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To provide evidence of the cross-contamination of emerging pathogenic microbes in a local network between long-term care facilities (LTCFs) and hospitals, this study emphasizes the molecular typing, the prevalence of virulence genes, and the antibiotic resistance pattern of methicillin-resistant Staphylococcus aureus. MRSA isolates were characterized from 246 samples collected from LTCFs, medical tubes of LTCF residents, and hospital environments of two cities, Chiayi and Changhua. Species identification, molecular characterization, and drug resistance analysis were performed. Hospital environments had a higher MRSA detection rate than that of LTCF environments, where moist samples are a hotspot of MRSA habitats, including tube samples from LTCF residents. All MRSA isolates in this study carried the exfoliative toxin eta gene (100%). The majority of MRSA isolates were resistant to erythromycin (76.7%), gentamicin (60%), and ciprofloxacin (55%). The percentage of multidrug-resistant MRSA isolates was approximately 50%. The enterobacterial repetitive intergenic consensus polymerase chain reaction results showed that 18 MRSA isolates belonged to a specific cluster. This implied that genetically similar isolates were spread between hospitals and LTCFs in Changhua city. This study highlights the threat to the health of LTCFs’ residents posed by hospital contact with MRSA.

Background The prevalence rate of reflux esophagitis (RE) in Asia, including Taiwan, has increased dramatically in recent years. However, few studies have discussed on its relationship with metabolic syndrome (MetS). This study aimed to evaluate the correlation between RE and MetS and its components. Methods We conducted a cross-sectional study during 2013 to 2014 in Taiwan. A total of 4895 subjects who completed upper gastrointestinal endoscopy at the Health Examination Center of Changhua Christian Hospital were enrolled. RE was defined according to the upper gastrointestinal endoscopic findings and MetS was defined according to the Taiwanese criteria. Univariate and multivariate logistic regression analyses were applied to calculate odds ratios and 95% confidence intervals for each variable to assess the associated features for RE. We analyzed the relationship between the number of MetS components and the severity of RE using the chi-square test for trend. Results The prevalence rates of MetS and RE were respectively 28.5 and 59.6%. According to univariate logistic regression analysis, MetS was significantly associated with RE and remained a positive association in multivariate logistic regression analysis (adjusted ORß = 1.251; 95% CI = 1.071–1.462; p = 0.005). Furthermore, among the five MetS components, elevated blood pressure (adjusted ORγ = 1.163; 95% CI = 1.023–1.323; p = 0.021), abdominal obesity (adjusted ORγ = 1.173; 95% CI = 1.020–1.349; p = 0.026) and hyperglycemia (adjusted ORγ = 1.306; 95% CI = 1.142–1.495; p

In view of the limitations of the linear model used in the traditional supply chain solution method, it cannot adapt to the dynamic supply chain network solution method in the multi-source big data environment of the Internet, and maps the dynamic supply chain into a network diagram model, and proposes e-commerce. Supply chain network model, based on this model, presents a semi-instance pattern detection method based on collaborative matrix decomposition, which is used to detect a semi-instantiated collaborative behaviour pattern in the supply chain network. According to the given collaborative behaviour model, the collaborative supply matrix decomposition method is first used to calculate the candidate supply chain of the personalized supply chain, and the degree of intimacy between node entities in the supply chain network is calculated. Using the A* graph search algorithm, a supply chain result candidate chain set is generated based on a personalized supply chain candidate set. According to personalized time, cost and other constraints, the final supply chain solution is tailored. The correctness, efficiency and accuracy of the method were verified by the e-commerce supply chain data set for apparel.

