Search

Mobile mapping technologies, for example multi-sensor integration and multi-platform mapping technology, have developed and improved over recent decades, various applications such as conventional mapping scenarios, rapid disaster response, smart city, and autonomous vehicle application arise synchronously. Especially, autonomous driving vehicles have made enormous progress. High-definition (HD) maps are key for autonomous driving because of their high accuracy and rich information of road scenes. However, how to make sure that HD maps are suitable for autonomous vehicle requirement is an important topic. The HD maps guidelines and standards in Taiwan are released since 2018 and mainly focus on point cloud and shape file format. In this paper, a procedure for the verification and validation of HD maps for OpenDRIVE and Autoware (Lanelet2) is proposed. It discusses about the verification strategies, suggestion review item, recommendation tools, and process. As shown by our preliminary results, the proposed process can conform not only in closed area but also public road. These issues can help reducing HD maps production costs. When the foundation of HD maps accomplishes, the autonomous driving techniques can naturally complement. The vision of full automation vehicle will come true rapidly in the future. [ABSTRACT FROM AUTHOR]

A dense linear geophone array is deployed across the Tatun volcano group (TVG) at the northern tip of Taiwan, where more than 7 million residents live in the Taipei metropolis. The array is composed of 50 geophones with a station spacing of ~ 200 m in average, and it is designed for striking in the NW–SE direction to record the many earthquakes in eastern Taiwan, where the Philippine Sea plate subducted beneath the Eurasia plate. The detailed examination of felt earthquakes shows consistent P-wave delays are recorded at particular stations of the array. The further forward modeling indicates there is a low-velocity zone (LVZ) at depths between ~ 0.5 and ~ 2.5 km beneath the major fumarole sites. Combining this preliminary result with previous studies including clustering seismicity, volcanic earthquakes, low-resistivity zone, strong degassing processes and shallow velocity structures, we suggest that the LVZ might be associated with the major hydrothermal reservoir at the TVG. The identification of the hydrothermal reservoir by the LVZ not only implies a potential volcanic threat, such as phreatic eruptions, in the future, but also provides the possibility of sustainable geothermal resources for replacing traditional nuclear and fossil fuel power plants. Detailed images of the LVZ and other volcanic structures will be obtained soon when dense geophone arrays with more than 600 geophones are deployed from 2020 to 2022. [ABSTRACT FROM AUTHOR]

Background The association between Parkinson's disease (PD) and stroke remains completely understood. Aim We aimed to investigate stroke risk and post-stroke outcomes in patients with PD. Design The retrospective cohort study included 1303 patients aged ≥ 40 years with new-diagnosed PD and 5212 non-PD adults were selected by frequency matching with age and sex in 2000–05. Both two groups were followed up until the end of 2013. Another nested stroke cohort study of 17 678 patients with stroke hospitalization in 2002–09 was conducted to compare the admission outcome in patients with and without PD history. Methods We collected patients' characteristics and medical conditions in the present two studies from claims data of Taiwan's National Health Insurance. Incidences and risks of stroke in people with and without PD during the follow-up period were calculated by adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) in the Cox proportional hazard model. Complications and mortality during the stroke admission associated with PD were analysed by calculating adjusted odds ratios (ORs) and 95% CIs in the logistic regressions. Results Incidences of stroke for people with and without PD were 19.8 and 9.93 per 1000 person-years, respectively, with corresponding HR of 1.96 (95% CI 1.67–2.30). History of PD was associated with post-stroke gastrointestinal bleeding (OR 1.25, 95% CI 1.05–1.49), epilepsy (OR 1.64, 95% CI 1.32–2.04), pneumonia (OR 1.34, 95% CI 1.20–1.49), urinary tract infection (OR 1.33, 95% CI 1.21–1.45) and mortality (OR 1.35, 95% CI 1.13–1.62). Conclusion PD increases stroke risk and influences post-stroke outcomes. [ABSTRACT FROM AUTHOR]

Summary: What is known and objective: Patients with rheumatic disease are at risk for infections. Evaluating antitumour necrosis factor (anti‐TNF) drug‐associated risk of infections requires justification of baseline risk in the population at high risk of infection. We examined the incidence of active tuberculosis (TB) and its risk factors in patients with rheumatic disease started with anti‐TNF‐α therapy or with existing disease‐modifying antirheumatic drug (DMARD) therapy. Methods: A retrospective cohort study of anti‐TNF‐α therapy new users (anti‐TNF‐α group) and those starting with a DMARD after the failure of at least one other DMARD or who had added to existing DMARD treatment (DMARD group) for rheumatic disease in the largest medical setting in Taiwan from 1 January 2005 through 31 November 2013 was conducted to determine relative risk of TB between patient groups. Patients in the DMARD group were stratified into “mild” and “severe” disease severity as proxies for low and high background risk of infection. Results and discussion: A total of 3640 patients were enrolled (anti‐TNF: 955; DMARD: 2685). The incidence of TB was 903.9/100 000 patient‐years for anti‐TNF‐α new users and 391.7/100 000 patient‐years for DMARD switchers. In Cox regression model, adjusted HR for TB in the anti‐TNF‐α group was higher than for the entire DMARD group (aHR, 2.41; 95% confidence interval [CI], 1.2‐4.85), subgroup with mild disease (2.91; 1.31‐6.47) and subgroup with severe disease (1.65; 0.68‐4.03). Significant independent risk factors for TB were being male, age ≥60 years, history of respiratory disease, glucocorticoids dose >7.5 mg/d and living in a TB‐prevalent region. What is new and conclusion: Anti‐TNF‐α therapy was independently associated with increased risk of TB in patients with mild disease, but it was not significantly correlated in patients with severe disease after adjusting for confounders. [ABSTRACT FROM AUTHOR]

Abstract: We uncovered two critical issues in earlier studies: (a) some studies have shown that mobile learning technology is not beneficial for all students due to complexity of learning environments and student prior knowledge, skills, and experience and (b) familiarity of students with the authentic environments in which they learn using mobile technology did not receive much attention in earlier studies. To address these issues, we designed three learning tasks for a class of 26 junior high school students. The students applied language skills by completing the tasks in authentic environments individually in a first task, loosely collaborating with peers in a second task, and tightly collaborating with peers in a third task. A mobile learning system was also designed in this study to support students to accomplish the tasks. The aim of this study was to explore students' learning experiences using the learning system, their perceptions towards the system, and to assess how differently the students perform on the three tasks. According to our design, in the first task, the students took pictures of objects and described them orally or in writing using the mobile learning system. In the second task, after the students completed assignments, each student received comments from a partner through the system. In comments, the partner indicated flaws in student assignments and suggested how to fix them. In the third task, the students completed assignments, shared them using the system, and then exchanged comments with their partners face to face regarding issues related to their completed assignments and suggested how to improve them. Such learning behaviours in the three tasks enabled the students to practise writing and speaking skills. Our results demonstrate that most of the students highly valued our learning system and intend to use it in the future. Furthermore, the results show that the students performed best when they collaborated; namely, student performance was enhanced the most after the third task that required tight collaboration. Based on our results, we learned that students' familiarity with authentic environments is very important and beneficial for their learning. In addition, we learned that even in complex environment, less skilled and experienced students with low prior knowledge can perform well when they tightly collaborate with more skilled and experienced students with high prior knowledge, and our learning system can facilitate such collaboration. [ABSTRACT FROM AUTHOR]

