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How to deal with the waste polystyrene and rubber has become a key research topic recently. This research attempted to process the waste rubber and waste polystyrene with chemical additives to produce the flexible coating material for concrete waterproofing. Based on the best guess on the configuration of the coating constituents by the grid-point method, the design experimental levels (3 levels) for different coating constituents could be decided by introducing the golden-section ratio. Then, the orthogonal experimental design method L27(313) was adopted by choosing surface-drying time, viscosity, water permeability, tensile strength, pull-elongation rate as orthogonal indicators. Through orthogonal experiment design method, the most influential coating constituents on different indicators were experimentally investigated. The results of the water permeability test showed that the water permeability of the coating was 0 mL and the water resistance was good. The analysis results of the orthogonal table showed that the material factors and levels affecting the tensile strength of the waste EPS flexible waterproof coating were: plasticizer (10.09%), polystyrene (17%), rubber powder (14%) and curing agent (5.1%), and the material factors and levels affecting the elongation of the waste EPS flexible waterproof coating are: plasticizer (2%), curing agent (5.1%), rubber powder (11.91%) and EPS (17%). This result can be used as a reference for adjusting the proportion of waste EPS flexible waterproof coating in the future.

Inhibition of diacylglycerol lipase (DGL)β prevents LPS-induced pro-inflammatory responses in mouse peritoneal macrophages. Thus, the present study tested whether DGLβ inhibition reverses allodynic responses of mice in the LPS model of inflammatory pain, as well as in neuropathic pain models.Initial experiments examined the cellular expression of DGLβ and inflammatory mediators within the LPS-injected paw pad. DAGL-β (-/-) mice or wild-type mice treated with the DGLβ inhibitor KT109 were assessed in the LPS model of inflammatory pain. Additional studies examined the locus of action for KT109-induced antinociception, its efficacy in chronic constrictive injury (CCI) of sciatic nerve and chemotherapy-induced neuropathic pain (CINP) models.Intraplantar LPS evoked mechanical allodynia that was associated with increased expression of DGLβ, which was co-localized with increased TNF-α and prostaglandins in paws. DAGL-β (-/-) mice or KT109-treated wild-type mice displayed reductions in LPS-induced allodynia. Repeated KT109 administration prevented the expression of LPS-induced allodynia, without evidence of tolerance. Intraplantar injection of KT109 into the LPS-treated paw, but not the contralateral paw, reversed the allodynic responses. However, i.c.v. or i.t. administration of KT109 did not alter LPS-induced allodynia. Finally, KT109 also reversed allodynia in the CCI and CINP models and lacked discernible side effects (e.g. gross motor deficits, anxiogenic behaviour or gastric ulcers).These findings suggest that local inhibition of DGLβ at the site of inflammation represents a novel avenue to treat pathological pain, with no apparent untoward side effects.

Noah (version 2.7.1), the community land-surface model (LSM) of NCEP-NCAR, which is widely used to describe the land-surface processes either in stand-alone or in coupled land–atmospheric model systems, is recognized because snow–water equivalent (SWE) can be underestimated. Noah's SWE bias can be attributed to its simple snow sub-model, which does not effectively describe the physical processes during snow accumulation and melt period. To improve SWE simulation in the Noah LSM, the Utah Energy Balance (UEB) snow model is implemented in Noah to test alternate snow-surface temperature and snow-melt outflow schemes. Snow surface temperature was estimated using force–restore method and snow melt event is regulated by accounting for the internal energy of the snowpack. The modified Noah SWE is compared with the SWE observed at California's NRCS SNOTEL stations for seven water years: 2002–2008, while the model snow-surface temperature is verified with observed surface-temperature data at an observation site in Utah. The experiments show that modification in Noah's snow process substantially reduced SWE estimation bias while keeping the simplicity of the Noah LSM. The results suggest that the model did not benefit from the alternate temperature representation but primary improvement can be attributed to the substituted snow melt process.