Background and Objectives: There are limited data on the association between severity of non-alcoholic fatty liver disease (NAFLD) and coronary artery calcification. This study investigated sonographic diagnosed NAFLD and coronary artery calcium score (CAC) as detected by cardiac multidetector computed tomography in general populations. Materials and Methods: A total of 545 patients were enrolled in this study. NAFLD was diagnosed by ultrasonography examination and CAC score were evaluated by cardiac multidetector computed tomography. The association between NAFLD and artery calcium score stage was determined by logistic regression analysis and Spearman correlation coefficient analysis. Results: Of all the participants, 437 (80.2%) had ultrasonography-diagnosed NAFLD and 242 (44%) had coronary artery calcification (CAC &gt, 0). After adjustment for cardiovascular risk factors, the risk of developing coronary artery calcification was 1.36-fold greater in the patients with different severity of NAFLD compared to those without NAFLD (OR = 1.36, 95% CI = 1.07–1.77, p = 0.016). The highest OR for separate coronary artery calcification was 1.98 (OR = 1.98, 95% CI = 1.37–2.87, p &lt, 0.001) in the left main artery, and the risk was still 1.71-fold greater after adjustments (OR = 1.71, 95% CI = 1.16–2.54, p = 0.007). Conclusions: This cross-sectional study demonstrated that the severity of NAFLD was associated with the presence of significant coronary artery calcification, especially in the left main coronary artery, suggesting increasing the cardiovascular risk.

// Shih-Wen Chen 1, * , Chiang-Ting Chou 2, 3, * , Cheng-Chi Chang 1, 4, 5, 6, 7, 8 , Yue-Ju Li 4 , Szu-Ta Chen 9, 10 , I-Ching Lin 11, 12, 13 , Sang-Heng Kok 14, 15 , Shih-Jung Cheng 1, 4, 15 , Jang-Jaer Lee 7 , Tai-Sheng Wu 4 , Min-Liang Kuo 17 , Been-Ren Lin 16 1 Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan 2 Department of Nursing, Division of Basic Medical Sciences, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan 3 Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan 4 Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan 5 Angiogenesis Research Center, National Taiwan University, Taipei, Taiwan 6 Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan 7 Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan 8 Department of Biotechnology, Asia University, Taichung, Taiwan 9 Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan 10 Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan 11 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 12 Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan 13 School of Medicine, Chung Shan Medical University, Taichung, Taiwan 14 Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan 15 Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan 16 Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan 17 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan * These authors contributed equally to this work Correspondence to: Been-Ren Lin, email: beenrenlin@ntu.edu.tw Keywords: HMGCS2, PPARα, metastasis, CRC, OSCC Received: May 31, 2016 Accepted: October 21, 2016 Published: November 01, 2016 ABSTRACT Mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase (HMGCS2) is the rate-limiting enzyme of ketogenesis. Growing evidence indicates that HMGCS2 may be involved in cancer progression, but its exact role is largely unknown. In this study, we demonstrate that HMGCS2 mRNA expression is associated with poor clinical prognosis and outcomes in patients with colorectal cancer (CRC) and oral squamous cell carcinoma (OSCC). In vitro , ectopic expression of HMGCS2 enhanced cancer cell motility in a ketogenesis-independent manner. Moreover, HMGCS2 promoted Src activity by directly binding to peroxisome proliferator-activated receptor alpha (PPARα), a transcriptional activator of Src. Taken together, these results suggest that HMGCS2 may serve as a useful prognostic marker and vital target for future therapeutic strategies against advanced cancer.

Delivery time affects the logistics route, depending on the needs of the place and quantity. An efficient prediction of delivery demand would help the construction of logistics model. The data on delivery demand are time-dependency and space-correlation. Modeling the multidimensional sequence or making the prediction based on it would be a computation consuming work. Our research is based on deep learning to propose an efficient procedure to predict delivery demand. With the simulation study, the prediction performance of the proposed procedure is acceptable. This is conducive to the further study of logistics decisions making.

This study was undertaken to assess the effect of blood glucose on BMD and interactions with age, sex, and BMI in a Taiwanese population. Both obese and non-obese people with type 2 diabetes (T2DM) had higher BMD, at lumbar spine and femoral neck, compared with healthy subjects. In addition, the prevalence of osteoporosis significantly decreased with blood sugar and HbA1c. This study was undertaken to assess the effect of blood glucose on BMD and possible interactions with age, sex, and BMI in a Taiwanese population. This study was a retrospective cross-sectional study using data from the Health Examination Database of Changhua Christian Hospital. Data on BMD of the lumbar spine and femoral neck were obtained by dual X-ray absorptiometry (DXA), and other relevant clinical and laboratory data were recorded. The type 2 diabetes (T2DM) group had a higher BMD than the controls. When comparing the prevalence of osteoporosis between subjects by glucose and HbA1c level, the prevalence of osteoporosis significantly decreased with blood glucose and HbA1c. In addition, the BMD of the lumbar spine and femoral neck was higher in the T2DM group than in the controls. Osteoporosis was negatively associated with DM, BMI, and drinking, but positively associated with age, female gender, previous fracture history, and other diseases of the musculoskeletal system and connective tissue. The association between diabetes and osteoporosis remained statistically significant after adjusting for the above factors. T2DM was associated with lower odds of osteoporosis in both obese (OR = 0.77) and non-obese (OR = 0.63) (p for interaction = 0.555). Both obese and non-obese people with T2DM had higher BMD, at lumbar spine and femoral neck, compared with healthy subjects. In addition, the prevalence of osteoporosis significantly decreased with blood glucose and HbA1c.