Previously, it was believed that the prokaryote communities of typical 'low-microbial abundance' (LMA) or 'non-symbiont harboring' sponges were merely subsets of the prokaryote plankton community. Recent research has, however, shown that these sponges are dominated by particular clades of Proteobacteria or Cyanobacteria. Here, we expand on this research and assess the composition and putative functional profiles of prokaryotic communities from LMA sponges collected in two ecosystems (coral reef and hydrothermal vent) from vicinal islands of Taiwan with distinct physicochemical conditions. Six sponge species identified as Acanthella cavernosa (Bubarida), Echinodictyum asperum, Ptilocaulis spiculifer (Axinellida), Jaspis splendens (Tetractinellida), Stylissa carteri (Scopalinida) and Suberites sp. (Suberitida) were sampled in coral reefs in the Penghu archipelago. One sponge species provisionally identified as Hymeniacidon novo spec. (Suberitida) was sampled in hydrothermal vent habitat. Each sponge was dominated by a limited set of operational taxonomic units which were similar to sequences from organisms previously obtained from other LMA sponges. There was a distinct bacterial community between sponges collected in coral reef and in hydrothermal vents. The putative functional profile revealed that the prokaryote community from sponges collected in hydrothermal vents was significantly enriched for pathways related to DNA replication and repair. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the association of different dental prophylactic modalities and osteoradionecrosis (ORN) and determine the risk of ORN under different timing periods of scaling, with the use chlorhexidine mouth rinse after surgery and with different strategies of fluoride gel application in head and neck cancer (HNC) participants. A cohort of 18,231 HNC participants, including 941 ORN patients and 17,290 matched control cases, were enrolled from a Longitudinal Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) in Taiwan. Based on different dental prophylactic modalities before radiotherapy, including chlorhexidine mouth rinse, scaling, and fluoride gel, all HNC subjects were stratified into different groups. The Cox proportional hazard regression was used to compare ORN incidences under different dental prophylactic modalities. The results revealed that scaling and chlorhexidine mouth rinse were significantly related to ORN risk ( P = 0.004 and P < 0.0001). Chlorhexidine mouth rinse was highly correlated to ORN occurrence (hazard ratio [HR], 1.83-2.66), as exposure increased the risk by 2.43-fold among oral cancer patients, regardless of whether they had received major oral surgery or not. Oral cancer patients receiving scaling within 2 wk before radiotherapy increased their incidence of ORN by 1.28-fold compared with patients who had not undergone scaling within 6 mo. There is no significance of fluoride application for dental prophylaxis in increasing ORN occurrence. In conclusion, dental prophylaxis before radiotherapy is strongly correlated to ORN in HNC patients. Chlorhexidine exposure and dental scaling within 2 wk before radiotherapy is significantly related to ORN risk, especially in oral cancer patients. The use of 1.1% NaF topical application did not significantly increase the risk of ORN in HNC patients. An optimal dental prophylaxis protocol to reduce ORN should concern cancer location, cautious prescription of chlorhexidine mouth rinse, and proper timing of scaling. [ABSTRACT FROM AUTHOR]

New variants of porcine epidemic diarrhoea virus ( PEDV), which emerged in Taiwan in late 2013, have caused a high morbidity and mortality in neonatal piglets. To investigate the molecular characteristics of the spike (S) gene of the emerging Taiwan PEDV strains for a better understanding of the genetic diversity and relationship among the Taiwan new variants and the global PEDVs, full-length S genes of PEDVs from nine 1-7 day-old piglets from three pig farms in the central and southern Taiwan were sequenced and analysed. The result of phylogenetic analysis of the S gene showed that all the Taiwan PEDV strains were closely related to the non-S INDEL strains from US, Canada and China, suggesting a common ancestor for these strains. As compared with the historic PEDVs and CV777-based vaccine strains, the nine Taiwan PEDV variants shared almost the same genetic signatures as the global non-S INDEL strains, including a series of insertions, deletions and mutations in the amino terminal as well as identical mutations in the neutralizing epitopes of the S gene. The high similarity of the S protein among the Taiwan and the globally emerged non-S INDEL PEDV strains suggests that the Taiwan new variants may share similar pathogenesis and immunogenicity as the global outbreak variants. The development of a novel vaccine based on the Taiwan or the global non-S INDEL strains may be contributive to the control of the current global porcine epidemic diarrhoea outbreaks. [ABSTRACT FROM AUTHOR]

Panicum maximum (guinea grass), a native grass of Africa, has invaded and displaced the native Miscanthus sinensis grassland at Dadu terrace in central Taiwan. The Dadu terrace has distinct wet and dry seasons and is prone to fire during the dry seasons. We compared photosynthesis and growth, as well as the growth response to two water treatments, between P. maximum and M. sinensis plants to understand ecophysiological factors contributing to the successful invasion of the grass. In comparison with M. sinensis, P. maximum had a significantly higher photosynthetic rate, larger specific leaf area and a higher leaf area/total biomass ratio, and thus grew faster and higher, and accumulated more biomass under well-watered conditions. The growth of P. maximum was more susceptible than M. sinensis to drought stress. Faster growth of seedlings and more biomass accumulation of mature plants would give P. maximum a highly competitive advantage over M. sinensis for resource acquisition in the Dadu terrace during the wet season, which might contribute to the successful invasion of P. maximum into the grassland of M. sinensis. [ABSTRACT FROM AUTHOR]

One major drawback of previous research on speech-to-text recognition (STR) is that most findings showing the effectiveness of STR for learning were based upon subjective evidence. Very few studies have used eye-tracking techniques to investigate visual attention of students on STR-generated text. Furthermore, not much attention was paid to learning differences, such as learning ability, learning style preferences and gender, to use STR texts. Therefore, this study carried out one experiment. Firstly, participants' visual attention on STR-generated text was investigated by employing eye-tracking technique. Secondly, how differently effective STR-generated texts can be to influence participants' learning achievement was tested. Thirdly, this study compared visual attention and learning behaviour with the different characteristics of participants, such as learning ability, learning style preferences and gender, to use STR-generated texts. Finally, this study explored students' perceptions regarding usefulness of STR-generated texts for learning. This paper discusses results, research findings and implications along with conclusions and several suggestions for future development and research. [ABSTRACT FROM AUTHOR]

This study investigated how the integration of a game-based learning strategy and a tangible user interface (TUI) device improves the learning achievement of fifth-grade students in studying Chinese idioms. By using the sifting, and sorting, features of Sifteo Cubes, learners, via a gaming situation, manually composed the cubes to the correct idioms, and the system also provided the origins of the idioms, facilitating meaningful learning. Aquasi-experimental non-equivalent control-group design was conducted. Both the experimental and control groups were administered a pre-test and post-test, the Idiom Learning Performance Test (ILPT), to investigate the variations between the treatment and groups. Furthermore, the Index of Learning Style for Youth (ILSY) survey was administered to determine how different learning styles and learning strategies affect learning achievement. The results showed that, after the CILS was used, the post-test scores were significantly higher than the pre-test scores in the experimental group. In addition, the post-test scores of active and visual learners were higher than the pre-test scores, and were significantly higher than reflective and verbal learners. The results suggested that the CILS is suitable for active and visual learners. Recommendations for using the CILS and Sifteo Cubes in instruction and further direction research are provided. [ABSTRACT FROM AUTHOR]

Background and purpose To assess the efficacy of various antiepileptic drugs ( AEDs) for controlling post-stroke epilepsy. Methods This nationwide cohort study was conducted by using data from 2004 to 2008 on new occurrence of post-stroke epilepsy obtained from the National Health Insurance Research Database of Taiwan. The examined AEDs were phenytoin ( PHT), valproic acid ( VPA), carbamazepine ( CBZ) and new AEDs. Recurrent seizures requiring either emergency room ( ER) visits or hospitalization were used to measure the efficacy of seizure control. The Kaplan−Meier failure curve and Cox proportional hazard regression analyses were used to compare the risk of seizure recurrence in patients taking various AEDs. Results In all, 3622 late-onset post-stroke epilepsy patients were selected. Overall, 1.05 and 0.70 recurrent seizure incidences occurred per 100 person-months based on ER visits [95% confidence interval ( CI) 0.95-1.15] and hospitalizations (95% CI 0.62-0.78), respectively. The incidences of ER visits for patients using different AEDs were 1.26, 0.70, 0.43 and 0.38 per 100 person-months for PHT, VPA, CBZ and new AEDs, respectively. Compared with patients using PHT, the adjusted hazard ratios for ER visits were 0.56 (95% CI 0.42-0.74; P < 0.001), 0.37 (95% CI 0.18-0.75; P = 0.006) and 0.28 (95% CI 0.15-0.52; P < 0.001) for patients using VPA, CBZ and new AEDs, respectively. The adjusted hazard ratios of hospitalizations for seizure recurrence yielded similar results. Conclusions This large nationwide, population-based study demonstrated that late-onset post-stroke epilepsy patients using VPA and new AEDs have better seizure control than those using PHT as demonstrated by lower risks of ER visits and hospitalization. [ABSTRACT FROM AUTHOR]

