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Abstract: After tooth extraction, the alveolar ridge undergoes resorption and atrophy, which usually leads to a wide range of tissue dimensional changes. Preservation of the alveolar ridge can maintain its volume, reduce ridge resorption, and help subsequent dental implant treatment. This retrospective cohort study aims to investigate the marginal bone stability of implants placed in alveolar ridge preservation areas using deproteinized bovine bone mineral with 10% collagen (DBBM-collagen) combined with a native collagen membrane (CM). In this study, forty-seven implant sites divided into either intact or defective extraction sockets were included, using vertical bite-wing films to measure the bone level at baseline, 6 months, and 12 months after implant prosthesis placement. The result of peri-implant mean bone loss was -0.03 ± 0.84mm at 12 months compared to baseline. There was no significant difference in mesial and distal sites compared to baseline. In addition, no significant difference was found between the defective and intact sockets for marginal bone changes. Therefore, ridge preservation combined with DBBM-collagen and CM can provide an ideal alveolar ridge, simplify dental implant procedures, and maintain implant marginal bone stability. &nbsp

We compared risks of clinical outcomes, mortality and healthcare costs among new users of different classes of anti-diabetic medications. This is a population-based, retrospective, new-user design cohort study using the Taiwan National Health Insurance Database between May 2, 2015 and September 30, 2017. An individual was assigned to a medication group based on the first anti-diabetic prescription on or after May 1, 2016: SGLT-2 inhibitors, DPP-4 inhibitors, GLP-1 agonists or older agents (metformin, etc.). Clinical outcomes included lower extremity amputation, peripheral vascular disease, critical limb ischemia, osteomyelitis, and ulcer. We built three Cox proportional hazards models for clinical outcomes and mortality, and three regression models with a log-link function and gamma distribution for healthcare costs, all with propensity-score weighting and covariates. We identified 1,222,436 eligible individuals. After adjustment, new users of SGLT-2 inhibitors were associated with 73% lower mortality compared to those of DPP-4 inhibitors or users of older agents, while 36% lower total costs against those of GLP-1 agonists. However, there was no statistically significant difference in the risk of lower extremity amputation across medication groups. Our study suggested that SGLT-2 inhibitors is associated with lower mortality compared to DPP 4 inhibitors and lower costs compared to GLP-1 agonists.

Medication compliance is an important determinant in schizophrenia treatment outcomes. This study aimed to investigate medication compliance in cases of patients receiving a single antipsychotic medication among adult outpatients with schizophrenia, and examine whether their antipsychotic therapy and other factors may affect the medication compliance. Subjects with schizophrenia who had received any single outpatient first- or second-generation antipsychotic therapy from the Yuli Veterans Hospital, Taiwan, during August and November 2006 were identified from medical chart reviews. The selected subjects were surveyed for information including their medication compliance, sociodemographics, treatment-related side effects, social support, and perceived treatmentrelated benefits. Their physicians were also surveyed on their medication compliance, Clinical Global Impression (CGI) scores, and comorbid mental illness (es). Good medication compliance was defined as consumption of more than 75% of prescribed antipsychotics in the previous month. Subjects were categorized into this group when both their self-reported consumption and their physicians' estimation were higher than 75%. A logistic regression model was adopted to evaluate the association of each factor with medication compliance. Of the 76 subjects surveyed, 39 (51%) received second-generation antipsychotics (amisulpride, risperidone, or olanzapine), while 37 (49%) received first-generation antipsychotics (haloperidol or sulpiride). Thirty-eight (50%) consumed more than 75% of prescribed medications in the previous month. The average age was 41, and 62% of the sample was male. Education level and employment type were significantly different between individuals with good and poor medication compliance. The regression result indicated that education of above nine years was significantly associated with an increased likelihood of good medication compliance. Employment and perceived treatment benefits were marginally significantly correlated with good medication compliance. Second-generation antipsychotics, however, had no correlation with good medication compliance.

