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Background Methicillin-resistant Staphylococcus aureus (MRSA) is the predominant cause of skin and soft tissue infections (SSTIs), which is a problem in prisons and jails. We conducted this study to understand MRSA molecular characteristics among inmates with SSTIs, and we chose MRSA isolates from a community hospital as a comparison. Methods A total of 219 MRSA isolates from three custodial facilities and 134 isolates from a community hospital in Taiwan were collected in the 2017 calendar year. MRSA isolates were investigated molecularly by staphylococcal chromosome cassette mec (SCCmec) type, mupirocin, and chlorhexidine genotypical resistance, and multi-locus sequence typing (ST). Results Of the 219 MRSA isolates from custodial facilities, SCCmec IV was the most prevalent type (65.3%), followed by type VT (32.4%) and type V (1.8%). Regarding sequence types, ST59 (36.4%), 8 (35.3%), and 45 (17.9%) were the leading three predominant types out of 184 selected MRSA isolates, and ST45 MRSA was more prevalent in custodial facilities (p = 0.019). The antimicrobial resistance rates varied for different MRSA strains, with ST45 MRSA having the lowest rates of resistance to most antimicrobials. Overall, 91.5% of isolates carried mupA gene and 25.8% were positive for qacA/B gene, this was independent of the MRSA sequence types. Conclusions ST59, ST8, and ST45 MRSA are the leading three MRSA strains causing SSTIs in Taiwan, 2017, but the molecular distribution varied distinctly between the custodial facilities and hospital settings. The genotypical mupirocin resistance rate is quite high in this study. The frequency of chlorhexidine resistance gene is relatively low, especially in MRSA isolates from custodial facilities.

Viral bronchiolitis presents a heterogeneous spectrum. In this study, we investigated the clinical characteristics and the cytokines/chemokines profiles among respiratory syncytial virus (RSV), rhinovirus (RV), and their dual infection in Taiwanese children with viral bronchiolitis.This study was conducted between October 2014 and June 2017. Viral etiology was identified using a Luminex respiratory virus panel and blood cytokines were evaluated using a MILLIPLEX MAP Human Cytokine/Chemokine Panel. Cytokine/Chemokine expressions were compared by clinical severity, steroid treatment, and viral entities.A total of 184 patients were evaluated; at least one respiratory virus was identified in 163 (88.6%) patients. RSV and RV were the two leading viral etiologies, with 25.5% and 17.3%, respectively. RV bronchiolitis has a comparable severity to RSV but is more common in children of an older age with a history of recurrent wheezing and blood eosinophilia. Decreased tumor necrosis factor-alpha (TNF-α) and interferon gamma (INF-γ) levels were correlated with clinical severity. Patients infected with RV exhibited higher levels of Interleukin (IL)-22, IL-23, IL-25, IL-31, and IL-33 (p 0.05), whereas those with RSV had higher levels of TNF-α, INF-γ, and IL-10 (p 0.05). Systemic steroid treatment was associated with higher expressions of IL-4, IL-8, IL-13, and MIP-1α levels (p 0.05). Cluster analysis revealed a high correlation of IL-33 and IL-31(RDifferent viral infections elicited the characteristic clinical presentation and immune profiles in bronchiolitis. Our findings also highlight the role of the IL-33/IL-31 axis in the immunopathogenesis of bronchiolitis.

Human respiratory syncytial virus (RSV) is a leading pathogen of acute respiratory tract disease among infants and young children. Compared with previous seasons, RSV outbreaks in Taiwan during the 2020-2021 season were delayed because of COVID-19 mitigation measures. We conducted this study to determine the association of viral factors with clinical characteristics of preschool children with RSV infection.We performed a molecular epidemiology analysis of RSV among inpatient preschool children in Taiwan. In 80 nasopharyngeal samples positive for RSV, we sequenced and analyzed viral genotypes according to patient data. Patients' clinical data were obtained from medical files, and their clinical profiles were compared with those of RSV cases recorded during the 2014-2017 seasons.Phylogenetic analysis revealed that among the RSV-positive samples, all RSV strains identified during the 2020-2021 season belonged to the ON1 genotype. Most of the Taiwan ON1 strains were categorized into two well-supported clusters with distinct G protein amino acid substitution patterns that had never been demonstrated previously. Furthermore, the proportion of cases among children aged24 months increased (P 0.001). Compared with patients infected during the 2014-2017 seasons, patients infected during the 2020-2021 season were hospitalized for shorter days from hospital admission to dereference (P = 0.004) and had a greater need for oxygen supplements (P = 0.021) and systemic steroid therapy (P = 0.026).The delayed 2020-2021 RSV outbreak in Taiwan was caused by two novel RSV ON1.1 variants. How the change in RSV epidemiology affects future RSV outbreaks warrants exploration.