Summary: The association between Parkinson's disease and fracture was not completely understood. This nationwide study investigated increased risk of fracture in patients with Parkinson's disease. In the nested cohort study, Parkinson's disease was associated with pneumonia, septicemia, stroke, urinary tract infection, and mortality after fracture admission. Introduction: Falls are a common complication in people with Parkinson's disease (PD). This study evaluated fracture risk and post-fracture outcomes in patients with PD. Methods: We identified 1,423 adults aged 40 years and older newly diagnosed with PD using the Taiwan National Health Insurance Research Database from 2000 to 2003. Comparison cohort consisted of 5,692 adults without PD randomly selected from the same dataset, frequency matched in age and sex. Followed-up events of fracture from January 1, 2000, until December 31, 2008, were ascertained from medical claims. Adjusted hazard ratios (HR) and 95 % confidence interval (CI) of fracture associated with PD were evaluated. Another nested cohort study of 397,766 hospitalized fracture patients analyzed for adjusted odds ratios (ORs) and 95 % CIs of adverse events after fracture among patients with and without PD between 2004 and 2010. Results: The incidences of fracture for people with and without PD were 39.5 and 23.9 per 1,000 person-years, respectively ( p < 0.0001). Compared with control, the adjusted HR of fracture was 2.25 (95 % CI 1.97-2.58) for PD patients. Previous PD was associated with risks of pneumonia (OR 1.44, 95 % CI 1.36-1.52), septicemia (OR 1.41, 95 % CI 1.33-1.49), stroke (OR 1.40, 95 % CI 1.32-1.50), urinary tract infection (OR 1.53, 95 % CI 1.46-1.61), and mortality (OR 1.25, 95 % CI 1.15-1.35) after fracture. Conclusions: PD was associated with higher risk of fracture. Patients with PD had more complications and mortality after fracture. Fracture prevention and attention to post-fracture adverse events are needed for this susceptible population. [ABSTRACT FROM AUTHOR]

Three varieties of the introduced Bidens pilosa ( Hairy beggar-ticks; Asteraceae) co-exist in Taiwan. Bidens pilosa var. minor and var. pilosa are naturalised, while only var. radiata is invasive. Differences in seed set in bagged versus open-pollinated capitula, pollen-pistil interactions and the pollen/ovule (P/O) ratio were investigated among these three varieties. In contrast with the resulting 45-55% seed set in each bagged capitulum of var. minor and var. pilosa, almost no mature seeds (1-2 seeds) were found in bagged capitula of var. radiata, showing that var. radiata has a low capability of autonomous seed production. In bagged capitula, only 1.5% of pistils of var. radiata, but 76% and 52% of those of var. minor and pilosa, respectively, had pollen tubes penetrating into their styles, suggesting that var. radiata has strong self-incompatibility mechanisms preventing autonomous autogamy. The P/O ratio, with mean values of 8189, 2053 and 1613 for var. radiata, var. minor and var. pilosa, respectively, were counted. These results support the hypothesis that the three varieties bear different breeding systems; the invasive var. radiata is highly self-incompatible, whereas the other two naturalised varieties are self-compatible. [ABSTRACT FROM AUTHOR]

Summary: While alendronate inhibits atherosclerosis experimentally, its effect on lower limb ischemia risk is unknown. Our results suggest that alendronate reduces the risk of lower limb ischemic vascular events requiring surgical interventions, including amputation. Our results are relevant for patients at risk of lower limb ischemia undergoing fragility fracture treatment. Introduction: This study aimed to determine the association between alendronate therapy and the risk of lower limb ischemic vascular events (i.e., bypass surgery, endovascular stenting, and major lower limb amputation for lower limb ischemia). Methods: We used a nationwide population-based cohort of patients aged over 50 years diagnosed with a vertebral or hip fracture between January 1999 and June 2010. We compared the risk of lower limb ischemic vascular events between patients undergoing treatment with alendronate ( n = 3,731) and an age- and sex-matched comparison group ( n = 7,462) over 5 years of follow-up. Hazard ratios (HR) were estimated using Cox proportional regression analysis with adjustment for treatment status, comorbidities, and other variables. Results: Ten patients (0.3 %) in the alendronate treatment group had a lower limb ischemic vascular event compared with 51 patients (0.7 %) in the comparison group. The incidence of lower limb ischemic vascular events was 8.4 (95 % CI, 4.0-15.5) per 10,000 person-years in the alendronate group and 21.8 (95 % CI, 16.2-28.7) per 10,000 person-years in the comparison group. The risk of a lower limb ischemic vascular event in the alendronate treatment group was lower (adjusted HR, 0.41; 95 % CI, 0.21-0.82). Conclusion: Alendronate treatment was associated with a reduced risk of lower limb ischemic vascular events among hip or vertebral fragility fracture patients. [ABSTRACT FROM AUTHOR]

Study design:An observational study.Objectives:To investigate the factors associated with silent autonomic dysreflexia (AD) during urodynamics (UD) in spinal cord injury (SCI) patients.Setting:Taichung city, Taiwan, ROC.Methods:Blood pressure (BP) and symptoms of AD were continuously monitored during UD, and systolic blood pressure (SBP) elevations >20 mmHg was considered an AD reaction. AD patients were divided into a symptomatic group and a silent group (without AD symptoms), and variables (basic demographic data, hemodynamic data and UD parameters) were compared.Results:A total of 42 patients, 21 in symptomatic and 21 in silent AD groups, were analyzed. Symptomatic group had significantly greater diastolic blood pressure (DBP) increment and rates of SBP/DBP changes (change of BP divided by duration) as compared to the silent group (29.5 vs 21.7 mmHg; 4.8 vs 2.3 mmHg min−1 and 2.8 vs 1.4 mmHg min−1) (P<0.05). The cutoff points of these three variables, determined by receiver operating characteristic analysis, are: DBP increment of 21 mmHg and rates of SBP/DBP change of 2.27 and 1.16 mmHg min−1. Age had a weak negative correlation with DBP change (Pearson's r=−0.377, P=0.048) and the silent group was significantly older than the symptomatic group (49.4 vs 40.1 years, P<0.05).Conclusion:Patients with more symptomatic AD tended to have significant DBP elevation and more rapid SBP/DBP increments, and this was negatively correlated with age. Aging decreases AD symptoms and the magnitude of DBP elevation, possibly through the mechanism of decreased baroreceptor sensitivity. BP monitoring during UD and other invasive procedures is strongly recommended, especially for elderly SCI patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical characteristics and pathological features of patients with mycobacterial tenosynovitis and arthritis. Methods: All patients with tenosynovitis and arthritis caused by Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM) who were treated at a medical center in Taiwan from 2001 to 2010 were analyzed. Results: Thirty-two patients with mycobacterial tenosynovitis and arthritis were identified. MTB was isolated exclusively from patients with arthritis of large joints ( n = 11), while NTM were isolated from patients with arthritis of large joints ( n = 4) and from those with tenosynovitis ( n = 17). Among patients with tenosynovitis due to NTM, the most commonly found NTM were M. marinum ( n = 7), M. intracellulare ( n = 5), and M. abscessus (sensu stricto) ( n = 2). Six of the seven patients with tenosynovitis due to M. marinum had suffered fishing-related injuries to the hands. All four patients with NTM arthritis had recurrent septic arthritis after surgery. NTM were isolated once from the debrided tissue specimens in three of these patients; the other patient died of systemic infection caused by M. intracellulare and multiple bacterial pathogens. Conclusion: Mycobacterial tenosynovitis should be considered in patients who present with indolent symptoms of chronic tenosynovitis. Complete clinical information, including history of trauma or joint replacement surgery and underlying systemic disease, is helpful in establishing an early diagnosis of the disease. [ABSTRACT FROM AUTHOR]

Naegleria spp. is a free-living amoeba that can be found in the natural environment. A number of Naegleria spp. can cause fatal infections in the central nervous system in humans and animals, and the most important source of infection is through direct water contact. In this study, water samples from various thermal springs were taken from four thermal spring areas. Naegleria spp. was detected via culture confirmation and molecular taxonomic identification. Among the 60 samples obtained, Naegleria spp. was identified in 26 (43·3%) samples. The identified species included Naegleria australiensis, Naegleria gruberi, Naegleria lovaniensis and Naegleria mexicana. The presence of living Naegleria spp. was significantly associated with elevated pH value in the water sample. Significance and Impact of Study In this study, we examined the presence of living Naegleria spp. in thermal spring waters in south-eastern Taiwan. Naegleria spp. was isolated and culture-confirmed from thermal spring water. Naegleria fowleri was not found in all water samples, and Naegleria australiensis was the most common Naegleria genotype. [ABSTRACT FROM AUTHOR]