Here we develop a novel but fundamental strategy for optimizing the ion-removal capacity of electrode materials in capacitive deionization (CDI) and inverted-capacitive deionization (i-CDI) systems without sacrificing their coulombic efficiency. The most efficient working cell voltages of different systems can be precisely determined by our newly designed cell voltage-programming method. We employ a palladium hydride reference electrode to monitor the electrode potentials of positive and negative electrodes during the double-layer charging-discharging processes. Accordingly, charge balance and maximum working cell voltages of CDI and i-CDI systems in brackish water can be achieved simultaneously to optimize the desalination efficiencies. Hence, the ion removal capability of an activated carbon//activated carbon (AC//AC) cell in 0.3–1.9 V reaches 12.2 mg g−1 with minor pH change in deionized solutions. The asymmetric CDI cell consisting of a positive graphene oxide-CNT composite and a negative AC electrode (GO@CNT//AC) is the most efficient CDI system with ion removal capacity of 21.3 mg g−1 in 0.2–1.45 V. The asymmetric AC//reduced GO-CNT composite (AC//rGO@CNT) cell is an exceptional i-CDI system which exhibits ion removal ability of 25.2 mg g−1 in 1.0–1.7 V. The above concepts in optimizing CDI/i-CDI performances are applicable to all types of electrode materials in various cell designs.

Background: Incidence of actinic keratosis (AKs) and nonmelanoma skin cancer appears to be increasing worldwide due to increasing levels of ultraviolet radiation, lifestyle changes, and an aging population. However, there is no population-based study focusing on AKs among Asian population. We aimed to investigate the incidence, the treatment pattern, the medical utilization and the risk of malignant neoplasm of the AKs patients in Taiwan. Methods: We conducted a retrospective cohort study to investigate patients with AKs from 2003 to 2011 by using the National Health Insurance Research Database (NHIRD). The inclusion criteria were patients who had at least two outpatient visits or one hospital admission of AK identified by dermatologist from 2004 to 2011. There were 35,933 patients with AKs (elderly [aged ≥65 years]: n = 17,004; non-elderly [aged

The influence of low-temperature AlN (LT-AlN) nucleation layer thickness on the material properties of the GaN layer grown on the double-step AlN layer is investigated. When GaN was grown without the LT-AlN nucleation layer, the GaN layer has low sheet resistance of 464 ohm/sq and the surface was decorated with pitted region. On the other hand, when a LT-AlN layer with a thickness of 5 nm was inserted, a GaN layer with sheet resistance higher than 106 ohm/sq was achieved. This thin nucleation layer also improved the GaN morphology, suppressed inversion domain formation, and reduced oxygen impurity incorporation. However, the surface morphology and quality of the GaN crystal were severely degraded when the LT-AlN thickness was increased to 10 nm due to the formation of disorientated grains in the LT-AlN layer.

Background Recent global data show an increasing prevalence of psoriasis and psoriatic arthritis in western countries. Objective The current study analyzed the trend of prevalence rates of psoriasis and psoriatic arthritis in Taiwan and examined biologic prescription patterns by different specialties. Methods Data were accessed from the national payer National Health Insurance Research Database in Taiwan. This study protocol was approved by Joint Institutional Review Board established by Medical Research Ethics Foundation (No 13-S-001). Results Between 2003 and 2013, the prevalence of psoriasis and psoriatic arthritis increased by 41% (from 15.54 to 21.90 per 10,000 population) and 191% (from 0.45 to 1.31 per 10,000 population), respectively, while the prevalence of psoriatic arthritis among patients with psoriatic disease increased from 6.3% to 12.7%. Dermatologists are the main caregivers for patients with psoriasis and psoriatic arthritis; however, data suggest a decreasing trend in the proportion of dermatologists for psoriasis patients from 24.7% between 2003 and 2008 to 10.74% between 2008 and 2013, with a corresponding decrease in dermatologists for psoriatic arthritis patients from 62.30% to 44.65% during the same periods, respectively. In 2013, of the 51,191 patients with psoriasis, only 596 (1.16%) received biologics (73.3% by dermatologists and 25.8% by rheumatologists), while 1120 of the 7470 (14.99%) psoriatic arthritis patients received biologics (72.8% by rheumatologists and 22.3% by dermatologists). The proportion of biologics use was 1.12% and 7.75% among all patients with only psoriasis and 8.01% and 26.70% among all patients with psoriatic arthritis seen by dermatologists and rheumatologists, respectively. Conclusion The prevalence of psoriasis and psoriatic arthritis is increasing in Taiwan. The use of biologics in patients with psoriatic arthritis was comparable to that reported in previous studies in the United States and Europe; however, the use of biologics remained low in patients with psoriasis in Taiwan.