Yen-Tze Liu,1 Pei-Yu Yang,2 Yu-Wen Yang,1 Hung-Yu Sun,1 I-Ching Lin1,3,4 1Department of Family Medicine, Changhua Christian Hospital, 2Department of Laboratory, Show Chwan Memorial Hospital, Changhua City, 3School of Medicine, Chung Shan Medical University, Taichung City, 4School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan Background: Metabolic syndrome is a worldwide disorder and also the major risk factor of several systemic diseases. Evidence identifying the association between metabolic syndrome and nephrolithiasis is lacking, especially in Taiwan.Aim: The aim of this study was to investigate the association between nephrolithiasis and metabolic syndrome and its components.Design and setting: This was a cross-sectional study conducted in the Health Examination Department of a medical center in Changhua, Taiwan, from January 2010 to December 2010.Methods: We reviewed the medical records of patients who had visited the Health Examination Center of Changhua Christian Hospital in 2010. A total of 3,886 individuals were enrolled. According to the exclusion criteria, those with an age

Hypercalcaemia and leucocytosis are common in our patients with progressive oral squamous cell carcinoma (SCC). However, the precise incidence, prognostic value, and correlation with the condition of the tumour remain obscure. A total of 618 patients with oral SCC who were treated primarily between 2007 and 2012 and had serum calcium concentrations and white blood cell count (WCC) measured postoperatively were included in the study. Primary TNM stage, pathological features, and the presence of locoregional recurrence or distant metastasis after comprehensive surgical treatment were recorded. The incidence of hypercalcaemia was 9.1% and that of leucocytosis 7.2%. Hypercalcaemia correlated significantly with size of primary tumour (T status), nodal involvement (N status), TNM stage, perineural invasion, lymphovascular permeation, and recurrence or metastasis of disease. Leucocytosis, however, correlated only with T status, lymphovascular permeation, and recurrence or metastasis. In multivariate analysis of survival, recurrence, metastasis, hypercalcaemia, and leucocytosis were strong independent prognostic factors. Median survival was low if the patient had hypercalcaemia or leucocytosis (179 (range 3–73) days if the patient had distant metastasis, and 43 (range 3–102) days if the patient had locoregional recurrence). The incidence of hypercalcaemia and leucocytosis was high during the course of the disease, and both conditions have an adverse impact on survival from oral SCC. Periodic evaluation of serum calcium concentrations and WCC should be routine during the postoperative period.

Objective The purpose of our study was to determine the association of type 1 diabetes mellitus (T1DM) and the risk of herpes zoster (HZ). Methods In this cohort study, we selected 4736 patients with T1DM registered in the Catastrophic Illness Patient Database who received insulin therapy before 2003 and 18944 participants without DM who were selected by frequency matched based on sex and age. Cox proportional hazard regression analysis was used to measure the hazard ratios (HRs) of HZ in the T1DM group compared with that in the non-T1DM group. Results Cox proportional hazard regression analysis showed that the adjusted HR of HZ was 2.38 times higher for patients in the T1DM group (95% CI = 1.77–3.19) than for those in the non-T1DM group. According to diabetes severity, mild and serious T1DM patients were associated with a higher risk of HZ (adjusted HR = 2.26, 95% CI = 1.67–3.05; and adjusted HR = 5.08, 95% CI = 2.66–9.71, respectively) than subjects without T1DM. Conclusion Patients with T1DM are at a higher risk of HZ than those without T1DM.