Genetic and environmental factors may contribute to the pathogenesis of essential hypertension. To facilitate genetic studies of hypertension and renal disorders, we sought to clone novel genes from a modified, equalized kidney (MEK) cDNA library of a spontaneously hypertensive rat (SHR).A kidney cDNA library of an SHR was synthesized using the modified equalization method. Inserts of 350 random clones were amplified by polymerase chain reaction (PCR) and sequenced, of which 246 were presumably unknown after being compared against a nonredundant database in the GenBank. The cDNA ends of clone 38S were obtained by rapid amplification of cDNA ends, sequenced, and then analyzed with Translate, Prosite, Profile, SignalP, and TMpred programs.The full-length cDNA was 938 bp, and translated into a 182-amino acid protein. The deduced protein had a metallophosphoesterase domain, a signal peptide at its amino end, a protein kinase C phosphorylation site, and a transmembrane domain. Northern blot analysis revealed that this gene was expressed in the heart, brain, spleen, lungs, liver, skeletal muscles, kidneys and testes of Sprague-Dawley rats. A putative protein of Arabidopsis thaliana shares 62% homology with protein 38S, but the two proteins differ in terms of function and structure.Our results support that protein 38S is a novel membrane metallophosphoesterase, although its function in the kidneys remains to be elucidated. This study also demonstrates the feasibility of using PCR to clone novel genes from our MEK cDNA library.

During early ventricular depolarization, the normal body surface potential map (BSPM) has a maximal potential that is greater than the absolute value of the minimal potential; this reverses in late depolarization, so that the absolute value of the minimal potential is greater. Nevertheless, an abnormal "early reversal" BSPM pattern has been observed in some patients with cardiovascular disease. To investigate the implications of this abnormal pattern, BSPMs were studied in 100 patients with angiographically proven coronary artery disease (CAD). There were 57 patients (57%; group A) with an abnormal early reversal pattern and 43 (43%; group B) without this early reversal pattern. A significant (70% narrowing) CAD lesion was observed in a significantly higher proportion of group A (97%) than group B (77%) patients, although the number of involved coronary arteries was not significantly different between the two groups. The maximal extent of the abnormal negative potential was significantly greater in group A (21.2 +/- 9.6 cm2) than in group B (12.2 +/- 7.5 cm2). The abnormal negative potential lasted significantly longer in group A (22.1 +/- 12.1 msec) than in group B (14.4 +/- 9.2 msec). Similarly, the minimal potential lasted significantly longer in group A (20.1 +/- 11.3 msec) than in group B (11.8 +/- 7.1 msec). These findings suggest that the abnormal early reversal BSPM pattern is a valuable indicator of extensive myocardial lesions and the severity of CAD.

The central neural mechanisms of circadian rhythm are well known in animal models but less so in humans. In this study we looked for correlations between abnormalities of circadian rhythm and the sites of stroke, with the aim of identifying the location regulating the circadian rhythm in humans. We investigated the circadian profiles of arterial pressure in 100 stroke patients by ambulatory blood pressure monitoring within 2 days after their first stroke. Patients also underwent brain computed tomography and measurements of plasma norepinephrine and adrenal hormones. A total of 52 patients (group A) had abnormal patterns of circadian blood pressure rhythm while 48 patients had normal patterns (group N). The risk of an abnormal 24-hour blood pressure pattern was strongly inversely correlated with the distance between the lesion and the hypothalamus. There was also a close positive correlation between the distance from the lesion to the hypothalamus and the circadian indices of arterial blood pressure (systolic and diastolic pressure) in both groups. Abnormal circadian changes in adrenal hormones were found in 30 of 52 patients in group A, and in nine of 48 patients in group N. Apparently, the circadian rhythm of blood pressure is modulated mainly by direct neural effects and partly by the hormonal effects of the hypothalamus and its associated neural pathways. Individualized antihypertensive treatment and additional monitoring for possible cardiac events should be performed for those at a high risk of autonomic dysfunction.

Interatrial septal dissection and penetration into the aorta by a balloon catheter occurred in a 38-year-old man with mitral stenosis as a complication of percutaneous transluminal mitral commissurotomy during trans-septal puncture. It was speculated that the thickened septum was partially punctured into the potential space between the septa primum and secundum. Then, the balloon catheter went through the interatrial septum dissection into the aortic root. Emergency surgery was performed with the catheter left in situ. The surgical findings confirmed the speculated mechanism of this rare complication. In order to avoid this complication, the location of the tip of the Brockenbrough catheter after transeptal puncture must be confirmed. Checking the left atrial pressure tracing, arterial oxygenation and contrast injection are all important and indispensable procedures.