BACKGROUND:The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs) modify the risk of cardiovascular disease (CVD) in patients with psoriasis remains unknown. METHODS:Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD) and stroke between patients with and without SDs. RESULTS:Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22-1.28) and stroke (aHR, 1.24; 95% CI, 1.16-1.33) as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults. CONCLUSIONS:The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis.

Background Thiazolidinediones (TZDs) may reduce in-stent restenosis and improve clinical outcomes in type 2 diabetic patients after bare-metal stent implantation. However, it is still unknown whether diabetic patients with drug-eluting stents (DESs) could benefit from treatment with TZDs. Objective The objective was to evaluate the clinical outcomes of TZDs in type 2 diabetic patients within 1 year of receiving DESs. Methods This retrospective cohort study was performed in 1743 Taiwanese type 2 diabetic patients (1137 men; 606 women) who received DESs between December 1, 2006 and December 31, 2007. Patients were classified into TZD (n = 268) or non-TZD groups (n = 1,475) using medication records within 3 months of the index hospitalization. Follow-up data were available through December 31, 2008. Clinical outcome measurements included death, myocardial infarction (MI), and repeat revascularization within 1 year after the index date of hospitalization. Cox proportional hazards model and other analyses were performed for the study. Results For the TZD and non-TZD groups, the mean ages were 65.07 and 66.09 years, respectively, for those with limus-eluting stents (LESs) and 65.61 and 65.81 years, respectively, for those with paclitaxel-eluting stents (PESs). With or without TZD medication, there were no significant differences in the adjusted hazard ratios of death, MI, or repeat revascularization for diabetic patients who received LESs or PESs. TZD treatment in patients who received LESs and had a history of MI was associated with a higher risk of MI (hazard ratio = 5.292; 95% CI, 1.028–27.232). Conclusions TZDs did not improve the clinical outcomes in Taiwanese type 2 diabetes patients who received DESs. TZDs might have been a contributor to higher risk of MI in patients with LESs and a history of MI. Larger clinical trials are still needed to study this issue further.