We investigated the clinical characteristics and outcomes of 43 patients with Acinetobacter junii bacteremia at a 2,500-bed tertiary care center in northern Taiwan. These organisms were confirmed to the species level by an array assay and 16S rRNA gene sequence analysis. The antimicrobial susceptibilities of the 43 A. junii isolates to 13 agents were determined using the agar dilution method. Susceptibility testing for tigecycline was determined using the broth microdilution method. Most of the patients were hospital-acquired ( n = 36, 83.7 %) or healthcare facility-related infections ( n = 6, 13.9 %), and 55.8 % had impaired immunity. Central venous access devices were present in 35 (81.4 %) patients; among the total of 43 patients with A. junii bacteremia, 8 patients were diagnosed as catheter-related bloodstream infection and 19 patients were diagnosed as catheter-associated bloodstream infection. Shock requiring inotropic agents occurred in 2 patients (4.6 %). Most patients developed bacteremia in general wards ( n = 36, 83.7 %). The overall in-hospital mortality rate was low (7 %), despite the low rate of removal of central venous devices, low rate of holding usage of original central venous devices, and high rate of inappropriate antimicrobial regimens. Carbapenems, fluoroquinolones, and amikacin had potent activity (>95 % susceptible rate) against A. junii isolates. Interestingly, 35 % of the A. junii isolates were resistant to colistin. Tigecycline exhibited low minimum inhibitory concentration (MIC) values (range, 0.06-2 μg/ml, MIC, 1 μg/ml) against the A. junii isolates. [ABSTRACT FROM AUTHOR]

Objectives: To examine the significance of underweight and physical function as well as their interaction on mortality in the aged. Design: Prospective cohort. Setting: The Elderly Nutrition and Health Survey in Taiwan during 1999-2000. Participants: Total of 1435 representative free-living elders (739 men and 696 women). Measurements: Body composition was assessed by various anthropometrics. Physical function score (PF, ranged 0-100) was derived from the SF-36®. Death by December 31, 2006 was the outcome measure. Results: After 7.9 (median: 7.0) years follow-up, 381 (223 men, 158 women) of 1435 eligible participants had died. Those with the lowest PF (<45) had 3.43 (hazards ratio (HR), 95% confidence interval (CI) = 2.20-5.36) times the all-cause mortality risk of the highest PF (≥58). Interactions for PF and BMI (P =0.02) and for PF and wrist circumference (P =0.09) on death were found after controlling for potential confounders. Jointly, compared to normal-BMI-highest-PF, the greatest HR for death occurred where BMI <18.5 kg/m2 was combined with the lowest-PF after covariate adjustments (HR = 8.67, 95% CI = 3.77-20.0). Similarly, the lowest arm muscle circumference (MAMC)-PF had a HR of 5.22 compared to mid-MAMC-highest-PF. However, percent and absolute body fat, estimated by bioelectrical impedance, was comparable to non-sarcopenic individuals. Conclusion: Thin elderly Taiwanese with sarcopenia, and less skeleton, are at the most risk of death, especially if physical function is limited. [ABSTRACT FROM AUTHOR]

We reviewed 776 patients who were culture positive for Aspergillus species at the hospital from 2000 to 2009. The isolates were collected for species identification by oligonucleotide hybridization and sequence analysis. A total of 96 cases of proven or probable IA were identified according to published criteria. The incidence of IA has increased significantly during the study period. Aspergillus fumigatus and A. flavus (41.7% each) were equally prevalent causative species. IA due to unusual species including A. nidulans ( n = 2), A. versicolor ( n = 2), and A. tubingensis ( n = 1) were also found. Among patients with IA, 55.2% had hematological disorder, 19.8% had underlying lung disorder, and 10.4% had autoimmune disease. The isolates species ( P < 0.001) and underlying disease ( P < 0.001) significantly affect the association of a positive culture with invasive disease. The overall mortality at three months was 62.5%, which remained stable throughout the study period. Multivariate analysis identified prior steroid use ( P = 0.007) as a significant risk factor for death, while surgery ( P = 0.030) and voriconazole ( P = 0.012) had protective effects. In conclusion, autoimmune disorders and underlying pulmonary diseases should also be considered as important predisposing factors of IA. Further emphasis on surgery and voriconazole in the management of IA might be beneficial. [ABSTRACT FROM AUTHOR]

This study presents a new perspective to facilitate learner-centred weblog evaluation, based on content attractiveness, blogging support, and the value-added service construct. A mixed method, combining fishbone diagram, fuzzy logic techniques, and the analytic hierarchy process, was conducted to identify further the criteria that attract bloggers to engage in blogging, based on user perspectives in a higher education context. Results indicate that the dimensions of content attractiveness and value-added service for the benefit of students contributed two-thirds of the overall weights. Respondents' appreciating a pleasant atmosphere is the first priority. Findings also indicated both similarities and differences among freshmen, non-freshmen, and instructors and provide a valuable reference for various types of learning resources. This study made two contributions to research. First, the extracted weight values of the critical factors from the proposed hierarchical system framework serve as guidelines for enhancing the robustness and attractiveness of weblog content. Second, the evaluation process provided insights for managing weblog quality effectiveness to promote joyful interactions while exhibiting mutual connections. [ABSTRACT FROM AUTHOR]

Objective:Adipocytokine genes encoding adiponectin (ADIPOQ) and the leptin receptor (LEPR) affect glucose and fatty acid metabolism. The purpose of this study was to examine the association between early-onset type 2 diabetes mellitus (T2DM) and variability within these two genes in the Han Chinese population of Taiwan.Subjects:A cross-sectional study of 999 patients from the Han Chinese population of Taiwan with early-onset T2DM (n=264; age at diagnosis, 20 to <45 years) and late-onset T2DM (n=735; age at diagnosis, 45 years) was performed. Blood samples from T2DM patients were taken for DNA extraction, and levels of serological markers were measured at enrollment. Seven single-nucleotide polymorphisms (SNPs) were selected for genotyping (three SNPs in AIDPOQ and four SNPs in LEPR) by polymerase chain reaction in each patient.Results:Polymorphisms at the position rs10937273 in ADIPOQ and at the positions rs1892534 and rs2211651 in LEPR were statistically associated with early-onset T2DM (P=0.0246, 0.0014 and 0.0012, respectively). C-reactive protein levels were significantly different among the early-onset T2DM patients with different genotypes at the SNPs rs1892534 and rs2211651 in LEPR (P=0.003 and P=0.004, respectively). In addition, fasting glucose levels were also significantly different among different genotypes at the SNP rs1892534 in LEPR (P=0.038).Conclusion:We conclude that the polymorphisms in the adipocytokine genes ADIPOQ and LEPR are significantly associated with the age at diagnosis of T2DM in the Han Chinese population of Taiwan. [ABSTRACT FROM AUTHOR]

Daily air concentrations and dry deposition fluxes of seven metal species were monitored at five sites in central Taiwan for five or six days every month from September 2009 to August 2010. Annual average concentrations at the five sites were in the range of 2.8 to 3.6 ngm-3 for As, 25 to 82 ngm-3 for Mn, 1900 to 2800 ngm-3 for Fe, 69 to 109 ngm-3 for Zn, 18 to 33 ngm-3 for Cr, 60 to 110 ngm-3 for Cu, and 25 to 40 ngm-3 for Pb. Annual average dry deposition fluxes were on the order of 3, 20, 400, 50, 25, 50, and 50 µgm-2 day-1 for As, Mn, Fe, Zn, Cr, Cu, and Pb, respectively. Annual average dry deposition velocities (Vd) for the seven metal species ranged from 0.18 to 2.22 cm s-1 at these locations. Small seasonal and geographical variations, e.g. from a few percent to a factor of 2 for different species and/or at different locations, were found in the measured concentrations, fluxes, and Vds. The measured fluxes and air concentrations had moderate to good correlations for several of the species at several of the sites (e.g. Fe, Zn, and Mn at most of the sites), but had either weak or no correlations for the other species or at the other sites (e.g. As at Sites I and III, Zn and Cr at Site IV, and Cu at most of the sites). The latter cases were believed to have large uncertainties in the flux measurements using surrogate surfaces. Sensitivity tests were conducted for particle Vds using a size-segregated particle dry deposition model, assuming various combinations of three lognormal size distributions representing fine particles (PM2.5), coarse particles (PM2.5-10), and super-sized particles (PM10+), respectively. It was found that the measured dry deposition fluxes can be reproduced reasonably well using the size-segregated particle dry deposition model if the mass fractions of the metal species in PM2.5, PM2.5-10 and PM10+ were known. Significant correlations between the modeled and the measured daily fluxes were found for those cases that were believed to have small uncertainties in the flux measurements. [ABSTRACT FROM AUTHOR]