Conflicting viewpoints exist concerning the risk of cardiovascular morbidity for patients with white coat hypertension. The aim of this study was to compare cardiac end-organ change in white coat hypertension with persistent mildly hypertensive patients. Twenty-two white coat hypertensive patients and 15 persistently hypertensive patients were considered eligible for the study after 24 hour ambulatory blood pressure monitoring. Echocardiography was performed on all patients. The results demonstrated that both groups had similar clinical backgrounds except that white coat hypertensives were predominantly female and had less family history of hypertension. Persistent hypertensives had significantly higher average ambulatory blood pressures and pressure loads than white coat hypertensives but there was no difference in blood pressure variability. There were no differences in cardiac structural and functional changes between the two groups. As a result, we were unable to ascertain whether white coat hypertension is a benign condition. The prognostic significance of white coat hypertension requires long term follow-up and further investigation.

This study attempted to evaluate the efficacy of several "long-acting" antihypertensive agents. One-hundred consecutive hypertensive subjects with normal casual blood pressure after once-daily antihypertensive monotherapy treatment were studied. They were divided into three groups: group A, metoprolol (100 mg, daily); group B, atenolol (100 mg, daily); and group C, nadolol (80 mg, daily). Ambulatory blood pressure monitoring (ABPM) was used to evaluate the efficacy of the antihypertensive agents. The overall average ambulatory blood pressures were within the normal limits for all three groups. However, there were some abnormally high blood pressure (BP) readings shown on ABPM. Patients with an abnormally high systolic blood pressure (SBP) average140 mmHg accounted for 16.7% of group A, 19.4% of group B and 20% of group C. Those with an abnormally high diastolic blood pressure (DBP) average90 mmHg accounted for 16.7%, 19.4% and 10%, respectively, of the corresponding groups. There were no significant differences in the frequency of abnormally high SBP and DBP among the three groups. These "long-acting" antihypertensive drugs did not effectively control BP throughout the entire day. The duration of antihypertensive effect is not necessarily reflected by the blood half-life of the drug. ABPM is an effective way to ascertain the efficacy of "long-acting" hypertensive agents.

To find the best predictors of outcome for patients undergoing intra-aortic balloon counterpulsation (IABP) for cardiogenic shock, we prospectively studied 30 consecutive patients by examining hemodynamic parameters and cardiac lactic acid extraction ratios before the procedure. 1 hour after and then every 6 hours for 3 days. Complete hemodynamic data were obtained from the recordings of Swan-Ganz catheterization. Blood samples were drawn from the peripheral artery, central vein, pulmonary artery wedge position (PAW) and right atrium (RA) to quantify lactic acid levels. The simplified lactic acid extraction ratio was defined as the concentration of lactic acid in RA--the concentration of lactic acid in PAW/the concentration of lactic acid in PAW. The traditional systemic lactic acid production ratio was defined as the concentration of lactic acid in the central vein--the concentration of lactic acid in the peripheral artery/the concentration of lactic acid in the peripheral artery. Of the 30 patients studied, 19 died of cardiogenic shock, (group 1), while the surviving 11 patients formed group 2. The lactic acid extraction ratios at each of the time periods after the procedure were all significantly different, while the differences in the systemic lactic acid production ratio and hemodynamic parameters, including the systemic arterial pressure, cardiac output, cardiac index and PAW pressure, became significant at varying times after IABP. In group 2, the lactic acid extraction ratios 1 hour after IABP and later were all significantly higher than at baseline. This trend was not seen in group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