Background Bisphosphonates are the class of medication used most widely to treat osteoporosis. Since an article reported that patients who used zoledronic acid, a bisphosphonate, had a higher proportion of atrial fibrillation (AF) in 2007, the issue of bisphosphonates and AF has become a growing concern. Due to the widespread use of bisphosphonates, it is necessary to explore the relationship between bisphosphonates and AF and other cardiovascular diseases. Objective We aimed to investigate the risk of AF, stroke, or acute myocardial infarction (AMI) associated with the use of the bisphosphonates alendronate and raloxifene in patients with osteoporosis. We also focused our analysis on the impact of different dosing regimens of alendronate. Methods The National Health Insurance Research Database was used to conduct an 8-year, population-based, retrospective cohort study. The study population comprised women who first took alendronate or raloxifene between 2002 and 2006 and who had a history of osteoporosis and vertebral or spinal fracture. Follow-up was conducted for every patient until the first diagnosis of AF, stroke, or AMI or until the end of the 1-year follow-up period. The Cox proportional hazards model was used to evaluate the association between the risk of cardiovascular disease and the prescription of alendronate or raloxifene. Results We identified 9609 women who had been prescribed either alendronate (n = 6949) or raloxifene (n = 2660). The patients treated with alendronate were at a lower risk of AF, stroke, or AMI compared with the raloxifene group (AF: hazard ratio [HR] = 0.60 [95% CI, 0.42–0.85]; stroke: HR = 0.47 [95% CI, 0.39–0.57]; AMI: HR = 0.51 [95% CI, 0.36–0.72]). However, when analyzing the groups by different alendronate dosing regimens, those patients who received alendronate 10 mg had a significantly higher risk of AF and stroke compared with patients who received raloxifene (AF: HR = 1.66 [95% CI, 1.12–2.46]; stroke: HR = 1.56 [95% CI, 1.23–1.98]). The alendronate 70-mg group demonstrated a lower risk of cardiovascular disease, be it AF, stroke, or AMI (AF: HR = 0.28 [95% CI, 0.18–0.43]; stroke: HR = 0.23 [95% CI, 0.18–0.30]; AMI: HR = 0.28 [95% CI, 0.18–0.41]). When we assigned alendronate 10 mg as the reference group, the alendronate 70 mg group had a lower risk of 3 cardiovascular diseases (AF: HR = 0.17 [95% CI, 0.10–0.27]; stroke: HR = 0.16 [95% CI, 0.12–0.22]; AMI: HR = 0.21 [95% CI, 0.13–0.35]). Conclusions Alendronate 10 mg was associated with a higher risk of cardiovascular disease than alendronate 70 mg. Further studies are required to investigate this relationship.

Background Carbamazepine has been associated with severe cutaneous adverse drug reactions (ADR). It is important for patients with these ADRs under off-label prescriptions are not eligible for drug injury relief in Taiwan. We conducted a study to depict the demography and possible factors related to the off-label carbamazepine use in Taiwan. We also explored the policy influence of carbamazepine use. Methods We used the dataset of one million randomly-sampled insured persons in the Taiwan National Health Insurance Research Database for 2002 and 2006 to conduct a cross-sectional study. With the use of a computerized clinical information system, carbamazepine prescriptions were categorized into five groups (A, B, C, D and E) according to these indications: Group A, B were defined as on-label use; group C, D and E were defined as various levels of off-label use, depending on the strength of support from the literature. A logistic regression model was conducted to find the factors related to off-label use. Results Based on the one million representative samples, 6305 and 5703 patients received 31 146 and 27 579 carbamazepine prescriptions in 2002 and 2006 respectively. In both years, nearly 43% of total prescriptions were related to on-label uses. Prescriptions from primary clinics and departments of internal medicine and psychiatry, the physician's age, and the patient's age were factors associated with higher risk of off-label carbamazepine use. Conclusions Our study echoes the highly prevalent off-label use of carbamazepine in Taiwan and adds to the rare research on this subject in the East Asian population. The carbamazepine relabelling in 2004 did not change either prescription patterns or factors related to off-label use.

To examine the relationship between different anti-diabetic therapies (dipeptidyl peptidase-4 (DPP-4), metformin and sulfonylureas) and risk of acute pancreatitis among type 2 diabetic patients in Taiwan, and explore each drug's dose-response relationship.We derived a nationwide retrospective cohort of patients with type 2 diabetes in Taiwan. The inclusion criteria are adult diabetic patients with continuous baseline enrollment, new users of the studied drugs, and without missing demographics. There were 4113/101 498/44 772 DPP-4/Metformin/Sulfonylurea users. Adjusted hazards ratios for pancreatitis associated with DPP-4, derived from Cox proportional hazard models with propensity score weighting, were estimated; dose-response analyses were also conducted.Dipeptidyl peptidase-4 was statistically significantly associated with a decreased risk of acute pancreatitis compared with sulfonylureas (adjusted HR: 0.36, 95%CI [0.17, 0.75]) but not metformin (adjusted HR: 0.67, 95%CI [0.32, 1.41]); metformin was statistically significantly associated with a lower risk of pancreatitis than sulfonylurea (adjusted HR: 0. 53; 95%CI [0.37, 0.76]). In addition, low-dose metformin was statistically significantly associated with a lower risk of pancreatitis compared with high-dose metformin (HR: 0.65; 95%CI [0.44, 0.97]).Our findings suggest that sulfonylureas may potentially be associated with an increased risk of pancreatitis compared with DPP-4 or metformin. Studies with longer follow up, larger sample sizes, and more precise capture of confounders may be needed to determine the risk of pancreatitis associated with incretin based therapies.