Traumatic intracranial hemorrhage (ICH) is prevalent worldwide with long-term consequences, including disabilities. However, studies on the association of traumatic ICH with coronary artery disease (CAD) are scant. Therefore, this study explored the aforementioned association in a large-scale, population-based cohort. A total of 128,997 patients with newly diagnosed traumatic ICH and 257,994 age- and sex-matched patients without traumatic ICH from 2000 to 2010 were identified from Taiwan's National Health Insurance Research Database. The Kaplan–Meier method was used for measuring the cumulative incidence of CAD in each cohort. Cox proportional regression models were used for evaluating the risk of CAD in patients with and without traumatic ICH and for comparing the risk between the 2 cohorts. The Kaplan–Meier analysis revealed that the cumulative incidence curves of CAD were significantly higher in patients with traumatic ICH than in those without ICH (log-rank test, P

Patients with end-stage head and neck cancer suffer from many physical and psychological symptoms, however, there have been relatively few studies looking at end-of-life symptoms in the head and neck cancer population. The objective of this study was to describe the symptom patterns of patients with terminal head and neck cancer in the palliative care unit.A retrospective chart review of 94 patients with terminal head and neck cancer admitted to a palliative care unit between May 2006 and December 2008 was performed. Demographic data, performance status, primary tumor site, time from diagnosis to first hospice admission, survival time after admission, medication for pain control, and main symptoms at the time of admission were examined.The mean time from diagnosis to first hospice admission was 33.1 ± 51.6 months. The mean survival time in the hospice was 21.9 ± 18.9 days. In this study, the most common symptom experienced was weight loss, followed by pain, cough, dysphagia, feeding difficulties, and communication difficulties. A statistically significant association of communication difficulties was found with presence or absence of a tracheostomy (p 0.001). Change of morphine dosage after hospice care is related to the site location of head and neck cancer. Levels of education seem to be related to the increasing use of morphine (p = 0.025). Change of morphine dosage was statistically correlated with survival time after hospice admission (p 0.001)Numerous symptoms at the end of life highlight the complexity of head and neck cancer patients that may necessitate early hospice referral for symptom control.

The association between the hepatitis C virus (HCV) infection and the risk of myocardial infarction (MI) and stroke has been previously investigated. However, the association between the HCV infection and the risk of venous thromboembolism (VTE) has not been extensively discussed. Using the Longitudinal Health Insurance Database 2000 (LHID2000), we selected 3686 patients with newly diagnosed HCV infection. We randomly selected 14,744 people with no HCV or hepatitis B virus (HBV) infection as comparison group and frequency matched them with patients with HCV infection according to their age, sex, and index year. The incidence density rates and hazard ratios (HRs) of deep vein thrombosis (DVT) and pulmonary embolism (PE) were calculated until the end of 2011. The mean follow-up duration of 5.14 years for the HCV cohort and 5.61 years for the non-HCV cohort, the overall incidence density rates of DVT were 7.92 and 3.51 per 10,000 person-years in the non-HCV group, and the HCV groups, respectively (crude HR = 2.25; 95% confidence interval [CI] = 1.21–4.21). After adjusted for age, sex, and comorbidities, the risk of DVT remained significantly higher in the HCV group than in the non-HCV group (adjusted HR = 1.96; 95% CI = 1.03–3.73). The overall incidence density rates of PE in the HCV and non-HCV groups were not significantly different (crude HR = 2.20; 95% CI = 0.94–5.14). HCV infection is associated with the risk of DVT in a long-term follow-up period.

Objective Diabetes is a common diseases and a major problem worldwide. Diabetic osteopathy might be elevated in diabetic patients and is usually caused by bone fracture. Several diabetes medications, such as thiazolidinediones (TZDs), could lead to increased risks of fracture. Methods We used the nationwide database to identified 32466 patients who had developed type 2 diabetes from 2000 to 2010 as the diabetic cohort and, from that group, we selected 3427 diabetic patients who had developed bone fracture to survey the possible risk factors, includng commonly used diabetes medication. Results We found that TZDs might present increased risks for fracture in patients who used it for an extended period (7 to 730 days before the index date), especially in female patients younger than 64 years old, for whom the risk was elevated from a 1.74- to a 2.58-fold odds ratio. Conclusions We recommend that clinics follow up with non-osteoporotic female patients younger than 64 years old who are using TZDs, to avoid the associated risks of fracture.

