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This study documented the process of evolution of the continuous design and revision of the tools of a novice mathematics teacher educator--researcher (MTE-R) as he planned and implemented design-based professional development workshops for in-service mathematics teachers in Taiwan. In order to effectively facilitate teachers designing and implementing their own conjecturing activities during the workshops, the MTE-R fostered their professional learning and growth through reflection upon students' performance. From the perspective of activity theory, this study examined the evolution of the MTE-R's mentoring activities and tools whose design gradually changed from being based on the literature content toward being learner-centered activities with teachers as learners. Such evolution not only enhanced teachers' learning outcomes, but also facilitated the MTE-R's own professional growth in different areas, including mathematics, mathematics learning, mathematics teaching, teacher education, and, in particular, the extrapolation of generic examples for understanding mathematical concepts.

Previous studies showed that there is a discrepancy between total subsidence (measured on the ground surface) and shallow compression (measured within several hundred meters beneath the ground surface) in Taiwan. This difference is referred to as deep displacement in this study. The variations of deep displacement are opposite to those of ground surface displacement and groundwater level within the depth of several hundred meters. The mechanism is unknown and requires further investigation. This study adopts two kinds of geodetic observation data and separates land subsidence into shallow compression and deep displacement to investigate the mechanism of deep displacement. A tectonically active coastal area in Taiwan is selected as the study area. The assessment results show that the associated variations are likely due to cyclic hydraulic loading and unloading. The variations of deep displacement are opposite to those of ground surface displacement. This study proposes that these variations are due to hydraulic expansion and contraction. The mechanism is demonstrated using a hydromechanical model. The results of a cross-correlation analysis show that hydraulic expansion and contraction occur at certain depths. The study results provide important information on the mechanism of deep displacement that can be used in tectonophysical and land subsidence investigations. [ABSTRACT FROM AUTHOR]

Background: Despite a significant 30% ten-year readmission rate for SBO patients, investigations into recurrent risk factors after non-operative management are scarce. The study aims to generate a risk factor scoring system, the 'Small Bowel Obstruction Recurrence Score' (SBORS), predicting 6-month recurrence of small bowel obstruction (SBO) after successful non-surgical management in patients who have history of intra-abdominal surgery. Methods: We analyzed data from patients aged ≥ 18 with a history of intra-abdominal surgery and diagnosed with SBO (ICD-9 code: 560, 568) and were successful treated non-surgically between 2004 and 2008. Participants were divided into model-derivation (80%) and validation (20%) group. Results: We analyzed 23,901 patients and developed the SBORS based on factors including the length of hospital stay > 4 days, previous operations > once, hemiplegia, extra-abdominal and intra-abdominal malignancy, esophagogastric surgery and intestino-colonic surgery. Scores > 2 indicated higher rates and risks of recurrence within 6 months (12.96% vs. 7.27%, OR 1.898, p < 0.001 in model-derivation group, 12.60% vs. 7.05%, OR 1.901, p < 0.001 in validation group) with a significantly increased risk of mortality and operative events for recurrent episodes. The SBORS model demonstrated good calibration and acceptable discrimination, with an area under curve values of 0.607 and 0.599 for the score generation and validation group, respectively. Conclusions: We established the effective 'SBORS' to predict 6-month SBO recurrence risk in patients who have history of intra-abdominal surgery and have been successfully managed non-surgically for the initial obstruction event. Those with scores > 2 face higher recurrence rates and operative risks after successful non-surgical management. [ABSTRACT FROM AUTHOR]

This study examines the air pollutant emission characteristics, activity intensity, and trends of mobile sources from 2013 to 2021. The target pollutants include criteria pollutants (fine particulate matters, nitrogen oxides, and hydrocarbons) and hazardous air pollutants (benzene, formaldehyde, and BaP). The results indicated that the activity intensity levels of road mobile sources in Taiwan were148 × 109, 156 × 109, 159 × 109, and 155 × 109 km/year in 2013, 2016, 2019, and 2021, respectively, with the largest proportion attributed to gasoline passenger cars (42.6%), followed by four-stroke motorcycles (32.6%). An emission factor of PM2.5 was estimated by EPA's MOVES (Motor Vehicle Emission Simulator) model, and the results showed that the emission sequence was diesel > gasoline > motorcycle; the NOx emission factor was estimated using the MOBILE6.2 model, and the results showed that the order was diesel > gasoline > motorcycle; the HC emission factor was compiled with the use of gasoline vehicle dynamometer data, and the results showed that motorcycle > gasoline vehicles. Further results showed that the emission sequence for benzene was motorcycle > gasoline ≥ diesel; the formaldehyde emission sequence was diesel > motorcycle ≥ gasoline. The BaP emission factors of different vehicle types were estimated using MOVES, and the emission factors of old heavy-duty diesel vehicles were the highest. [ABSTRACT FROM AUTHOR]

