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Clin Microbiol Infect 2010; 16: 663–670 The aim of this study was to investigate the efficacy of the influenza vaccine among cancer patients in Taiwan. We determined the effect of immunization on the following outcomes of disease: hospitalizations, emergency department visits, hospital outpatient visits, physician office visits, and deaths. Cost-effectiveness was analysed from the perspectives of the healthcare system and society. A decision tree was used, with estimates of disease burden and costs based on data from published and unpublished sources. The model followed 34 112 cancer patients aged 20–64 years who were registered by the Taiwan National Cancer Registry in 2002. An influenza immunization programme for the cancer population would prevent 2555 cases of all types of influenza infection, 660 of which would be serious cases involving hospitalization, emergency department visits and death. From the perspective of the healthcare system, the programme would cost US$7.7 million, providing net savings of US$5.4 million. From a societal perspective, the programme would cost US$28.6 million, providing net savings of US$22.3 million. This corresponds to savings of US$2107 and US$6338 per case averted, from healthcare and societal perspectives, respectively, as well as 110 lives saved. Lesser disease burden, greater vaccine efficacy and lower cost of hospitalizations increased cost-effectiveness. Influenza immunization for cancer patients is cost-saving and cost-effective from a healthcare and societal perspective in Taiwan. We highly recommend annual influenza vaccinations for this patient group. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2010; 16: 761–763 An epidemiological investigation with Legionella and molecular subtyping was conducted to determine the source of a case of nosocomial Legionnaires’ disease (LD) who was hospitalized in three hospitals within a month. Legionella pneumophila serogroup 3, an uncommon serogroup for infection, was isolated from the patient’s sputum. Environmental surveillance revealed Legionella colonization in all three hospitals; the patient isolate matched the isolate from the first hospital by molecular typing. Culturing the hospital water supply for Legionella is a pro-active strategy for detection of nosocomial LD even in hospitals experiencing no previous cases. [ABSTRACT FROM AUTHOR]

Q fever (QF) is a worldwide zoonosis associated with outbreaks. Only a few nationwide studies regarding the surveillance and epidemiology of human QF have been reported. Although QF is endemic in Taiwan, a nationwide database investigation of the epidemiology and characteristics of QF and its associations with scrub typhus (ST), murine typhus (MT) and leptospirosis (LS) has never been reported. We analysed nationwide databases of suspected QF, ST, MT and LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan. A total of 468 (4.2%) QF cases were identified among 11 109 suspected QF cases. QF cases were mainly distributed in the southern and Kaohsiung-Pingtung regions but rarely in the eastern region. Compared to non-QF cases, QF cases had significantly higher percentages of males (88.7 versus 66.2%) and high-risk occupations (farming, animal husbandry or veterinary medicine) (16.2 versus 10.5%). But the percentages of specific animal contact, including cattle (0.6 versus 0.8%) and goats (0.9 versus 1.0%), were low in both. The majority of suspected QF cases (89.4%) were simultaneously suspected with ST, MT or LS, and the combinations of suspected diseases differed between regions. The number of suspected QF cases from the eastern region decreased since 2009, which was not observed in other regions. A total of 1420 (12.8%) cases had confirmed diseases, including QF (453, 4.1%), QF+ST (7, 0.06%), QF+MT (4, 0.04%), QF+LS (4, 0.04%), MT (186, 1.7%), ST (545, 4.9%), ST+LS (11, 0.1%) and LS (210, 1.9%). Compared to cases of unknown disease, QF cases had larger percentages of high-risk occupations (16.2 versus 9.6%) but similar histories of animal contact (29.8 versus 25.1%). QF is an endemic disease in southern Taiwan. It is difficult to differentiate QF from ST, MT or LS only by high-risk occupations and history of animal contact, and co-infection of QF with these diseases should be considered. [ABSTRACT FROM AUTHOR]

Objective This study evaluated customer attitudes, perceptions, and utilisation of a traffic-light food labelling (TFL) programme before and after the TFL was implemented in a worksite canteen in Taiwan. Study design A one-arm intervention was implemented in the canteen and buffet of a research park in Taiwan. Phase 1 consisted of dissemination of information regarding the TFL, targeting the customers (June–July, 2014); phase 2 consisted of implementation of the TFL in the buffet starting in August 2014. The TFL included red, yellow and green labels, indicating ‘unhealthy/stop’, ‘moderately unhealthy/wait’ and ‘healthy/go’, respectively. Methods The evaluation was based on two independent anonymous surveys in July 2014 (in phase 1) and April 2015 (in phase 2). Customers were invited to take a survey regarding the TFL programme, the food environment in the canteen, and their lunch choices. Logistic regression models examined the changes in customers' attention and attitudes towards the labelling and their food choices between the two surveys. Results The customers reported positive attitudes towards the TFL. The proportion of customers who reported choosing foods based on the recommendations increased from 38% to 50% (P < 0.01). The proportion of the buffet customers who chose green-light entrées and red-light entrées changed from 13% and 63% to 36% and 21%, respectively (P < 0.001). The availability of green-light entrées in the buffet increased as well. Conclusions This first report of a TFL intervention in an Asian worksite suggests that TFL is acceptable and well understood by this population and may assist customers in choosing healthier items when healthier choices are available. [ABSTRACT FROM AUTHOR]