Background The factors that predict the progression of Mycoplasma pneumoniae infection remain inconclusive. Therefore, we investigated macrolide resistance prevalence, M pneumoniae genotype, and clinical characteristics of childhood M pneumoniae respiratory tract infections in Taiwan. Methods A total of 295 children hospitalized with respiratory tract infections with positive serological M pneumoniae immunoglobulin M test results were enrolled in this 3-year prospective study. Oropharyngeal swabs were obtained for M pneumoniae cultures and polymerase chain reaction tests. All M pneumoniae specimens were further characterized by P1 typing, multilocus variable-number tandem-repeat analysis (MLVA), and macrolide resistance genotyping. The clinical characteristics and blood cytokine profiles were analyzed accordingly. Results Of 138 M pneumoniae specimens, type I P1 was the predominant (136 of 138, 98.6%). The MLVA type P (4-4-5-7-2) was the leading strain (42 of 138, 30.4%), followed by type J, U, A, and X. The overall macrolide-resistant rate was 38.4% (53 of 138); the resistance rate increased dramatically yearly: 10.6% in 2017, 47.5% in 2018, and 62.5% in 2019 (P, We present a 3-year prospective study on the molecular epidemiology, clinical characteristics, and cytokine profiles of childhood M pneumoniae infection in Taiwan. An increased macrolide resistance rate associated with emergence of MLVA type U was noted.

Background and objective: Screening and identification of methicillin-resistant Staphylococcus aureus (MRSA) carriage are helpful for controlling MRSA dissemination in hospitals. The aim of our study was to determine the prevalence of nasal carriages and diversity of MRSA among patients and healthcare workers (HCWs) at two regional hospitals in Taiwan. Methods: Nasal swabs were obtained prospectively from 204 patients visiting the emergency department (ED) and 326 HCWs in two regional hospitals in Changhua, Taiwan, between February 2015 and June 2015. All the MRSA isolates were further molecularly characterized. Results: Of the 204 participating patients, the nasal carriage rates of S. aureus and MRSA were 22.1% and 7.8%, respectively. For HCWs, the S. aureus and MRSA carriage rates were 26.1% and 6.1%, respectively. There was no statistically significant difference in MRSA carriage rate between patients and HCWs (P = 0.447). Patients receiving hemodialysis were significantly associated with MRSA colonization (P = 0.012). The leading three sequence types (ST) were ST59 (16, 44.4%), ST45 (11, 30.6%), and ST239 (3, 8.3%) for all 36 MRSA isolates. ST59/SCCmec IV/t437/PVL-negative and ST45/SCCmec V/t1081/PVL-negative were the predominant clones among HCWs (30%) and participating patients (19%), respectively. Conclusion: Overall, a substantial proportion of patients visiting the ED and HCWs harbored CA-MRSA, mostly ST59 strains, in their nares. It is noteworthy that MRSA ST45 strains supplanted ST239 as the second leading nasal MRSA colonization strain in our study. Keywords: Methicillin-resistant Staphylococcus aureus (MRSA), Nasal carriage, Molecular epidemiology