The electrical properties in the InAlN/AlN/GaN high electron mobility transistor grown by metal-organic vapor deposition (MOCVD) with different growth parameters were investigated in this study. We observed that two-dimensional electron gas (2DEG) channel was influenced by thickness of AlN spacer layer and a stable stage prior to the growth of AlN spacer layer. The TEM images showed the generation of dislocations at interface between AlN/GaN and InAlN/AlN with the thicker AlN spacer layer. These dislocations acted as electron scattering center and degraded the electron mobility in the 2DEG channel. Besides, a too long stable stage also appeared degradation in the electron mobility due to the etching effect of H 2 gas. By optimizing growth parameters, the highest electron mobility of 890 cm2/V.s

For observation of parasitic reaction effect during InAlN material growth by Matel-Organic Chemical Vapor Deposition (MOCVD), the growth parameters include temperature and pressure had been varied to investigate it. The pressure would be kept at 50torr, 100torr and 150torr and temperature was varied from 700 °C to 780 °C by 20 °C step in each growth pressure. The experimental results appeared that higher pressure gave rise to more serious parasitic reaction during material growth. It made the less Al atoms incorporate into the AllnN. In addition the 100-torr growth pressure shows the best efficiency of Al atom incorporation compare with other two growth pressures. By the AFM analysis, the morphology of Al0.82In0.18N grown with three different pressures was also examined.

Objective To investigate whether there is an increased risk of cardiac events in diabetic patients with a combined therapy of clopidogrel (CLO) and proton pump inhibitors (PPIs) after drug-eluting stent (DES) deployment. Methods By using National Health Insurance Research Database, all patients who received CLO with or without PPI therapy within 90 days after undergoing DES (limus-eluting or paclitaxel-eluting stents) deployment were enrolled. Endpoints were acute coronary syndrome (ACS) and readmission for revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery) after 3, 6, and 12 months. Results A total of 6,603 diabetic patients received LESs (5,933 in the CLO subgroup and 670 in the CLO plus PPIs subgroup), and 3,202 patients received PESs (2,923 in the CLO subgroup and 279 in the CLO plus PPIs subgroup). The patients who received CLO plus PPIs were at higher risk of ACS than those receiving CLO within 1 year after DES deployment (LESs: 6-month hazard ratio [HR] = 1.63, and 1-year HR = 1.37; PESs: 3-month HR = 1.72). Patients with a history of ACS who received CLO plus PPIs were at higher risk of ACS after LES implantation (HR = 1.55) than those in the CLO group. Conclusion In “real-world” diabetic patients with LES deployment, the combination of PPIs and CLO is associated with higher rates of ACS after 6 months and 1 year. Even after correction for confounding factors, concomitant PPI use remained an independent predictor of cardiac events, emphasizing the clinical importance of this drug—drug interaction.

The influence of the thickness of a high-temperature AlN (HT-AlN) buffer layer on the properties of an InAlN/GaN high-electron-mobility transistor (HEMT) grown on a sapphire substrate was investigated. As revealed by atomic force microscope analysis, a rougher surface and larger grain size were observed with a thicker buffer layer. The larger grains promoted the two-dimensional (2D) growth mode of the GaN layer at the initial growth stage. This suppressed oxygen incorporation at the GaN/HT-AlN interface and thus improved the resistivity of the GaN layer. Moreover, the lower grain density also resulted in enhanced GaN crystal quality of the GaN layer. As a consequence, the electrical properties of the InAlN/GaN HEMT device, such as output current, transconductance and off-state breakdown voltage, were improved by increasing the HT-AlN buffer layer thickness.

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