Resistance mutations A2058G and A2059G, within the 23S rRNA gene of Treponema pallidum, have been reported to cause treatment failures in patients receiving azithromycin for syphilis. Genotyping of T. pallidum strains sequentially isolated from patients with recurrent syphilis is rarely performed. From September 2009 to August 2013, we collected 658 clinical specimens from 375 patients who presented with syphilis for genotyping to examine the number of 60-bp repeats in the acidic repeat protein ( arp) gene, T. pallidum repeat ( tpr) polymorphism, and tp0548 gene, and to detect A2058G and A2059G point mutations by restriction fragment length polymorphism. Treponemal DNA was identified in 45.2% ( n = 298) of the specimens that were collected from 216 (57.6%) patients; 268 (40.7%) specimens tested positive for the 23S rRNA gene, and were examined for macrolide resistance. Two isolates (0.7%) harboured the A2058G mutation, and no A2059G mutation was identified. A total of 14 strains of T. pallidum were identified, with 14f/f (57.5%) and 14b/c (10.0%) being the two predominant strains. Forty patients who presented with recurrent episodes of syphilis had T. pallidum DNA identified from the initial and subsequent episodes, with five cases showing strain discrepancies. One patient had two strains identified from different clinical specimens collected in the same episode. Our findings show that 14f/f is the most common T. pallidum strain in Taiwan, where the prevalence of T. pallidum strains that show A2058G or A2059G mutation remains low. Different genotypes of T. pallidum can be identified in patients with recurrent episodes of syphilis. [ABSTRACT FROM AUTHOR]

Background Hepatitis C virus ( HCV) infection has been linked to an increased risk of insulin resistance and carotid atherosclerosis. Aim To investigate the association between HCV infection and stroke, and the effect of interferon-based therapy ( IBT) on stroke risk in chronic hepatitis C ( CHC) patients. Methods We conducted a retrospective cohort study that followed up 3113 subjects with a newly detected HCV infection and 12 452 age- and gender-matched subjects without HCV infection selected from a random sample of 106 beneficiaries from the Taiwan National Health Insurance Program up to 5 years. Use of IBT was defined as treatment with interferon alpha, pegylated interferon alpha-2a or pegylated interferon alpha-2b for at least 3 months. The hazard ratio ( HR) for newly detected stroke was calculated for subjects with HCV compared to those without HCV, and for IBT-treated HCV patients compared to non- IBT-treated HCV patients while adjusting for possible confounding factors. Results The overall person-years of follow-up were 8624.11 in patients with HCV, 54 533.69 in patients without HCV, 666.65 in IBT-treated patients, and 7886.49 in nontreated patients. The multivariable-adjusted hazard ratio ( HR) for newly detected stroke was 1.23 for subjects with HCV compared to the age- and sex-matched subjects without HCV (adjusted HR = 1.23, 95% CI = 1.06-1.42, P = 0.008). Moreover, use of IBT significantly reduced the risk of stroke in HCV patients (adjusted HR = 0.39, 95% CI = 0.16-0.95, P = 0.039) after adjusting for known prognostic factors. Conclusions Interferon-based therapy may reduce the long-term risk of stroke in patients with chronic HCV infection. [ABSTRACT FROM AUTHOR]

This retrospective study investigated the clinical significance and impact of Stenotrophomonas maltophilia bacteraemia in 49 haematology and oncology patients at a tertiary referral medical centre in Taipei between July 1999 and December 2003. Sixteen patients had 24 episodes of central venous catheter (CVC)-related bacteraemia, with the main clinical characteristics being a nosocomial bacteraemia (100%), preceding antibiotic therapy (94%), bacteraemia developed in a general ward (87%), immunosuppressive therapy (75%), in-situ CVC-related bacteraemia (75%), and neutropenia (63%). Only four (25%) patients had inflammatory signs at the CVC site following diagnosis of bacteraemia. Five patients had recurrent bacteraemia, with risk-factors being long-lasting (>10 days) neutropenia (p 0.036) and an initial failure to remove the CVC (p 0.001). These cases did not involve re-infection, as the same S. maltophilia strain was identified following random amplified polymorphic DNA (RAPD) analysis of the initial and subsequent isolates. However, relapses could occur after long latency periods (maximum, 200 days). Most patients were cured after removal of the CVC, even without appropriate antibiotic treatment. Physicians should have a high index of suspicion for CVC-related bacteraemia with haematology and oncology patients with CVCs and S. maltophilia bacteraemia. In addition to appropriate antibiotic therapy, removal of the CVC is crucial for successful treatment of CVC-related S. maltophilia bacteraemia and prevention of relapses. [ABSTRACT FROM AUTHOR]