Background: Congenital cytomegalovirus (CMV) infection is the leading cause of neurologic disabilities and sensorineural hearing loss in children. However, in Taiwan, there is limited information on the genotypic diversity and prevalence of perinatal CMV infection in both mothers and neonates. The aim of this study was to screen samples from both mothers and umbilical cord blood for CMV at the time of delivery and to determine the CMV genotypic distribution. Methods: Between June 2012 and July 2015, residual maternal and umbilical cord blood samples were collected from consenting participants admitted to the Chang Bing Show Chwan Memorial Hospital in central Taiwan. The blood samples were screened for CMV DNA using real-time PCR assay, and the genotypic classification of the CMV UL55, UL144, and US28 genes was determined by sequencing and phylogenetic analysis. Results: A total of 1282 mother-neonate paired samples were enrolled in the study, 95.3% of whom were Taiwanese. CMV DNA was detectable in 6.2% of the maternal blood samples, with a significantly higher rate noted in non-Taiwanese mothers (11.7%,p = 0.027). For the 1,282 umbilical cord blood samples, CMV DNA was detectable in 5.3% of the samples. The presence of CMV DNA in maternal blood was positively associated with the presence of CMV DNA in umbilical cord blood (p = 0.01). In addition, the UL55, UL144, and US28 genotypic distribution was similar between mothers and neonates. Conclusion: The prevalence of CMV DNAemia in childbearing mothers and neonates is similar and their genotypic distribution implies potential CMV infection during pregnancy. Keywords: Congenital infection, Cytomegalovirus, Genotype, Neonate, Taiwan

Customer relationship management (CRM) is an integral part in the manufacturing enterprise information. The content of CRM is based on customer information and business transaction data, and using computer information technology to deeply analysis massive data of data warehouse. The purpose is to identify customers’ different features and analyze customer behaviors, then dig out the information of commercial value to help business planning and decision-making related business activities. The thesis introduces the system of the CRM based on Data Warehouse: to describe and predict the model of enterprise customers’ behavior by data warehouse and data mining theory and technology. The purpose is to optimize the entire CRM process, and effectively realize customer relationship management ultimately. Research and analysis of data warehouse in CRM to achieve other functions such as customer behavior analysis, key customers found and market performance evaluation. It can further analyze amounts of customer information in data warehouse, acquire efficient information about how to enhance the advantages of market competition, make the concept and goal of CRM can be achieved and satisfy the demand and challenge in modern e-commerce times. It can help enterprises increase market decision-making ability, gain competitive advantages and perfect business plan.

Firstly, the thesis analyzes the basic concepts and features of X3D virtual reality modeling language (VRML), X3D is 3D graphic criterion that is follow on, extensible. Secondly, the thesis presents the application frame of VRML in B2C Electronic Commerce systems. By using the technology of VRML, such as the 3D modeling technology, interactive technology and database access technology combined with ASP, the E-commerce system can connect business and customer. The B2C E-commerce platform based on X3D/VRML technology has the trait of instant, 3d, interactive and verisimilitude, provide enhanced receptivity and interactivity for E-commerce. With the organic integration of E-commerce system and VRML technology, the competitiveness of E-commerce will be improved. Virtual 3D B2C E-commerce system will be the platform for enterprise informatization.

Natural language understanding (NLU) focusing on machine reading comprehension is a branch of natural language processing (NLP). The domain of the developing NLU system covers from sentence decoding to text understanding and the automatic decoding of GP sentence belongs to the domain of NLU system. GP sentence is a special linguistic phenomenon in which processing breakdown and backtracking are two key features. If the syntax-based system can present the special features of GP sentence and decode GP sentence completely and perfectly, NLU system can improve the effectiveness and develop the understanding skill greatly. On the one hand, by means of showing Octav Popescu's model of NLU system, we argue that the emphasis on the integration of syntactic, semantic and cognitive backgrounds in system is necessary. On the other hand, we focus on the programming skill of IF-THEN-ELSE statement used in N-S flowchart and highlight the function of context free grammar (CFG) created to decode GP sentence. On the basis of example-based analysis, we reach the conclusion that syntax- based machine comprehension is technically feasible and semantically acceptable, and that N-S flowchart and CFG can help NLU system present the decoding procedure of GP sentence successfully. In short, syntax-based NLU system can bring a deeper understanding of GP sentence and thus paves the way for further development of syntax-based natural language processing and artificial intelligence.

This paper discusses the computational parsing of GP sentences. By an approach of combining computational linguistic methods, e.g. CFG, ATN and BNF, we analyze the various syntactic structures of pre-grammatical, common, ambiguous and GP sentences. The evidence shows both ambiguous and GP sentences have lexical or syntactic crossings. Any choice of the crossing in ambiguous sentences can bring a full-parsed structure. In GP sentences, the probability-based choice is the cognitive prototype of parsing. Once the part-parsed priority structure is replaced by the full-parsed structure of low probability, the distinctive feature of backtracking appears. The computational analysis supports Pritchett’s idea on processing breakdown of GP sentences.