Data envelopment analysis (DEA) is a method frequently used to evaluate relative firm performance. However, high values in a few indicators can lead to a company being regarded as 'efficient', despite valuing poorly in other essential indicators. The Inefficiency Countervailed DEA (IC-DEA) method is thus developed. The method first defines an inefficient frontier using the proposed Reverse DEA (RDEA) model. An IC-DEA value is then determined by summing both the DEA and RDEA values. The IC-DEA method was applied to assess the environmental performance of major opto-electronic companies in Taiwan, demonstrating its applicability. [ABSTRACT FROM AUTHOR]

Background and purpose: Recent studies have suggested increased prevalence of impulsive/compulsive behaviors (ICB) in patients with Parkinson's disease (PD) as compared to general population in different ethnic groups. The spectrum of these behaviors includes dopamine dysregulation syndrome (DDS), punding, pathological gambling (PG), hypersexuality (HS), binge eating (BE), and compulsive shopping (CS). Methods: Two hundred and seventy-eight consecutive patients with idiopathic PD regularly followed-up at an outpatient clinic were interviewed and screened for the ICB between September 2008 and December 2008 using designated diagnostic criteria. All patients who screened positive for ICB or obsessive-compulsive disorder (OCD) were further confirmed by an experienced psychiatrist. Results: Of all the studied patients, 15 patients confirmed to have ICB (lifetime prevalence: 5.60%), 3 (1.12%) were diagnosed to have DDS, 1 (0.37%) punding, 4 (1.49%) PG, 8 (2.99%) HS, 1 (0.37%) BE, 0 (0%) CS. OCD was found in one patient (0.37%). Conclusions: The prevalence of ICB is lower in Taiwan as compared with the Caucasians, with similar risk factors. The possible reasons include differences in ethnicity, environmental, cultural, and social factors as well as the dosage and selection of dopaminergic medications. [ABSTRACT FROM AUTHOR]

This study attempts to optimize the operations of the Recycling Fund Management Board (RFMB), founded by the Environmental Protection Administration of the R.O.C. Government (on Taiwan), through the decision of a subsidy rate for the domestic glass recycling industry. The hierarchical and interactive nature between the two parties is modelled by bi-level programming, where the RFMB plays the upper-level decision unit while the recycling industry is the lower-level counterpart. In order to solve the problem by optimization software, the bi-level formulation is transformed to a single-level problem via Karush-Kuhn-Tucker optimality conditions and is further transformed to a 0-1 mixed integer programming problem by variable substitution. The problem is solved with real-world data, and the obtained solutions are analysed and compared with the RFMB's current operations. The results suggest that the proposed approach can improve the operations of the RFMB. [ABSTRACT FROM AUTHOR]

This multicenter study in Taiwan investigated the clinical presentations of various Nocardia species infections based on 16S rRNA sequence analysis. Patients with nocardiosis in four large medical centers from 1998 to 2010 were included. A total of 100 preserved nonduplicate isolates causing human infection were identified as Nocardia species. Sequencing analysis of 16S rRNA confirmed that 35 of 36 N. asteroides isolates identified by conventional tests were non- asteroides Nocardia species, and that two of 50 N. brasiliensis isolates had also been initially misidentified. N. brasiliensis (50%) was the most common pathogen, followed by N. cyriacigeorgica (18%). In addition, several rare pathogens were identified, including N. asiatica, N. rhamnosiphila, N. abscessus, N. transvalensis, N. elegans, and N. carnea. Primary cutaneous infection was the most common presentation, noted in 55 (55%) patients, while pulmonary infection presented in 26 (26%) patients. The crude mortality rate was 6.7% (6/89), and was lowest for primary cutaneous infection (2.2%) and highest for disseminated disease and pulmonary infection (16.7%). In conclusion, N. brasiliensis and N. cyriacigeorgica were the most common pathogens causing nocardiosis in Taiwan. Molecular methods for identifying Nocardia to the species level are mandatory for better understanding the epidemiology and clinical characteristics of patients with nocardiosis. [ABSTRACT FROM AUTHOR]

We investigated clinical and microbiological characteristics of 30 patients with Brevundimonas bacteremia treated at a tertiary care hospital in Taiwan during 2000-2010. All the 30 bacteria isolates were confirmed to the species level by 16S rRNA sequencing analysis. Minimum inhibitory concentrations (MICs) of 11 antimicrobial agents against these isolates were determined by the agar dilution method. Seventeen (57%) patients had underlying malignancy, 12 (40%) had undergone central catheter placement, and 13 (43%) had received chemotherapy within the previous three months. Eight (27%) patients had community-acquired bacteremia and the remaining 22 patients (73%) had healthcare-associated bacteremia. The overall 14-day and 30-day mortality rates were 13% and 17%, respectively. Among the 30 isolates, B. vesicularis constituted most commonly ( n = 22, 63%), followed by B. nasdae ( n = 5) and B. diminuta ( n = 3). All isolates were susceptible to piperacillin-tazobactam and amikacin, while all were resistant to ciprofloxacin and colistin. Tigecycline (MICs at which 90% of isolates are inhibited [MIC] was 0.12 mg/L) and doripenem (MIC of 1 mg/L) both possessed good in vitro activities. In conclusions, Brevundimonas should be considered a pathogen that can cause bacteremia in immunocompromised hosts. Piperacillin-tazobactam, amikacin, doripenem, and tigecycline exhibit good in vitro activities against these ciprofloxacin- and colistin-resistant Brevundimonas species. [ABSTRACT FROM AUTHOR]

Background and purpose: The association between glucocerebrosidase ( GBA) mutations and Parkinson's disease (PD) is attracting increased attention worldwide. In patients of Chinese ethnicity, other than the common L444P mutation, a few mutations have been reported. However, the contribution of GBA to PD can be answered only by a thorough investigation of its mutations in a unique large population. Methods: We enrolled 1747 participants: 967 PD patients and 780 healthy individuals. We screened entire GBA coding regions and exon-intron boundaries in 30 randomly chosen PD patients, followed by testing five variants (L444P, D409H, R120W, L174P, and Q497R) in all participants. The G2385R and R1628P in LRRK2 had been previously studied in almost all participants. Results: In total, 36 patients (3.72%) carried a heterozygous mutant GBA allele (27 L444P, 7 Rec NciI, and 2 D409H). Only two controls (0.26%) carried heterozygous GBA mutation (1 L444P and 1 Rec NciI). In PD group, the mean age at onset in carriers was younger than in non-carriers. The difference in percentage of mutation frequencies between patients and controls was highly significant for the L444P mutation ( P < 0.0001). One L444P carrier was also associated with LRRK2 G2385R variant, but no atypical Parkinsonism was observed. Conclusions: The present study ascertains that L444P mutation in GBA gene may contribute to an earlier onset of development of PD in Han/Chinese population. Following LRRK2 variants, GBA is the second most frequent mutations indicated for sporadic PD development in the Han/Chinese population. These GBA carriers are associated with an earlier onset of Parkinsonism. [ABSTRACT FROM AUTHOR]

A total of 118 patients with Elizabethkingia meningoseptica bacteremia at a medical center in Taiwan from 1999 to 2006 were studied. Minimum inhibitory concentrations (MICs) of 99 preserved isolates were determined. The incidence (per 100,000 admissions) of E. meningoseptica bacteremia increased from 7.5 in 1996 to 35.6 in 2006 ( p = 0.006). Among them, 84% presented with fever, 86% had nosocomial infections, and 60% had acquired the infection in intensive care units (ICUs). The most common underlying diseases were malignancy (36%) and diabetes mellitus (25%). Seventy-eight percent of patients had primary bacteremia, followed by pneumonia (9%), soft tissue infection, and catheter-related bacteremia (6%). Forty-five patients (38%) had polymicrobial bacteremia. Overall, the 14-day mortality was 23.4%. Multivariate analysis revealed E. meningoseptica bacteremia acquired in an ICU ( p = 0.048, odds ratio [OR] 4.23) and presence of effective antibiotic treatment after the availability of culture results ( p = 0.049, OR 0.31) were independent predictors of 14-day mortality. The 14-day mortality was higher among patients receiving carbapenems ( p = 0.046) than fluoroquinolones or other antimicrobial agents. More than 80% of the isolates tested were susceptible to trimethoprim-sulfamethoxzole, moxifloxacin, and levofloxacin. The MIC and MIC of the isolates to tigecycline and doxycycline were both 4 μg/mL and 8 μg/ml, respectively. [ABSTRACT FROM AUTHOR]