Aims: Type 2 diabetes mellitus (T2DM) frequently co‐exists with osteoporosis and dyslipidemia. Statins have been commonly used in the treatment of dyslipidemia. Recent studies have indicated a therapeutic role of statins in decreasing the risk of osteoporosis and fractures, but conflicting results have been reported. This study investigated the association between statin use and hip fracture (HFx) risk among T2DM patients. Materials and Methods: A retrospective Taiwan population‐based propensity‐matched cohort study was performed using the Diabetes Mellitus Health Database from Taiwan National Health Insurance Research Database. Patients with newly diagnosed with T2DM between 2010 and 2014 were identified. Patients who previously used statins and had ever suffered HFx before the index date were excluded. HFx that occurred from 2010 to 2019 was collected to compute the cumulative rate of HFx. Hazard ratios (HRs) were calculated for the HFx risk according to the use or non‐use of statins. To evaluate the dose–effect relationship of statins, sensitivity analyses were conducted. Results: After propensity score matching for age and sex, 188,588 patients were identified as statin users and non‐statin users. Statin use after T2DM diagnosis was associated with a decreased HFx risk with an adjusted HR (aHR) of 0.69 (P < 0.001). A dose–effect relationship was identified. The aHRs for developing HFx were 1.29, 0.67, and 0.36 for patients who used 28–174, 175–447, and >447 cumulative defined daily doses of statins, respectively (P < 0.001). Conclusions: Statin use in adults with T2DM showed a lower risk of HFx by demonstrating a dose–response relationship. [ABSTRACT FROM AUTHOR]

A continuous increase in follicular lymphoma has been observed in Taiwan, Japan, and South Korea over the last few decades. This study aimed to evaluate the difference in incidence trends of follicular lymphoma in Taiwan, Japan, and South Korea between 2001 and 2019. The data for the Taiwanese populations was obtained from the Taiwan Cancer Registry Database, and those for the Japanese and Korean population were retrieved from the Japan National Cancer Registry and some additional reports, both of which included population-based cancer registry data, from Japan and Korea. Follicular lymphoma accounted for 4231 cases from 2002–2019 in Taiwan, 3744 cases from 2001–2008 and 49,731 cases from 2014–2019 in Japan; and 1365 cases from 2001–2012 and 1244 cases from 2011–2016 in South Korea. The annual percentage change for each time period was 3.49% (95% confidence interval: 2.75–4.24%) in Taiwan, 12.66% (95% confidence interval [CI]: 9.59–15.81%) and 4.95% (95% CI: 2.14–7.84%) in Japan, and 5.72% (95% CI: 2.79–8.73%) and 7.93% (95% CI: −1.63–18.42%) in South Korea. Our study confirms that the increasing trends of follicular lymphoma incidence in Taiwan and Japan have been remarkable in recent years, especially the rapid increase in Japan between 2014 and 2019; however, there was no significant in-crease from 2011 to 2015 in South Korea. [ABSTRACT FROM AUTHOR]