Type 2 diabetes mellitus (DM) is known to be closely associated with lifestyle and obesity and has a prevalence that increases with age. This study aimed to assess the short-term composite effect of diet, physical activity, psychosocial health, and waist circumference (WC) on the incidence of DM in the elderly and to provide a lifestyle-based predictive index.We used baseline measurements (2009-2013) of 5349 community-dwelling participants (aged 55 years and older, 52% female) of the Healthy Aging Longitudinal Study in Taiwan (HALST) for fasting plasma glucose, HbA1C, serum cholesterol, triglycerides, blood pressures, WC, and outcomes of home-visit questionnaire. Principal component analysis (PCA) was used to identify participants with a healthy lifestyle (HLF: higher diet, physical activity, and psychosocial scores) and a lower WC, with cutoffs determined by the receiver-operating characteristics. A Cox regression model was applied to 3424 participants without DM at baseline by linking to their National Health Insurance records (median follow-up of 3.1 years).In total, 247 new DM cases (7.2%) were identified. The HLF and lower WC group had a relative risk (RR) of DM of 0.54 (95% CI 0.35-0.82) compared to the non-HLF and higher WC group. When stratified by the presence of impaired glucose tolerance (IGT) or metabolic syndrome (MS), only participants with IGT/MS showed significant risks (RR 0.55; 95% CI 0.33-0.92). However, except for WC, the individual lifestyle factors were nonsignificant in the overall model without PCA.A composite protective effect of HLF and normal WC on DM within 5 years was observed, especially in those with IGT or MS. Psychosocial health constituted an important lifestyle factor in the elderly. The cutoffs identified could be used as a lifestyle-based risk index for DM. Maintaining an HLF to prevent DM is especially important for the elderly.

Supplemental Digital Content is available in the text, The objective of this study was to examine the association of depression, psychotropic medications, and mental illness with cardiovascular disease in a nationwide community-dwelling elderly population in Taiwan. A total of 5664 participants who enrolled in the Healthy Aging Longitudinal Study in Taiwan (HALST) were included in the study. Multiple logistic regression was applied to investigate the association of depression, psychotropic medication use, and mental illness, separately, with cardiovascular disease. The results suggested that cardiovascular disease was significantly associated with various definitions of depression, including: the Center for Epidemiologic Studies-Depression scale (CES-D) ≥ 16, self-reported, and physician-diagnosed for depression (adjusted odds ratio [AOR] = 1.51; 95% confidence interval (CI): 1.14–2.00 for CES-D; AOR = 3.29; 95% CI: 1.99–5.42 for self-reported; and AOR = 2.45; 95% CI: 1.51–3.97 for physician-diagnosed). Additionally, significant associations of cardiovascular disease with the use of antipsychotics (AOR = 2.04; 95% CI: 1.25–3.34), benzodiazepines (BZDs) (AOR = 1.84; 95% CI: 1.52–2.21), and Z-drugs (AOR = 1.41; 95% CI: 1.03–1.93), respectively, were also observed, but not the use of antidepressants. In addition, a significant association of cardiovascular disease with mental illness was found in this study (AOR = 2.33; 95% CI: 1.68–3.24). In line with previous reports, these findings provided supportive evidence that depression and/or mental illness were significantly associated with cardiovascular disease in a community-dwelling elderly population in Taiwan. Moreover, significant associations of cardiovascular disease with the use of antipsychotics, BZDs, and Z-drugs, individually, were found. Further investigation would be of importance to clarify the causal relationship of depression and/or psychotropic medications with cardiovascular disease, especially among elderly populations.

The aim of this study was to evaluate the risk of depression in and effect of L-thyroxine therapy on patients with Hashimoto thyroiditis (HT) in Taiwan.In this retrospective, nationwide cohort study, we retrieved data from the Longitudinal Health Insurance Database 2000. We collected data of 1220 patients with HT and 4880 patients without HT for the period 2000 to 2011. The mean follow-up period for the HT cohort was 5.77 years. Univariate and multivariate Cox proportional hazards regression models were used to estimate the risk of depression in the HT cohort.In the HT cohort, 89.6% of the patients were women. Compared with the non-HT cohort, the HT cohort exhibited a higher prevalence of diabetes mellitus, hyperlipidemia, and coronary artery disease. Furthermore, the HT cohort showed a higher overall incidence of depression compared with the non-HT cohort (8.67 and 5.49 per 1000 person-year; crude hazard ratio [HR] = 1.58, 95% confidence interval [CI] = 1.18-2.13). The risk of depression decreased after administration of L-thyroxine treatment for more than 1 year (adjusted HR = 1.02; 95% CI = 0.66-1.59).In Taiwan, the overall incidence of depression was greater in the young HT cohort. L-thyroxine treatment reduced the risk of depression.