Objectives: To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI-R) and the Dietary Diversity Score (DDS) among representative Taiwanese aged 65 and older. Design: Prospective cohort. Setting: The Elderly Nutrition and Health Survey in Taiwan during 1999-2000. Participants: One thousand seven hundred forty three (860 men and 883 women). Measurements: Dietary quality measures, the ODI-R (0-100) and DDS (0-6) were based on 24-hour dietary recall and a food frequency questionnaire at baseline. Death by National Death Registry up to 2008 was the outcome measure. Results: During follow-up, 624 subjects died. The survivors had both significantly higher (P <0.001) ODI-R (66.9 vs. 63.6) and DDS (4.69 vs. 4.30) than the deceased. The two indices were correlated (r=0.46). After adjustment for potential covariates, the hazard ratios (HR) (95% CI) were 0.63 (0.42-0.97), 0.71 (0.49-1.04) and 0.53 (0.37-0.76) for those whose ODI-R scores were 60-65, 65-70, >70, respectively, compared to those whose ODI-R scores were £ 50 (P for trend <0.001). For DDS, the multi-variable HRs (95% CI) were 0.74 (0.55-1.00), 0.52 (0.38-0.72) and 0.50 (0.31-0.81) for those whose DDS were 4, 5, 6, respectively, compared to those whose DDS were <3 (P for trend<0.001). Total cancer, diabetes mortalities and pneumonia were similarly benefited according to trends. Conclusion: ODIR ≥ 60, and DDS ≥ 4 are predictors of all-cause and cause-specific mortalities. Of the two, DDS is the more predictive. Nutrition policy could be informed and clinical practice enhanced by these population relevant foodhealth relationships. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2011; 17: 1226-1231 Abstract Human infections caused by Weissella confusa are rarely reported. Ten patients with bacteraemia caused by W. confusa who were treated at a tertiary-care hospital in Taiwan during 1997-2007 were studied. All isolates were initially misidentified as various Lactobacillus and Leuconostoc species by two commercial automated identification methods, and were confirmed to be W. confusa by 16S rRNA sequencing analysis. MICs of these isolates for ten antimicrobial agents were determined by the agar dilution method. The characteristics of these patients included underlying malignancy ( n = 4), presence of a central catheter ( n = 6), surgery within the previous 3 months ( n = 4) and concomitant polymicrobial bacteraemia ( n = 5, 50%). Mortality was directly attributed to bacteraemia in two patients. All isolates exhibited high trimethoprim-sulphamethoxazole and ceftazidime MICs (≥128 mg/L) and were inhibited by linezolid, daptomycin, ceftobiprole and tigecycline at 4, 0.12, 2 and 0.12 mg/L, respectively. In conclusion, W. confusa should be included in the list of organisms causing bacteraemia in immunocompromised hosts. Novel antibiotics, including daptomycin, moxifloxacin, doripenem and tigecycline, exert good activity against W. confusa. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 54-month-old girl with acute gastroenteritis and a 31-month-old boy with acute gastroenteritis who were both hospitalized in Taiwan. It states that nucleotide sequencing and reverse transcription polymerase chain reaction amplification were performed to characterize the two Taiwanese G3P[9] strains. The study discovered that the strains caused serious infection in the patients that led to their hospitalization.

The aim of this study was to investigate the clinical significance of nontuberculous mycobacteria (NTM) isolates in elderly Taiwanese patients. From 2004 through 2008, patients >65 years old with NTM isolation were identified. The definitions of NTM disease followed the American Thoracic Society and Infectious Disease Society of America (ATS/IDSA) criteria. Among the 3,175 NTM isolates, Mycobacterium avium complex (MAC; n = 1,118, 35.2%) was the most prevalent species, followed by M. abscessus ( n = 545, 17.2%). Among the 1,633 elderly patients with NTM isolates, the most prevalent NTM species were MAC ( n = 592, 36.3%) and M. fortuitum complex ( n = 311, 19.0%). NTM colonization was found in 1,339 (80.4%) patients and only 326 (19.6%) patients had NTM diseases. During the study period, the annual incidence rates (per 100,000 inpatients and outpatients) of NTM colonization and disease both increased significantly ( p < 0.0001) from 10.5 to 15.8 and from 2.1 to 4.3, respectively. Isolated pulmonary NTM infections compromised 294 (90.2%) of the 326 elderly cases of NTM disease. In conclusion, this study found an increasing trend in the incidence of both NTM isolates and NTM diseases among elderly Taiwanese patients. MAC and M. abscessus were the most frequent species causing various types of NTM disease. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the diagnostic performance of an enzyme-linked immunospot (ELISPOT) assay for interferon-γ in patients with suspected skeletal tuberculosis (TB). From March 2007 to June 2010, a total of 36 patients with suspected skeletal TB in a tertiary care hospital in Taiwan were enrolled. Twelve patients (35.3%) had culture-confirmed TB, three (8.8%) patients had probable TB, and the remaining 21 (58.3%) patients did not have TB. Fourteen patients with mycobacterial infection had available biopsy or surgical specimens for histopathological examination and 12 (85.7%) specimens had pathological features consistent with mycobacterial infection. Among the 12 patients with positive findings indicating mycobacterial infection, all seven patients with spinal TB and three of five patients with TB arthritis had positive ELISPOT assays. All nine patients with spinal TB had positive ELISPOT assays, but only four of six patients with TB arthritis had positive ELISPOT assays. The sensitivity, specificity, positive predictive value, and negative predictive value for skeletal TB diagnosis by the ELISPOT assay were 86.7%, 61.9%, 61.9%, and 86.7%, respectively. In conclusion, the ELISPOT assay can provide useful support in diagnosing skeletal TB, and spinal TB can be excluded based on a negative ELISPOT assay. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Lin C, Yang C, Shih Y, Hsu H, Yang T, Cheng Y, Chang C, Hsieh L, Chen B, Lee C, Huang Y. Rubella seroepidemiology and estimations of the catch-up immunisation rate and persistence of antibody titers in pregnant women in Taiwan. BJOG 2011;118:706-712. To examine rubella seroepidemiology, and estimate rates of catch-up immunisation and persistence of antibody titers in pregnant women in Taiwan after mass immunisation. A retrospective study. Two medical centres and four regional hospitals specialising in obstetric care. A total of 43 640 prenatal rubella test results for pregnant women from 2001 to 2008. Rubella immunoglobulin G (IgG) antibody assay. Seronegativity, rate of catch-up immunization, and antibody decline. The seronegativity was 10.9% in all pregnant women. Immigrant women had higher seronegativity than indigenous women (OR 2.86; 95% CI 2.65, 3.01). Indigenous women born prior to implementation of the vaccination programmes were more susceptible (20.1%) to rubella infection than were women born thereafter (6.7%). Rates of seropositive conversion were low in both Taiwanese-born and foreign-born women (11.5 and 30.7%, respectively). The rubella antibody titers for vaccinated Taiwanese women in the 1971-1976 and after-1976 birth cohorts declined by 0.6 and 2.3% per year, respectively. This study demonstrates high seronegativity of older indigenous and immigrant women, a low catch-up immunisation rate, and the persistence of rubella antibodies in Taiwan after mass vaccination. Our study suggests that a single dose of rubella vaccine in teenagers effectively increased rubella seropositivity during their childbearing years. This finding is useful for countries that lack the resources necessary for a two-dose regimen. We recommend free rubella antibody tests to women of childbearing age and free vaccination as required. All postpartum women testing negative for rubella antibodies should be vaccinated before they leave hospital. [ABSTRACT FROM AUTHOR]

This study investigated the correlation between antibiotic consumption and resistance among Staphylococcus aureus and enterococci causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2009. Overall, the trend of total consumption (defined daily dose [DDD] per 1,000 patient-days) of glycopeptides, including vancomycin and teicoplanin, significantly increased during 2000 to 2003 and remained stable during 2004-2009. Vancomycin consumption significantly increased during 2003 and decreased after 2004. A significant decrease in the resistance rate with time was found for oxacillin- and gentamicin-resistant S. aureus. In contrast, the rates of vancomycin- and teicoplanin-resistant enterocci increased significantly. A significant correlation was found between the increased use of extended-spectrum cephalosporins, β-lactam-β-lactamase inhibitor combinations, carbapenems and the decreased prevalence of methicillin-resistant S. aureus (MRSA). In contrast, the increased use of teicoplanin, extended-spectrum cephalosporins, β-lactam-β-lactamase inhibitor combinations, and carbapenems was correlated with the increased prevalence of vancomycin-resistant enterococci (VRE). In conclusion, this 10-year study in a single institution identified different correlations between the prescription of antibiotics and the resistance rates of MRSA and VRE. Strict implementation of infection control policy based on these correlates would be helpful in decreasing the presence of these multidrug-resistant pathogens in hospitals. [ABSTRACT FROM AUTHOR]