Background: Through data mining of a published transcriptomic database of urothelial carcinomas of the urinary bladder (GSE32894), colony stimulating factor 2 (CSF2) was identified as the most significant gene showing stepwise upregulation related to positive regulation of tyrosine phosphorylation of STAT5 (GO:0042523). We therefore analysed CSF2 transcript and protein expression and their association with clinicopathological factors and survival in our well-characterised cohort of urothelial carcinomas. Methods: Laser capture microdissection coupled with real-time qRT-PCR was used to detect CSF2 transcript level in 24 urothelial carcinomas of the urinary bladder and six non-tumour urothelium samples. Immunohistochemistry evaluated by using H-score was used to determine CSF2 protein expression in 296 urothelial carcinomas of the urinary bladder and 340 urothelial carcinomas of the upper urinary tract. Protein expression was correlated with clinicopathological features and disease-specific survival (DSS) and metastasis-free survival (MeFS). Findings: CSF2 transcripts were detected exclusively in tumour lesions (p=0.010) with stepwise upregulation. CSF2 protein overexpression was significantly associated with advanced pT status (urothelial carcinomas of the upper urinary tract, p=0.011; urothelial carcinomas of the urinary bladder, p<0.001), and perineural invasion (urothelial carcinomas of the upper urinary tract, p=0.002; urothelial carcinomas of the urinary bladder, p= 0.001) in both groups of urothelial carcinoma. CSF2 overexpression not only predicted worse DSS (urothelial carcinomas of the upper urinary tract, p=0.0001; urothelial carcinomas of the urinary bladder, p<0.0001) and MeFS (urothelial carcinomas of the upper urinary tract, p=0.0001; urothelial carcinomas of the urinary bladder, p=0.0002) at univariate analysis, but also inferior DSS (urothelial carcinomas of the upper urinary tract, p=0.015; urothelial carcinomas of the urinary bladder, p=0.004) and MeFS (urothelial carcinomas of the upper urinary tract, p=0.008; urothelial carcinomas of the urinary bladder, p=0.027) in multivariate analysis. Interpretation: CSF2 overexpression is associated with advanced clinical features for both patients with urothelial carcinomas of the upper urinary tract and urothelial carcinomas of the urinary bladder, suggesting it may serve as a potential prognostic and a novel therapeutic target of urothelial carcinoma. [ABSTRACT FROM AUTHOR]

Background: Alpha-methylacyl CoA racemase (AMACR) is essential for catabolism of branched-chain fatty acids, allowing their subsequent β-oxidation to generate energy. However, its significance has not been assessed in urothelial carcinoma. We therefore analysed the clinicopathological and biological significance of AMACR expression in urothelial carcinoma. Methods: Laser capture microdissection coupled with real-time qRT-PCR was used to detect AMACR transcript level in 22 urothelial carcinomas of the urinary bladder. Immunohistochemistry evaluated by using H-score was used to determine AMACR protein expression in 295 urothelial carcinomas of the urinary bladder and 340 urothelial carcinomas of the upper urinary tract. mRNA and protein expression were correlated with clinicopathological features. AMACR protein expression was further evaluated for associations with disease-specific survival (DSS) and metastasis-free survival (MeFS). In vitro, AMACR overexpressing urothelial carcinoma cell lines (BFTC905 and RTCC-1) were evaluated for its biological function using RNA interference. Findings: Increments of AMACR transcript level was associated with higher pT status (p=0.017). AMACR protein overexpression was significantly associated with advanced pT status (both p<0.001), nodal metastasis (both p≼0.001), high histological grade (both p≼0.001), vascular invasion (urothelial carcinomas of the upper urinary tract, p<0.001; urothelial carcinomas of the urinary bladder, p=0.003), frequent mitoses (urothelial carcinomas of the upper urinary tract, p=0.007; urothelial carcinomas of the urinary bladder, p<0.001) in both groups of urothelial carcinomas. AMACR overexpression not only predicted worse DSS and MeFS at univariate analysis, but was also associated with inferior DSS (urothelial carcinomas of the upper urinary tract, p=0.025; urothelial carcinomas of the urinary bladder, p=0.001) and MeFS (urothelial carcinomas of the upper urinary tract, p=0.028; urothelial carcinomas of the urinary bladder, p=0.019) in multivariate analysis. In both urothelial carcinoma cell lines, stable AMACR knockdown resulted in impaired cell proliferation, as well as migration/invasion capabilities. Interpretation: AMACR overexpression is associated with advanced clinical features for patients with urothelial carcinoma and may serve as a potential prognostic biomarker and a novel therapeutic target. [ABSTRACT FROM AUTHOR]