We designed a population-based retrospective cohort study to investigate the association between the event of benzodiazepine (BZD) poisoning and the risk of acute pancreatitis. In the present study, 12,893 patients with BZD poisoning during 2000 to 2011 were enrolled and matched with 4 comparison patients according to mean age and sex. We determined the cumulative incidences and adjusted hazard ratios of acute pancreatitis. A significant association was observed between BZD poisoning and acute pancreatitis. After adjustment for potential risk factors, the patients with BZD poisoning had a 5.33-fold increased risk of acute pancreatitis compared with the controls without BZD poisoning (HR = 5.33, 95% CI = 2.26–12.60). The results revealed that acute pancreatitis in patients with BZD poisoning occurred in a follow-up time of ≤1 month (HR = 50.0, P 1 month (HR = 1.07, P > .05). This population-based study revealed the positive correlation between the event of BZD poisoning and an increased risk of acute pancreatitis. The findings warrant further large-scale and in-depth investigation.

This paper proposes an approach to visualize the benefits of applying contemporary technology in explicit knowledge management processes. The “Knowledge Long Tail” is a novel way of categorizing individual and organizational knowledge, and of modeling knowledge in organizations in terms of its type and frequency of use. The concept is inspired by the market long tail phenomenon raised by Chris Anderson [1]. Based on theoretical considerations, it is proposed that by using the three “long tail technology drivers” to integrate individual knowledge into an organizational knowledge management system, individual and organizational knowledge can be utilized in a more efficient and effective manner.

The temperature performance of metal–oxide–silicon tunneling light-emitting diodes was studied. An electron–hole-plasma model can be used to fit all the emission spectra from room temperature to 98 K. At constant voltage bias in the accumulation region, the normalized integral emission intensity slightly increases at low temperature with activation energy as low as 12 meV. From room temperature down to 98 K, the extracted band gaps are ∼80 meV lower than the value of Varshni equation, and the linewidth drops from 65 to 30 meV. The transverse optical and longitudinal optical phonons are involved in the light-emission process due to the reduction of extracted band gaps and the resemblance between electroluminescence and photoluminescence spectra at similar temperature.

An electron-hole plasma recombination model is used to fit the room-temperature electroluminescence from metal–oxide–silicon tunneling diodes. The relatively narrow line shape in the emission spectra can be understood by the quasi-Fermi level positions of electrons and holes, which both lie in the band gap. This model also gives a narrower band gap than that of bulk silicon. The surface band bending in the Si/oxide interface is responsible for this energy gap reduction.

Small numbers of the papers have studied the association between organophosphate (OP) poisoning and the subsequent acute kidney injury (AKI). Therefore, we used the National Health Insurance Research Database (NHIRD) to study whether patients with OP poisoning are associated with a higher risk to have subsequent AKI.The retrospective cohort study comprised patients aged ≥20 years with OP poisoning and hospitalized diagnosis during 2000-2011 (N = 8924). Each OP poisoning patient was frequency-matched to 4 control patients based on age, sex, index year, and comorbidities of diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, coronary artery disease, and stroke (N = 35,696). We conducted Cox proportional hazard regression analysis to estimate the effects of OP poisoning on AKI risk.The overall incidence of AKI was higher in the patients with OP poisoning than in the controls (4.85 vs 3.47/1000 person-years). After adjustment for age, sex, comorbidity, and interaction terms, patients with OP poisoning were associated with a 6.17-fold higher risk of AKI compared with the comparison cohort. Patients with highly severe OP poisoning were associated with a substantially increased risk of AKI.The study found OP poisoning is associated with increased risk of subsequent AKI. Future studies are encouraged to evaluate whether long-term effects exist and the best guideline to prevent the continuously impaired renal function.

