Direct Oral Anticoagulants in Atrial Fibrillation Patients With Concomitant Hyperthyroidism

Objective Patients with hyperthyroidism were excluded from randomized clinical trials of direct oral anticoagulants(DOACs) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Methods We performed a nationwide retrospective cohort study using data from the Taiwan National Health Insurance Research Database. We enrolled 3,213 and 1,181 NVAF patients with hyperthyroidism taking DOACs and warfarin, respectively, from June 1, 2012 to December 31, 2017. We also enrolled 53,591 and 16,564 NVAF patients without hyperthyroidism taking DOACs and warfarin, respectively. We used propensity score-based stabilized weights (PSSWs) to balance covariates across the study groups. We also used 1:4 matching on both taking DOACs, with (n=3,213) and without hyperthyroidism (n=12,852); and both taking warfarin, with (n=1,181) and without hyperthyroidism (n=4,724). Results After PSSW, DOAC had a comparable risk of ischemic stroke/systemic embolism (IS/SE) and a lower risk of major bleeding (hazard ratio (HR):0.65; [95% confidential interval (CI):0.44-0.96]; P=0.0295) than warfarin among patients with hyperthyroidism. There were comparable risks of IS/SE and major bleeding between those patients with and without hyperthyroidism. However, patients taking warfarin with hyperthyroidism had a lower risk of IS/SE than those without hyperthyroidism (HR:0.61; [95%CI:0.43-0.86]; P=0.0050). Conclusion Among NVAF Asian patients with concomitant hyperthyroidism, DOACs may be an effective and safer alternative to warfarin. Thromboprophylaxis with DOACs may be considered for such patients, and it is important to validate this finding in further prospective study.Supplemental materials (figures and tables) for the article of "Direct Oral Anticoagulants in Atrial Fibrillation Patients with Concomitant Hyperthyroidism" Funding provided by: Chang Gung Memorial HospitalCrossref Funder Registry ID: http://dx.doi.org/10.13039/100012553Award Number: CMRPG3G1371-3Funding provided by: Chang Gung Memorial HospitalCrossref Funder Registry ID: http://dx.doi.org/10.13039/100012553Award Number: CMRPG3F0991-3Funding provided by: Chang Gung Memorial HospitalCrossref Funder Registry ID: http://dx.doi.org/10.13039/100012553Award Number: CMRPD1K0031Funding provided by: Chang Gung Memorial HospitalCrossref Funder Registry ID: http://dx.doi.org/10.13039/100012553Award Number: CMRPG3K0021We performed a nationwide retrospective cohort study using data from the Taiwan National Health Insurance Research Database. We enrolled 3,213 and 1,181 NVAF patients with hyperthyroidism taking DOACs and warfarin, respectively, from June 1, 2012 to December 31, 2017

Peer-based behavioral health program for drug users in China: a pilot study

<p>Abstract</p> <p>Background</p> <p>Many injection drug users (IDUs) in China have high risk sexual behaviors that contribute to the spread of HIV infection. Although many IDUs in China move through drug rehabilitation centers, this opportunity for sexual health education has largely been overlooked.</p> <p>Methods</p> <p>A convenience sample of 667 drug users from two rehabilitation centers in South China was recruited in the study. Two hundred and forty seven drug users from a single Guangdong Province rehabilitation center received the peer-based education intervention, while 420 drug users from another rehabilitation center received routine HIV/STI education and was used as the control. One hundred and eighty nine (22.1%) individuals refused to participate in the study. HIV/STI behavioral and knowledge domains were assessed at 3 months in rehabilitation centers after the intervention (first follow-up) and at 2-23 months in the community after release (second follow-up).</p> <p>Results</p> <p>Drug users who completed the intervention reported more frequent condom use with casual sex partners (60.0% vs. 12.5% condom use every time, p = 0.011) and less frequent injection (56.7% vs. 26.4% no injection per day, p = 0.008) at the second follow-up compared to those in the routine education group. Loss to follow up was substantial in both control and intervention groups, and was associated with living far from the detention center and having poor HIV knowledge at baseline.</p> <p>Conclusions</p> <p>This study shows that rehabilitation centers may be a useful location for providing behavioral HIV/STI prevention services and referral of individuals to community-based programs upon release. More research is needed on behalf of detained drug users in China who have complex social, medical, and legal needs.</p

