, one with osteonecrosis and two with pneumonia and chest wall lesions. Among the patients with infective endocarditis, four had prosthetic valve replacement, four suffered from rheumatic heart disease and one had undergone surgical repair of ventricular septal defect. Lesions in the oral cavity were the probable portals of entry of the microorganism, and included carious teeth, periodontitis or radiotherapy of the ear-nose-throat field, and were noted in nine patients. Transthoracic echocardiography and/or transesophageal echocardiography were performed on the patients with probable infective endocarditis but growth was demonstrated in only four of these patients. Blood culture yielded A. actinomycetemcomitans after prolonged incubation. Three isolates were resistant to penicillin and two of these were also resistant to ampicillin.nnnCONCLUSIONnThe diagnosis of invasive A. actinomycetemcomitans infection was delayed due to the indolent clinical course, non-specific presentation and slow growth of the organism. Antibiotic therapy using amoxicillin/clavulanic acid, ampicillin, ampicillin/sulbactam, ceftriaxone, clindamycin, cefotaxime, or levofloxacin was successful in all patients. None of the patients demonstrated recurrence of infection 2-36 months following treatment.

Lower gastrointestinal tract tuberculosis: an important but neglected disease

PurposeDifficulties in early and accurate diagnosis of intestinal tuberculosis lead to frequent misdiagnosis even in endemic areas. This study aimed to investigate clinical and laboratory characteristics of patients with lower gastrointestinal tract tuberculosis (LGITB).Materials and methodsPatients who met the criteria for LGITB in a medical center from 1997 to 2006 were identified and their medical records reviewed.ResultsA number of 4,567 patients with culture or histology-proven tuberculosis were identified, and 30 (0.66%) were diagnosed with LGITB. Principal co-morbidities were type II diabetes mellitus (23%) and alcoholism (23%). Twenty-two (73%) had radiographic findings suggestive of pulmonary tuberculosis, which was culture-proven in 13. Mycobacterial cultures from stool or sputum had diagnostic yields of about 50%, comparable to that of histological studies of colonoscopic or surgical biopsies. Multidrug-resistant tuberculosis (MDRTB) was identified in four patients, including two alcoholics. Fourteen underwent surgery; two (14%) received right hemicolectomy under the diagnosis of colon cancer without pre- or intraoperative histological study. The 1-year mortality was 20% but was 50% in patients with MDRTB.ConclusionsA high rate of alcoholism and diabetes mellitus and a high percentage of MDRTB among alcoholics were observed in our patients with LGITB. The diagnostic yields of stool or sputum mycobacterial culture (50%) were similar to that of intestinal histological study. Pre- or intraoperative histological examination could prevent unnecessarily extensive surgery.

Tumor size matters differently in pulmonary adenocarcinoma and squamous cell carcinoma

Little about primary tumor size and nodal/distant metastases among different cell types in non-small cell lung cancer (NSCLC) was discussed. This study aimed to investigate distinct associations between tumor size and nodal/distant metastases in pulmonary adenocarcinoma and squamous cell carcinoma. The study also aimed to clarify the cutoff size relating to a higher likelihood of metastases. We retrospectively evaluated 932 NSCLC patients over a 3-year period and focused on cases with primary tumors less than 4.0 cm in size. Our data showed that 2.5 cm was the critical cutoff size regarding increased nodal/distant metastases in adenocarcinoma (p<0.001), but not in squamous cell carcinoma (p>0.05). In addition, the incidence of nodal/distant metastases reached a plateau of more than 80% in adenocarcinoma when the tumor size exceeded 2.5 cm. In contrast, there was no such correlation observed in squamous cell carcinoma. This study showed that tumor size mattered differently in pulmonary adenocarcinoma and squamous cell carcinoma.

Extensive GI tract involvement of Ewing's sarcoma/peripheral primitive neuroectodermal tumor in an octogenarian

Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (EWS/pPNET) is a rare disease with poor prognosis. It is uncommon in Asians and usually considered a disease of children and young adults. The most common age of diagnosis is in the second decade of life, and the median age of occurrence is 15 years. Only about 20% of cases are diagnosed after 20 years of age. EWS/pPNET with GI tract involvement is very rare, and there are few case reports in the English literature. All of the reported cases are children or young adults, and none of the cases report extensive GI tract involvement. Our patient is the first and oldest in the English literature to have extensive GI tract involvement of EWS/pPNET.

Arteriovenous Hemoaccess-Related Pulmonary Arterial Hypertension-Effect of Access Flow Reduction-a Case Report

Arteriovenous access-related pulmonary arterial hypertension is a previously under-diagnosed complication in hemodialysis patients, and should be kept in mind when hemodialysis patients using surgically created arteriovenous access encounter unexplained dyspnea. It was found that successful renal transplantation, peritoneal dialysis and hemodialysis with a permanent dialysis catheter can reduce pulmonary arterial pressure in this group of patients. The patient reported herein had severe pulmonary arterial hypertension but insisted on using an arteriovenous fistula for hemodialysis. Her pulmonary arterial pressure, dyspnea and oxygenation improved after ligation of the original high-flow arteriovenous fistula and creation of a low-flow alternative. Although the pulmonary arterial pressure did not decrease to a normal range, the patients clinical symptoms and quality of life clearly improved. This case may provide new insight into the management of pulmonary arterial hypertension in this group of patients.

A patient with bronchiectasis presented with progressive dyspnoea and an unresolved right lower lung infiltrate

A 71-year-old female non-smoker had bronchiectasis with productive cough for decades. Two months prior to this admission, she developed dyspnoea on exertion with more severe cough than before. There was no associated fever, night sweats, poor appetite or weight loss. Chest radiography displayed diffuse bronchiectatic changes on the bilateral airways, with multiple ill defined infiltrates and …