Supplemental Digital Content is available in the text, The current population-based study investigated the onset of neonatal urinary tract infection (UTI) and the associated risks of allergic rhinitis. From 2000 to 2005, 3285 children with neonatal UTI and 13,128 randomly selected controls were enrolled from the National Health Insurance Research Database in Taiwan and frequency matched by gender, urbanization of residential area, parental occupation, and baseline year. We compared the risk of allergic rhinitis between the non-UTI and UTI cohorts by performing multivariable Cox regression analysis. We observed a significant relationship between UTI and allergic rhinitis. This study examined 16,413 patients, among whom 3285 had UTI and 13,128 did not have UTI. The overall incidence rate ratio of allergic rhinitis was 1.41-fold higher in the UTI cohort than in the non-UTI cohort (100.2 vs 70.93 per 1000 person-y). After potential risk factors were adjusted for, the adjusted hazard ratio of allergic rhinitis was 1.32 (95% confidence interval = 1.23–1.41). Regardless of gender, the UTI cohort had a higher risk of allergic rhinitis than that of the non-UTI cohort. The patients with UTI in different follow-up durations were equally susceptible to developing allergic rhinitis compared with those without UTI, especially in follow-up durations shorter than 5 years. Patients with UTI and particular comorbidities such as infections and neonatal jaundice had a significantly increased risk of allergic rhinitis. UTI in newborns is significantly associated with the development of allergic rhinitis in childhood and might be a risk factor for subsequent childhood allergic rhinitis.

Studies have suggested that statin use is related to cancer risk and prostate cancer mortality. We conducted a population-based cohort study to determine whether using statins in prostate cancer patients is associated with reduced all-cause mortality rates. Data were obtained from the Taiwan National Health Insurance Research Database. The study cohort comprised 5179 patients diagnosed with prostate cancer who used statins for at least 6 months between January 1, 1998 and December 31, 2010. To form a comparison group, each patient was randomly frequency-matched (according to age and index date) with a prostate cancer patient who did not use any type of statin-based drugs during the study period. The study endpoint was mortality. The hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox regression models. Among prostate cancer patients, statin use was associated with significantly decreased all-cause mortality (adjusted HR = 0.65; 95% CI = 0.60–0.71). This phenomenon was observed among various types of statin, age groups, and treatment methods. Analyzing the defined daily dose of statins indicated that both low- and high-dose groups exhibited significantly decreased death rates compared with nonusers, suggesting a dose–response relationship. The results of this population-based cohort study suggest that using statins reduces all-cause mortality among prostate cancer patients, and a dose–response relationship may exist.

Background To investigate the association between metabolic syndrome, including its factors, and gallstone disease (GSD) in a Taiwanese population. Methods We conducted a cross-sectional study during 2011 ~ 2012. A total of 12050 subjects who completed a questionnaire and underwent physical examination, laboratory tests and abdominal ultrasonography formed the study population. Results The prevalences of metabolic syndrome and gallstone disease were 24.09% and 6.16%. In an age- and sex-adjusted logistic regression model, metabolic syndrome was associated with gallstone disease (OR = 1.61; P

Knowledge management is one element that determines success of new product development. This study explores how knowledge management is interrelated with new product development so that resource-limited organisations can break down knowledge management processes and focus on those most critical. With insights gained from existing literature, a framework is proposed focusing on integration of knowledge management processes and various perspectives (long and short term) of new product development. In order to verify and demonstrate this framework, application within a medium-sized manufacturing company in New Zealand is discussed. This study aims to improve current poor performance of knowledge management among companies, allowing these companies to better understand their knowledge management practices.

A patient with peripheral polyneuropathy after bariatric surgery for morbid obesity is reported. She suffered from frequent episodes of vomiting and abdominal pain after surgery. Muscle weakness in her lower limbs developed 5 months later and she experienced difficulty in walking and standing. Wrist drop, foot drop, and marked distal limb muscle atrophy were found bilaterally. Electromyography showed the presence of sensorimotor axonal polyneuropathy. Nutritional deficiencies may play an important role in pathogenesis. This uncommon neurological complication might be due to rapid weight loss and vitamin deficiency. Physicians who take care for patients after bariatric surgery should have a high index of awareness for the neurologic complications, and routine vitamin supplementation might be useful for these patients.