Peer-based behavioral health program for drug users in China: a pilot study

<p>Abstract</p> <p>Background</p> <p>Many injection drug users (IDUs) in China have high risk sexual behaviors that contribute to the spread of HIV infection. Although many IDUs in China move through drug rehabilitation centers, this opportunity for sexual health education has largely been overlooked.</p> <p>Methods</p> <p>A convenience sample of 667 drug users from two rehabilitation centers in South China was recruited in the study. Two hundred and forty seven drug users from a single Guangdong Province rehabilitation center received the peer-based education intervention, while 420 drug users from another rehabilitation center received routine HIV/STI education and was used as the control. One hundred and eighty nine (22.1%) individuals refused to participate in the study. HIV/STI behavioral and knowledge domains were assessed at 3 months in rehabilitation centers after the intervention (first follow-up) and at 2-23 months in the community after release (second follow-up).</p> <p>Results</p> <p>Drug users who completed the intervention reported more frequent condom use with casual sex partners (60.0% vs. 12.5% condom use every time, p = 0.011) and less frequent injection (56.7% vs. 26.4% no injection per day, p = 0.008) at the second follow-up compared to those in the routine education group. Loss to follow up was substantial in both control and intervention groups, and was associated with living far from the detention center and having poor HIV knowledge at baseline.</p> <p>Conclusions</p> <p>This study shows that rehabilitation centers may be a useful location for providing behavioral HIV/STI prevention services and referral of individuals to community-based programs upon release. More research is needed on behalf of detained drug users in China who have complex social, medical, and legal needs.</p

A Robust Re-Rank Approach with Application to Pooling-Based GWA Study Data

近年來隨著研究技術的蓬勃發展, 研究者愈來愈容易取得同時含有成千上萬個變項個數的資料庫, 使得樣本個數相較之下變得非常小。在這種變項個數遠大於樣本個數的情況之下, 傳統常用來偵測兩組差異的 t 統計量會因為變異估計不夠穩定而不太適用。另一方面, 同樣是用來偵測兩組差異的 ROC 曲線下面積 (AUC), 雖然屬於較不受分配限制的無母數方法, 仍然會因為重覆數值出現的頻率太高, 造成排序挑選的困擾。為了兼顧檢定力和穩健力, 改變傳統給定排序值的方法, 將其重新定義為在同一樣本內不同變項之間的排序, 會更加適用。在此研究中, 我們提出一種重覆排序方法, 以「rank-over-variable」概念為基礎, 再配合「random subset」和「re-rank」兩種技巧, 可用來幫助研究者在分析變項個數遠大於樣本個數的資料型態時，能有效挑選出在兩組間有差異的變項。為了評估此方法，我們以 GAIN-MDD 資料檔為基礎進行模擬分析，驗證相較於 t 統計量和 AUC，我們所提出的重覆排序方法能更有效地偵測出真正在兩組間有差異的變項，同時也較不容易受到小樣本數和實驗誤差的影響。最後, 我們實際將新方法應用於混合樣本之全基因體掃描研究, 偵測出可能與雙極性情感疾病相關的基因, 提供研究者進行更進一步的探討。Recently, more and more researches encounter the problem where the data objects have an extremely large number of variables while the available sample size is relatively small. To detect the difference between two populations in this situation, the widely used two sample t-test would fail to apply due to its instability in estimating variances. The non-parametric counterpart, AUC, will face the problem of tied values and also fail. To improve the detection power while keeping the robustness, the idea of ``rank-over-variable'' is more appropriate to analyze large-p-small-n datasets. In this study, we propose a robust re-rank approach to overcome the above-mentioned difficulties and reduce the influence of enormous features in the large-$p$-small-$n$ situation. In particular, we obtain a rank-based statistic for each feature based on the concept of &quot;rank-over-variable&quot;. Techniques of &quot;random subset&quot; and &quot;re-rank&quot; are then iteratively applied to ranking features. Finally, the leading features in the constructed ranking list will be selected for further research. To evaluate the performance of our proposed re-rank approach, we conduct several simulation studies based on the GAIN-MDD dataset. Compared with the t-statistic and AUC, our re-rank approach is able to identify more pre-defined truly relevant SNPs and robust for different pool number and pooling error. Furthermore, we also demonstrate a real data analysis to explore the markers associated with bipolar disorder