The objectives of this study were to examine the serial vectorcardiographic changes following acute myocardial infarct and to assess the relationship between QRS loop changes and infarct size. Fifty adult male Long-Evans rats of 250-350 gm body weight were used to study experimental acute myocardial infarction induced by coronary artery ligation. Vectorcardiograms (VCG) of the Frank lead system were recorded before, and 1 day and 7 days after operation. Animals were sacrificed on the 7th day for histological quantitation of infarct area ratios. We found that (1) before operation, rats have ST elevation, probably due to early repolarization. (2) After coronary artery ligation, ECG showed characteristic dome-shaped ST elevation at 1 hr after ligation which returned to normal during the first day. Abnormal Q waves appeared thereafter. (3) After ligation, maximum QRS vector, ST vector and maximum T vector were reduced in magnitude the first day and recovered by the 7th day. The vectors tended to shift their direction to the right and to the posterior. QRS-T angle, however, widened as time went on. About half of the rats revealed changes in the inscription direction of the QRS loop and abnormal QRS morphology also appeared in about half of the ligated rats. (4) Those in whom abnormal QRS loop morphology and/or biting appeared had significantly larger infarct area ratios (p0.01). (5) Change in QRS loop inscription direction seemed not to be related to the infarct size. (6) In the LS plane, the difference in max QRS vector magnitude between the 1st and 7th days significantly correlated with the infarct area ratio (r = 0.533, p0.05). In the H plane, the change in the max QRS vector magnitude at the 7th day correlated with the infarct area ratio (r = -0.531, p0.05). In the F plane, changes in the direction of the max QRS vector were significantly correlated to the infarct area ratio both on the first (r = 0.431, p0.05) and 7th days (r = 0.531, p0.05). It is concluded that the VCG, like the ECG, had evolutional changes in AMI and that the QRS loop seen on vectorcardiography has only a slight correlation with the histological myocardial infarct size.

EGb 761 is a preparation of Ginkgo biloba extract, which has complex biologic actions including free radical scavenging activity. To examine the anti-arrhythmic effect of EGb 761, a canine preparation of coronary artery occlusion-reperfusion was tested. Under intravenous anesthesia and open chest conditions, 32 dogs were subjected to 30 min of coronary occlusion, followed by reperfusion. Twelve received EGb 761 by intravenous injection, 1 mg/kg five minutes before coronary occlusion, followed by a continuous infusion of 0.1 mg/kg/min until five minutes after reperfusion. Immediately prior to reperfusion, an additional bolus dose of EGb 761 (1 mg/kg) was again injected (group A). The remaining 20 dogs received saline injection, and served as the control (group B). The electrocardiographic changes were recorded during the whole experimental course. The results showed that, during coronary occlusion, group A dogs had a lower count of ventricular premature beats than group B dogs. However, there was no difference in the incidence of ventricular tachycardia (VT) between the two groups. The duration of VT of the treated dogs was similar to that of the control dogs. The incidence of ventricular fibrillation (VF) was also similar. Upon reperfusion, the treated dogs were shown to be protected from VF. The duration of VT was also shorter in the treated group, although the incidence of VT was not different between the two groups. EGb 761 is effective in preventing early VF induced by coronary reperfusion while ineffective in protecting the ischemic VT and VF.

An unusual case of suprahepatic gallbladder with agenesis of the right lobe of the liver is reported. The anomalous position of the gallbladder was detected by ultrasonography. It was shown to be distended and to contain sludge. The suprahepatic location with agenesis of the right lobe of the liver was preoperatively confirmed by computed tomography. The patient underwent cholecystostomy with drainage and had an uneventful recovery. The postoperative follow-up examinations, including endoscopic retrograde cholangiopancreatography, ultrasonography, arteriography and portography, all added information rarely reported in the literature and helped in the understanding of this uncommon case. Laparoscopic cholecystectomies are widely used but such a procedure was contraindicated in this case because of the ectopic position and inaccessibility of the gallbladder.