We retrospectively investigated the prevalence of drug resistance in Mycobacterium tuberculosis (MTB) isolates recovered from elderly patients and compared the drug resistance patterns between the elderly (≥65 years old) and adult (15-64 years old) patients. Data on the prevalence of drug resistance in clinical and non-duplicate isolates of MTB recovered from 2000 to 2008 were evaluated. Among the 3,186 non-duplicate MTB isolates found during the study period, 1,497 isolates were recovered from elderly patients. Thirty-eight (2.54%) isolates were multidrug-resistant tuberculosis (MDRTB). The rates of resistance to isoniazid (INH), rifampicin (RIF), ethambutol (EMB), streptomycin (SM), ofloxacin, rifabutin, any one drug-resistant (ADR), and multidrug-resistant (MDR) were significantly lower in isolates from the elderly than from adults ( p < 0.05). Significant decreasing trends in resistance rates to EMB, SM, at least any one of the four first-line agents (ADR), and MDRTB were observed ( p < 0.05) . In conclusion, elderly patients had a lower rate of anti-TB drug resistance than adults and a decreasing overall trend of anti-TB drug resistance was found in the elderly in recent years, but the higher rate of MDRTB in Taiwan continues to present a challenge for the control of TB in the elderly. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the support to tuberculosis diagnosis of a new immunological tool, an enzyme-linked immunospot (ELISPOT) assay for interferon-γ, in diabetic patients. From March 2007 to January 2008, diabetic patients with suspected pulmonary tuberculosis were enrolled in a tertiary care hospital. Data on clinical characteristics of the patients and conventional laboratory results were collected and blood samples were obtained for ELISPOT assay (T SPOT-TB; Oxford Immunotec Ltd, Oxford, UK). A total of 84 patients with suspected pulmonary tuberculosis were recruited. Fifty-one (60.7%) of these patients were considered to have pulmonary tuberculosis, including 42 (50%) with confirmed tuberculosis and 9 (10.7%) with probable tuberculosis. The overall (confirmed and probable tuberculosis) sensitivity, specificity, positive predictive value and negative predictive value of the ELISPOT assay were 84.3%, 66.7%, 79.6%, and 73.3%, respectively. The negative predictive value of the ELISPOT assay was significantly higher in patients with adequate glycaemic control (90% vs 56.3%). In conclusion, the ELISPOT assay can provide useful support in diagnosing pulmonary tuberculosis in diabetic patients, especially those with adequate glycaemic control. [ABSTRACT FROM AUTHOR]

Background Obesity has been found to be associated with an increased risk of psoriasis in general population. However, studies addressing the relationship between obesity and clinical severity of psoriasis are still scarce, especially in Asian people. Objectives In this study, we investigated the relationship between levels of obesity and the clinical severity of psoriasis in Taiwanese psoriasis patients. Methods This was a hospital-based cross-sectional study. A total of 399 patients with chronic plaque psoriasis were recruited. Their body mass index (BMI) was calculated as weight in kilograms divided by height in metres squared and was categorized into four groups (BMI < 24, normal; 24 ≤ BMI < 27, overweight; 27 ≤ BMI < 30, mild obesity; and BMI ≥ 30, moderate-to-severe obesity). Disease severity was assessed by Psoriasis Area and Severity Index. Cumulative logistic regression models were used to estimate the association between BMI and Psoriasis Area and Severity Index. Results After adjusting for potential confounders (age, gender, cigarette smoking and duration of disease), moderate-to-severe obesity was significantly associated with an increased risk of clinically more severe psoriasis when compared with normal BMI [odds ratio, 2.70; 95% confidence interval,1.42–5.11]. There is a significant linear trend for clinically more severe psoriasis across increasing of BMI categories ( P for trend = 0.004). The effect of obesity on the severity of psoriasis was greater in men than in women (test for interaction, P = 0.03). Conclusions In psoriasis patients, obesity is associated with a more severe disease, especially in men. Bodyweight control may be important for the management of psoriasis. [ABSTRACT FROM AUTHOR]

The article discusses a retrospective observational study which examined the risk factors and outcome of prolonged stay in the surgical intensive care unit (SICU) at the National Taiwan University Hospital. An ICU stay of more than 16 days is considered as a prolonged SICU stay. A multivariate logistic regression model was used to determine factors associated with a prolonged SICU stay as well as factors associated with hospital mortality.

Avian coronavirus infectious bronchitis virus (IBV) poses a major threat to the global poultry industry. New IBV genoand serotypes are continually reported. However, information on IBV prevalence is not frequently addressed in these reports. This study reports on a viral surveillance program in Taiwan from 2005 to 2006 with sampling conducted in poultry slaughterhouses. The genetic features of the obtained field isolates were investigated using sequence analysis and SimPlot analysis. A 1-directional neutralization test was performed to examine the antigenic variations among the collected viruses. The selection pressures that may contribute to the evolution of Taiwan IBV during recent decades were assessed. The surveillance program revealed that 8 out of 47 flocks (17%) were IBV-infected, from which 13 IBV isolates were recovered. Based on the phylogenetic analysis of the Si gene, 11 of 13 isolates (84.6%) clustered with Taiwan group I. One IBV isolate showed evidence of frequent recombination events with China-like IBV in the spike glycoprotein (S) gene. Another isolate demonstrated the incorporation of China-like and H120-like genome fragments within the S2 gene and the membrane protein (M) gene region, respectively. Some antigenic changes were found in the 1-directional neutralization test. However, no positive selection pressures were related to those variations in the Si genes among Taiwan IBV. Based on our work, we suggest that sampling chickens in poultry slaughterhouses is an effective and valuable means of compiling viral prevalence data, particularly in situations where there is subclinical infection. Infectious bronchitis viruses from slaughtered chickens revealed intertypic genetic recombination and antigenic diversity. [ABSTRACT FROM AUTHOR]

XRCC1 plays a central role in mammalian DNA repair processes. Two polymorphisms of XRCC1, rs1799782 (Arg>Trp at codon 194) and rs25487 (Arg>Gln at codon 399), are common in the Han Chinese population. Our objective was to analyze the relationship between these two functional single-nucleotide polymorphisms (SNPs) and systemic lupus erythematosus (SLE) in the Taiwanese Han Chinese population. Genotyping was performed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) on 172 SLE patients and 160 normal controls. Our data indicate that the frequency of A/G at codon 399 differed between patients and controls (p=0.01; odds ratio: 1.80; 95% confidence interval: 1.17-2.75), but the allelic frequency analysis did not reveal significant differences. For the SNP at codon 194, there were no differences in either allelic or genotype frequencies between SLE patients and normal subjects. Clinical association studies of SLE symptoms revealed the involvement of the A/G polymorphism at codon 399 in SLE pathogenesis. Our results indicate that a functional SNP at codon 399 of XRCC1 is associated with the development of SLE. [ABSTRACT FROM AUTHOR]

Accurate molecular surveillance is important in monitoring the dynamics of Streptococcus pneumoniae. A prospective study was conducted to collect invasive isolates of S. pneumoniae from children for genetic analysis from January 2004 to December 2006 in Taiwan. PCRs were performed to detect the zmpC and zmpD genes, both encoding a metalloprotease virulence factor in pneumococci, among these invasive isolates. During the study period, 68 invasive isolates of S. pneumoniae were obtained for analysis. Serotype 14 was the most common type isolated from children with invasive disease and was significantly associated with pneumonia (OR 3.1; 95% CI] 1.1–8.8; p 0.035). Serotype 23F was significantly associated with bacteraemia (OR 7.5; 95% CI  1.8–31.3; p 0.006). The seven-valent conjugate vaccine covered 83.8% of invasive isolates, but non-vaccine serotypes were more frequently isolated from patients with underlying diseases than from patients without underlying diseases (p 0.007 by Fisher’s exact test). Clonal complexes related to international clones Spain23F ST81, Spain6B ST95, England14 ST9, Taiwan19F ST236, Taiwan23F ST242 and Colombia23F ST338 accounted for 52.9% of invasive isolates. Dissemination of the penicillin-resistant clones ST876, ST46, ST76 and ST2889, which were first identified in Taiwan, was also found; 1.5% of these invasive isolates carried the zmpC gene, and 47.1% of these invasive isolates carried the zmpD gene. In conclusion, the spread of certain international clones and some domestic antibiotic-resistant clones resulted in invasive diseases among Taiwanese children. [ABSTRACT FROM AUTHOR]