A Robust Rerank Approach for Feature Selection and Its Application to Pooling-Based GWA Studies

Large-p-small-n datasets are commonly encountered in modern biomedical studies. To detect the difference between two groups, conventional methods would fail to apply due to the instability in estimating variances in t-test and a high proportion of tied values in AUC (area under the receiver operating characteristic curve) estimates. The significance analysis of microarrays (SAM) may also not be satisfactory, since its performance is sensitive to the tuning parameter, and its selection is not straightforward. In this work, we propose a robust rerank approach to overcome the above-mentioned diffculties. In particular, we obtain a rank-based statistic for each feature based on the concept of “rank-over-variable.” Techniques of “random subset” and “rerank” are then iteratively applied to rank features, and the leading features will be selected for further studies. The proposed re-rank approach is especially applicable for large-p-small-n datasets. Moreover, it is insensitive to the selection of tuning parameters, which is an appealing property for practical implementation. Simulation studies and real data analysis of pooling-based genome wide association (GWA) studies demonstrate the usefulness of our method

First-year outcomes of very low birth weight preterm singleton infants with hypoxemic respiratory failure treated with milrinone and inhaled nitric oxide (iNO) compared to iNO alone: A nationwide retrospective study.

BackgroundInhaled nitric oxide (iNO) has a beneficial effect on hypoxemic respiratory failure. The increased use of concurrent iNO and milrinone was observed. We aimed to report the trends of iNO use in the past 15 years in Taiwan and compare the first-year outcomes of combining iNO and milrinone to the iNO alone in very low birth weight preterm (VLBWP) infants under mechanical ventilation.MethodsThis nationwide cohort study enrolled preterm singleton infants with birth weight ResultsAfter PSM, more infants in Group 2 needed inotropes. The mortality rate was significantly higher in Group 2 than in Group 1 from one month after birth till 1 year of age (55.1% vs. 13.5%) with the adjusted hazard ratio of 4.25 (95%CI = 2.42-7.47, p ConclusionCombined treatment of iNO and milrinone is increasingly applied in VLBWP infants in Taiwan. This retrospective study did not support the benefits of combining iNO and milrinone on one-year survival and BPD prevention. A future prospective study is warranted

A Robust GWSS Method to Simultaneously Detect Rare and Common Variants for Complex Disease

<div><p>The rapid advances in sequencing technologies and the resulting next-generation sequencing data provide the opportunity to detect disease-associated variants with a better solution, in particular for low-frequency variants. Although both common and rare variants might exert their independent effects on the risk for the trait of interest, previous methods to detect the association effects rarely consider them simultaneously. We proposed a class of test statistics, the generalized weighted-sum statistic (GWSS), to detect disease associations in the presence of common and rare variants with a case-control study design. Information of rare variants was aggregated using a weighted sum method, while signal directions and strength of the variants were considered at the same time. Permutations were performed to obtain the empirical <i>p</i>-values of the test statistics. Our simulation showed that, compared to the existing methods, the GWSS method had better performance in most of the scenarios. The GWSS (in particular VDWSS-<i>t</i>) method is particularly robust for opposite association directions, association strength, and varying distributions of minor-allele frequencies. It is therefore promising for detecting disease-associated loci. For empirical data application, we also applied our GWSS method to the Genetic Analysis Workshop 17 data, and the results were consistent with the simulation, suggesting good performance of our method. As re-sequencing studies become more popular to identify putative disease loci, we recommend the use of this newly developed GWSS to detect associations with both common and rare variants.</p></div