To investigate the influence of age on ambulatory blood pressure monitoring (ABPM) in hypertensive patients whose controlled casual blood pressure was normal, we studied the ABPM in 225 patients, including 122 men and 103 women, aged from 45-74 years. They were classified into three groups: Group A included 93 patients aged 45 to 54 years; Group B included 99 patients, aged 55-64 years; and Group C included 33 patients, aged 65 years and over. The various ABPM data were analyzed and compared among the three groups. The following results were found. The blood pressure (BP) averages for the whole day were normal in all three groups. There was no difference in the systolic BP average among the three groups, but the diastolic BP average declined as age increased. The variability in the systolic BP measurements increased with age. The variability in diastolic BP did not seem to change as conspicuously with age, except for the group C patients who showed a larger variability at nighttime than the other two groups. There were 123 patients (54.7%) with evidence of diurnal change in BP, and the incidence of diurnal change in BP decreased with age. The frequency of abnormally high systolic BP was similar among the three groups, but the frequency of an abnormally high diastolic BP decreased significantly with age. As for the maximal BP levels recorded in the ABPM, group C patients had a higher maximal systolic BP than the other two groups. Therefore, age has a great influence on ABPM in controlled hypertensive patients with normal casual BP.

Cardiac amyloidosis, an uncommon disease, has been reported to manifest as congestive heart failure (CHF) and/or various arrhythmias. Herein, we report a case of CHF and sick sinus syndrome. The patient, a 66-year-old man, was admitted to the National Taiwan University Hospital because of dizzy spells and recurrent syncope. Electrocardiogram showed a sinoatrial block, first degree atrioventricular block, right bundle branch block and low-voltage Q wave, R wave and S wave (QRS) complex. Prolonged corrected sinus node recovery time was documented by an atrial pacing study. A permanent pacemaker was implanted for the patient's bradyarrhythmia, but he developed progressive heart failure. Echocardiography revealed a normal-sized ventricular chamber, concentric left ventricular hypertrophy with a "granular sparkling" appearance of the myocardium, and impaired diastolic and systolic function of the left ventricle. Despite aggressive treatment, the patient expired due to intractable heart failure. Postmortem needle aspiration revealed amyloidosis involving the heart, lung and skin. We conclude that cardiac amyloidosis should be considered in elderly patients with conduction disturbance and unexplained congestive heart failure.

The pathogenic role of enterovirus in patients with idiopathic dilated cardiomyopathy has been determined through a molecular biologic approach. Sensitivity in the detection of viral genomes in tissues varied between conventional nucleic acid hybridization and polymerase chain gene amplification. To improve diagnosis, we developed a strategy for reverse transcription polymerase chain reaction (RT-PCR) to detect viral RNA. We synthesized two sequence-specific oligonucleotides, primer 1 (5'dACCGACGAATACCACTGTTA3') and primer 2 (5'dCCTCCGGCCCCTGAATGCGGCTAAT3'), complementary to the 5' conserved viral genomic fragments. Viral RNA was amplified by double PCR with these two primers and hybridized with a 32-P labeled inter-primer probe (5'dATGAAACCCACAGGCACAAAG3'). Using this strategy, we detected as little as 10(-8) micrograms of coxsackievirus B3 RNA after amplification with RT-PCR, but detected none in the plasma of eight healthy adults. Among 15 patients with idiopathic dilated cardiomyopathy, viral RNA could be detected in one out of 12 plasmas (8%) and three out of four explanted heart tissues (75%). In contrast, no viral RNA could be detected in six samples of myocardial tissue from patients with other heart diseases. The only patient who had viral RNA in his plasma also had viral RNA in his myocardium. Thus, the high incidence of viral RNA in these patients suggests a possible etiologic link between them. Correct selection of specific PCR primers and the application of double PCR can improve chances of diagnosing enteroviral infection.

To study the relationship between the plasma concentration of the atrial natriuretic peptide (ANP) and heart function and to discern the secretion pathway of ANP, we determined the peripheral plasma concentration of ANP in 18 heart patients and the intracardiac concentration of ANP in six heart patients during cardiac catheterization. All plasma was extracted through a Sep-Pak C18 cartridge by acid alcohol. The concentration of ANP was determined by a sensitive and specific radioimmunoassay method. We found that the plasma ANP concentration (pg/mL) in heart patients (ranging from 12 to 139, mean = 36.1 +/- 28.9) was statistically higher than that in normal adults (ranging from 8 to 20, mean = 12.4 +/- 3.3, n = 16; p less than 0.05). The ANP level in heart patients was inversely correlated with the left ventricular ejection fraction (r = -0.53, p less than 0.05) evaluated by radionuclide angiocardiography. The intracardiac level of ANP was 88 +/- 58 at the superior vena cava, 77 +/- 55 at the inferior vena cava, 124 +/- 68 at the right atrium, 98 +/- 64 at the right ventricle, 107 +/- 58 at the pulmonary artery, 98 +/- 52 at the left ventricle, 109 +/- 73 at the aorta and greater than 351 at the coronary sinus. In conclusion, ANP is mainly secreted via the coronary sinus into the atrial cavity. The peripheral plasma ANP concentration is higher in heart patients. It increases as the left ventricular ejection fraction decreases. Therefore, plasma ANP concentration may be a useful indicator for the assessment of cardiac function.