Tumour necrosis factor-α (TNF-α), an important proinflammatory cytokine, exerts a variety of physiological and pathogenic effects that lead to tissue destruction. Studies on the association of TNF-α genetic polymorphisms with systemic lupus erythematosus (SLE) have yielded inconclusive results. We investigated the association of TNF-α genetic polymorphisms (-1031T/C, -863C/A, -857T/C, -308A/G and +489A/G) with SLE in Taiwanese patients and controls. Our results indicate that 1) the frequency of the A-allele at -863 position was significantly higher in SLE patients (odds ratio = 1.46; 95% CI = 1.02-2.08); 2) the frequency of the A-allele at +489 position was significantly higher in SLE patients (odds ratio = 1.79; 95% CI = 1.21-2.65); 3) the AA or GA genotype frequencies at +489 position were significantly increased in SLE patients (AA genotype: odds ratio = 11.20; 95% CI = 1.36-92.55; GA genotype: odds ratio = 1.63; 95% CI = 1.03-2.58); 4) no significant association of TNF-α haplotypic distributions was observed, except for the haplotypes TCCGA, CACGA and CCCGG; and 5) the genotype frequency of the polymorphisms at -1031 was significantly different in patients with antinuclear antibodies (P = 0.022). The allele and genotype frequencies of the polymorphisms at -863 were not significantly different. The genotype frequency of the polymorphisms at -857 was significantly different in patients with haematological disorder (P = 0.025). The frequency of A allele of the polymorphisms at -308 was significantly increased in patients with malar rash (P = 0.033), discoid rash (P = 0.023), photosensitivity (P = 0.037), oral ulcers (P = 0.002) and serositis (P = 0.029). The genotype frequency of the polymorphisms at +489 was significantly different in patients with discoid rash and photosensitivity (data not shown; discoid rash, P = 0.031; photosensitivity, P = 0.044). These results suggest that TNF-α genetic polymorphisms contribute to SLE susceptibility in the Taiwanese population. [ABSTRACT FROM AUTHOR]

Background and purpose: Sialidosis type 1 (ST-1) is a neurodegenerative disorder with limited long-term follow-up report. This study is to document the chronological profile of ST-1. Methods: We perform serial analysis of 17 Taiwanese patients with ST-1 focusing on evolution of clinical features, electrophysiological findings, genetic studies, and neuroimage examinations. Results: All patients had a mutation at 554A→G in exon 3 of the NEU1 gene causing Ser182Gly substitution. Fifteen patients were homozygous. Two patients were heterozygous with novel mutations, 956C→T causing Ala319Val in one and 163C→T causing Gln55stop codon in the other. The neuraminidase activity was markedly decreased in all 11 available patients. Only three patients (17.6%) manifested the macular cherry-red spot. The majority of patients (82.3%) developed full-blown manifestation of myoclonus, ataxia, and seizures within 5 years. Abnormal somatosensory evoked potentials with giant cortical waves were found in all patients. Prolonged P100 peak latency of the visual evoked potentials (VEPs) were found in 16 patients (94.1%) in the early stage even without visual symptoms. Conclusion: ST-1 in Taiwanese population illustrates distinct characteristics of phenotype with infrequent cherry-red spot. We suggest to screen the NEU1 mutations in patients presenting action myoclonus with abnormal VEPs, even without macular cherry-red spots. [ABSTRACT FROM AUTHOR]

Abstract: Background: Combinations of Child-Pugh classification and Liver Cancer Study Group of Japan/Tumor-Node-Metastasis (LCSGJ/TNM) have been reported as Japan Integrated Staging (JIS). We previously modified the 6th AJCC/TNM to serve as a better staging system than the 5th and 6th AJCC/TNM. Aims: To develop a modified TNM-based JIS to predict the survival of hepatocellular carcinoma (HCC) patients more accurately. Methods: 3764 HCC patients were enrolled from 1986 to 2002 (2882 patients from 1986 to 2000 and 882 patients from 2001 to 2002). We compared the performance of original JIS, modified TNM-based JIS, modified TNM-based JIS combined α-fetoprotein (AFP), BCLC, and CLIP. Lower Akaike information criteria (AIC) values indicated better discriminatory abilities. Results: AIC value was lowest in CLIP during all periods. However, during 2001–2002, when early-stage HCC patients were predominant, AIC value was lowest when modified TNM-based JIS combined AFP was used. Conclusion: The CLIP system provided the best prognostic stratification in the present cohort of HCC patients who were mainly at late stages. However, early detection of HCCs has become more common in Taiwan in recent years, which has led to the predominance of early-stage HCC patients. Therefore, modified TNM-based JIS combined AFP may now be the most applicable system in recent years. [Copyright &y& Elsevier]

From August 2004 to July 2005, 210 clinical methicillin-resistant Staphylococcus aureus (MRSA) isolates were collected prospectively from 173 children admitted to Chang Gung Children’s Hospital in Taiwan. A comparative molecular analysis of the 111 community-associated (CA) isolates from 102 children and the 99 healthcare-associated (HA) isolates from 71 children was conducted. In comparison to the HA isolates (31%), the CA isolates (90%) were more likely to have been isolated from pus (p <5 × 10−8). For each patient with MRSA infection, only the first isolate was selected for molecular analysis. The molecular characteristics differed significantly between the CA and the HA isolates (p <5 × 10−8). The clone characterized as sequence type (ST)59/pulsotype  D (similar to USA1000)/staphylococcal chromosomal cassette (SCC) mec VT/Panton–Valentine leukocidin (PVL)-positive accounted for 69% of the CA isolates, and another clone, characterized as ST239/pulsotype  A (Hungary clone)/SCC mec III/PVL-negative, accounted for 45% of the 71 HA isolates. The CA clone of ST59 also accounted for 20% of the HA isolates, including 47% of the 17 community-onset isolates. It was concluded that the molecular characteristics of clinical MRSA isolates from children differed significantly between the CA and the HA isolates in northern Taiwan. However, the CA clone of ST59 was also identified in a substantial proportion of HA isolates. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to analyse the trends of mortality and causes of death among HIV-infected patients in Taiwan from 1984 to 2005. Methods Registered data and death certificates for HIV-infected patients from Taiwan Centers for Disease Control were reviewed. Mortality rate and causes of deaths were compared among patients whose HIV diagnosis was made in three different study periods: before the introduction of highly active antiretroviral therapy (HAART) (pre-HAART: from 1 January 1984 to 31 March 1997), in the early HAART period (from 1 April 1997 to 31 December 2001), and in the late HAART period (from 1 January 2002 to 31 December 2005). A subgroup of 1161 HIV-infected patients (11.4%) followed at a university hospital were analysed to investigate the trends of and risk factors for mortality. Results For 10 162 HIV-infected patients with a mean follow-up of 1.97 years, the mortality rate of HIV-infected patients declined from 10.2 deaths per 100 person-years (PY) in the pre-HAART period to 6.5 deaths and 3.7 deaths per 100 PY in the early and late HAART periods, respectively ( P<0.0001). For the 1161 patients followed at a university hospital (66.8% with CD4 count <200 cells/μL), HAART reduced mortality by 89% in multivariate analysis, and the adjusted hazard ratio for death was 0.28 (95% confidence interval 0.24, 0.33) in patients enrolled in the late HAART period compared with those in the pre-HAART period. Seventy-six per cent of the deaths in the pre-HAART period were attributable to AIDS-defining conditions, compared with 36% in the late HAART period ( P<0.0001). The leading causes of non-AIDS-related deaths were sepsis (14.7%) and accidental death (8.3%), both of which increased significantly throughout the three study periods. Compared with patients acquiring HIV infection through sexual contact, injecting drug users were more likely to die from non-AIDS-related causes. Conclusions The mortality of HIV-infected patients declined significantly after the introduction of HAART in Taiwan. In the HAART era, AIDS-related deaths decreased significantly while deaths from non-AIDS-related conditions increased. [ABSTRACT FROM AUTHOR]