Background: Cambium in lianas, responsible for secondary growth, develop diverse and diagnostic traits during the climbing phase. Studies on the cross-section of Taiwanese liana cambial variants are scarce. We collected multiple stem cross-sections from 287 liana species belonging to 52 families. Each sample was examined on five occasions, and the observations were documented. Results: The results showed that approximately 22 cambial variants types were displayed in Taiwan lianas. Among these, axial vascular elements in radial segments were the most common, followed by the variants with the irregular conformation and intraxylary phloem. Based on our assessment, we provide the following identification features of a few families: Apocynaceae had intraxylary phloem; Convolvulaceae had intraxylary phloem combined with successive cambia; Lardizabalaceae, Menispermaceae, and Ranunculaceae possessed axial vascular elements in segments; Piperaceae had external primary vascular bundle cylinder combined with axial vascular elements in segments; Vitaceae had axial vascular elements in segments combined with irregular conformation. Axial vascular elements in segments and intraxylary phloem appeared in six or five combination types, showing that these two types combined with many variants are helpful for the identification of lianas. Two species, Momordica charantia var. abbreviata, and Momordica cochinchinensis had a cambium element in the outer cylinder of cortical bicollateral vascular bundles and formed directional layers of successive cambia. Conclusions: Our study documented regular secondary growth with a single cambium in 36 species and cambial variants present in 16 species of Taiwanese lianas. Furthermore, we provide crucial baseline data on liana cambial variations, thereby improving our understanding of their morphology and identification. [ABSTRACT FROM AUTHOR]

Background: The role of adjuvant concurrent chemoradiotherapy (ACCRT) is unclear for patients with esophageal squamous cell carcinoma (ESCC) who receive esophagectomy with clean margins. We compared the survival of the ACCRT versus observation groups for these patients staged with positron emission tomography (PET) via a population‐based approach. Methods: Eligible patients with locally advanced ESCC diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratios (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between the ACCRT and observation groups. We also evaluated overall survival (OS) in subgroups of either with or without lymph node metastases. Results: Our primary analysis consisted of 105 patients in whom the covariates were well balanced after PS weighting. The HR for death when ACCRT was compared with observation was 0.58 (95% confidence interval 0.28–1.21, p = 0.15). The results were also not significantly different for IECM or in the subgroup analyses. Conclusion: We found that for patients with PET‐staged ESCC who received esophagectomy with clean margins, the survival was not statistically different between ACCRT and observation. Further studies (randomized or larger sample size) are needed to clarify this issue. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 pandemic significantly affected emergency department (ED) visits and urgent psychiatric consultation (UPC) seeking behavior in EDs. Our study explored the changes in UPCs during and after the pandemic peak. Methods: This retrospective observational study evaluated UPCs in the ED of a referral medical center in Taiwan, where treated both physical and psychiatric complaints. We defined the COVID-19 pandemic peak period as calendar week 4–18, 2020. The corresponding baseline as calendar week 4–18, 2019, and the slack period as week 4–18, 2021. The total number of UPCs, patient demographic data such as sex and age of the patients seen, the referral system (whether police or emergency medical service [EMS] or other sources), and the chief complaint (self-harm or violence) were recorded. Results: Compared with the baseline period, a significant decline in UPCs was observed in the pandemic peak period, and a rebound was observed in the slack period, with the median [IQR] Q1, Q3 values of 22 [18, 26], 12 [10, 17]), and 16 [15, 23], respectively. We observed significantly few men (34.9% vs 45.2%) and less violence (10.2% vs 17.6%) in the peak period compared with in the baseline period, but no significant difference was found compared with the slack period. Throughout the pandemic, younger patients (41.8 ± 17.4 in 2019, 39.2 ± 18.5 [p = 0.121] in 2020, and 35.6 ± 17.2 [p < 0.001] in 2021), higher proportions of police/EMS referral (38.7% in 2019, 41.9% [p = 0.473] in 2020, and 51.9% [p = 0.001] in 2021) and self-harm–related complaints (57% in 2019, 62.4% [p = 0.233] in 2020, and 64.9% [p = 0.049] in 2021) was noted among UPC seekers during the pandemic. However, the proportion of violence-related UPCs (17.6% in 2019, 10.2% [p = 0.023] in 2020, and 12.3% [p = 0.072] in 2021) declined. Conclusions: This study found that UPCs changed throughout the pandemic. This result raises the concern that mental health needs are masked during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Liver metastases from breast cancer are associated with poor prognosis, and treatment options are usually restricted to palliative systemic therapy. The impact of liver resection on metastasis remains controversial. The aim of this study is to investigate whether liver resection can offer better survival outcomes in cases of isolated liver metastases from breast cancer. Methods: We conducted a nationwide cohort study using a claims dataset from Taiwan's National Health Insurance Research Database (NHIRD). We identified all patients with breast cancer (diagnostic code ICD-9: 174.x) from the Registry for Catastrophic Illness Patient Database (RCIPD) of the NHIRD who underwent mastectomy between January 1, 2000, and December 31, 2008. Patients with other malignancies (history, initially, or during follow-up), those with a history of metastasis prior to or at initial admission for mastectomy, and those without liver metastases were excluded. Patients with other metastases between mastectomy and liver metastasis and those who died at first admission for liver resection were also excluded. All patients were followed up until December 31, 2013, or withdraw from the database because of death. Results: Data were analyzed for 1,116 patients who fulfilled the inclusion criteria (resection group: 89; non-resection group: 1,027). There were no differences in age, Charlson Comorbidity Index, or major coexisting diseases except renal disease between two groups. Kaplan–Meier analysis demonstrated that the liver resection group had significantly better overall survival (OS) than the non-resection group. (1-year: 96.6% vs. 52.3%, 2-year: 86.8% vs. 35.4%, 3-year: 72.3% vs. 25.2%, 5-year: 51.6% vs. 16.9%, respectively, p<0.001). Cox analysis revealed that the liver resection group exhibited a significant improvement in patient survival (hazard ratio [HR] = 0.321, 95% confidence interval [CI]: 0.234–0.440, p<0.001). Conclusion: These findings indicate that liver resection may offer better survival benefit in patients with breast cancer who develop new liver metastases post mastectomy. [ABSTRACT FROM AUTHOR]