Atrial natriuretic peptide (ANP) is a cardiac hormone with an important role in fluid, electrolyte and hemodynamic homeostasis. Rat ANP cDNA was cloned from the cDNA library constructed using 1 microgram of atrial mRNA from the heart of Wistar rats. Eight positive clones were isolated with an ANP oligonucleotide probe. One of them with about a 0.8 kb insert was selected for further subcloning and sequencing analysis. The rat ANP cDNA had 813 base pairs with a concensus sequence for transcription initiation, termination and poly A tailing. The deduced amino acid sequence contains a potential glycosylation site and two putative protease cleavage sites. Northern blot analysis showed that the ANP gene was specifically transcribed in the rat atria rather than the ventricles. The results suggest that ANP gene expression is differentially and developmentally controlled.

Vectorcardiographic (VCG) studies were conducted in 71 patients with pure mitral stenosis (MS) documented by clinical findings, echocardiograms and cardiac catheterization. Among them, 31 were males and 40 females, with ages ranging from 20 to 58 (mean age 36.3) years. The Frank lead system was adopted for the VCG study. By VCG, 67 patients (94.4%) showed right ventricular hypertrophy (RVH), among whom 15 (21.2%) were type A, 30 (42.3%) type B and 22 (31.0%) type C. Forty-five patients (63.4%) were in sinus rhythm (NSR), while the remaining 26 (36.6%) were in atrial fibrillation (AF). Patients with type A RVH had a significantly higher pulmonary wedge (PAW) and main pulmonary arterial (MPA) pressures than those with type B or C. Patients with type C had a higher mean MPA pressure (39.0 +/- 11.3 mmHg) than those with type B (32.3 +/- 10.1 mmHg) (p less than 0.05). Among the 3 types of RVH, the mean right atrial (RA) pressures were similar (p greater than 0.05). Patients with AF had a lower mean MPA pressure, but a higher RA pressure than those with NSR (p less than 0.05). The maximal anterior force and maximal rightward force at the horizontal plane were significantly correlated with the mean MPA pressure (r = 0.54 and 0.49, respectively, both p less than 0.01), but they did not correlated well with the PAW and RA pressures (p greater than 0.05). We conclude that in patients with MS, as pulmonary hypertension progresses, VCG seems to begin with type B RVH, then emerges into type C and finally becomes type A.(ABSTRACT TRUNCATED AT 250 WORDS)

Body surface potential maps (BSPMs) and the pathology of 32 dogs with coronary artery ligations were analyzed to research the application of BSPMs to acute myocardial infarction (AMI). The group consisted of 18 dogs with left anterior descending coronary artery (LAD) ligations, 8 with right coronary artery (RCA) ligations and 6 with left circumflex coronary artery (LCX) ligations. The abnormal distribution of negative potential and minimal potential were observed in all of the dogs. In dogs with RCA ligations, the abnormal negative potential displayed on the right-superior, right-inferior or right portion of the anterior thorax. In those with LAD ligations, the abnormal potential appeared on the left-superior, left-inferior, middle-superior or middle portion of the anterior thorax. In those with LCX ligations, the abnormal potential showed on the left-superior or left-middle portion of the thorax. A good correlation was observed between the area of myocardial lesion and the extent of abnormal negative potential distribution (r = 0.82, p less than 0.001). A close correlation was also found between the area of myocardial lesion and the duration of abnormal negative potential (r = 0.61, p less than 0.05). This study suggests that BSPMs are useful in the assessment of AMI in terms of diagnosis, location and extent of myocardial infarct.

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 out-patient 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.