Herein, we aimed to explore whether male patients with congenital collagen diseases had a higher risk of inguinal herniation than patients without these diseases. Data were retrospectively collected from the National Health Insurance Research Database of Taiwan. The study cohort included 1,801 male patients diagnosed with congenital collagen diseases based on the ICD-9 CM diagnostic codes; after propensity score matching, the control group comprised 6,493 men without congenital collagen diseases. The primary endpoint was inguinal hernia repair during the observation period. During a median follow-up period of 133.9 months, the risk of inguinal herniation in the collagen group was significantly higher than that in the control group (HR = 2.237, 95% CI 1.646–3.291, p < 0.001). This phenomenon was observed in patients younger than 18 years (HR: 3.040, 95% CI 1.819–5.083, p < 0.001) and in those aged 18–80 years (HR: 1.909, 95% CI 1.186–3.073, p < 0.001). Asian men with congenital collagen diseases are at a high risk of developing inguinal hernias, regardless of age. Detailed physical examination and patient education should be performed for these patients to prevent inguinal herniation. [ABSTRACT FROM AUTHOR]

Introduction: Our study aims to identify that patients who received hernia repair previously did have higher risk of occurrence of newly developed inguinal hernia, named as a contralateral inguinal hernia (CIH), than patients who never received inguinal hernia surgery before. Materials and methods: We collected data from the National Health Insurance Research Database (NHIRD) of Taiwan retrospectively. In the study cohort, 64,089 Asian male adults who underwent primary unilateral inguinal hernia repair during 2003–2008 were included using ICD-9 diagnostic and surgical codes. Another 64,089 male adults without hernia repair history were included as control group via propensity score match. Results: The median follow-up period is 93.53 months. After multivariate analysis, the risk of newly developed inguinal hernia in unilateral inguinal hernia (UIH) repair cohort was significantly higher (adjusted HR 6.364, 95% CI 6.012–6.737, P < 0.001) than the control group. In subgroup analysis, patients without mesh repair (adjusted HR 6.706, P < 0.001) and patients with mesh repair (adjusted HR 5.559, P < 0.001) both showed higher risk of developing newly developed inguinal hernia which needs repair. Conclusions: Asian men with UIH repair history had a higher risk of developing new inguinal hernia at the contralateral site, namely CIH, than the general population. The surgeon should inform the possibility of CIH after initial herniorrhaphy, therefore, monitoring the occurrence of CIH is necessary. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed the benefits and efficacy of bariatric surgery (BS) in reducing the risk of cancer in Asians with morbid obesity. Methods: Records for patients aged between 18 and 55 years whose diagnoses corresponded with the ICD-9 codes for obesity and BS were extracted from the National Health Insurance Research Database (NHIRD) in Taiwan between 2000 and 2015. The patients who underwent BS (BS group), those who did not undergo BS (NS group), and the general population (GP group) were propensity score matched. The outcome was newly diagnosed malignancy. Data were extracted from the Registry for Catastrophic Illness Patient Database (RCIPD) of the NHIRD. Results: The BS group developed significantly less malignancy (1.18%) than the GP group (1.46%, p = 0.0364). There was no statistically significant difference in malignancy risk between the BS and GP groups (aHR =1.00, p = 0.9997). The NS group developed significantly higher malignancy (2.48%) than the GP group (1.97%, p < 0.0001). There was a significantly higher malignancy risk in the NS group (aHR =1.22, p < 0.0001) than in the GP group. In the subgroup analysis, the malignancy risks of the NS group were significantly higher in the subgroup of men aged between 18 and 35 years (aHR =1.37, p = 0.003) and women aged between 18 and 35 years (aHR = 1.62, p < 0.0001), and 35–55 years (aHR = 1.27, p < 0.0001). All the subgroup analyses between the BS and GP groups demonstrated no significant differences. Conclusions: Our study demonstrated that BS reduced the risk of malignancy in patients with morbid obesity, particularly in women and young men. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to investigate the impact of bariatric surgery on non-traffic accident–related fractures in patients with obesity. Methods: This retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. Patients aged 18 to 55 years with obesity diagnosis between 2003 and 2008 were enrolled and divided into two groups: non-surgical and bariatric surgery groups. Patients with endocrine bone disease and malignancy history were excluded. Healthy patients were also randomly selected from the database and assigned to the general population group. The development of fracture was the primary end point. All patients were followed until the end of 2013 or death, whichever came first. Results: After propensity score matching, 1322, 1322, and 4359 subjects were included in the bariatric surgery (BS), non-surgical (NS), and general population (GP) groups, respectively. Based on multivariate analysis, the risk of overall fractures is similar between the BS group (hazard ratio [HR] = 0.774, p = 0.164) and the NS group; nevertheless, the risk of overall fractures was higher in the BS group (HR = 2.210, p<0.001) than in the GP group. The BS group had a significantly lower risk of non-traffic accident–related fractures (HR = 0.542, p = 0.010) than the NS group but a higher risk of non-traffic accident–related fractures (HR = 1.693, p = 0.023) than the GP group. Conclusions: Bariatric surgery may decrease the risk of non-traffic accident–related fractures; however, the risk remains higher in patients with obesity than in the general population. [ABSTRACT FROM AUTHOR]

AbstractCOVID-19 became a global epidemic after its breakout in December 2019. With the help of information technology, many countries developed contact tracing systems to reduce the spread of the epidemic. Although the WHO declared in May 2023 that COVID-19 is no longer a global public health emergency, the virus is still constantly changing and endangering individuals worldwide. In Taiwan, Social Distancing APP is a voluntary contact tracing app that has been downloaded and utilized approximately 9.5 million times. However, adoption remains low. To prevent the spread of the epidemic and encourage more people to use it, understanding the factors influencing continuance intentions to use social distancing apps is an important topic. The research model is composed of two parts: the modified expectation confirmation model (ECM) and personal norms. Our research model was assessed using data from a sample of 501 users of social distancing apps and was analyzed using the partial least squares structural equation model (PLS-SEM). The results of this study suggest that (1) personal norms are the most important factor influencing continuance intention, followed by satisfaction, perceived usefulness, and descriptive norms; (2) personal norms fully mediate the relationship between injunctive norms and continuance intention; (3) personal norms partially mediate the relationship between descriptive norms and continuance intention; (4) personal norms negatively moderate the relationship between satisfaction and continuance intention; and (5) personal norms positively moderate the relationship between disappointment and continuance intention. This study also discusses the implications of a modified ECM and personal norms for continuance intention to use contact tracing apps. [ABSTRACT FROM AUTHOR]

Adenostemma lavenia is a perennial herb belonging to the Compositae family and is widely distributed in the tropical parts of Asia. It has been widely used as medicine in Taiwan with the whole plant used to treat pulmonary congestion, pneumonia, bacterial infections of the respiratory tract, edema, and inflammation. This study sought to investigate the anti-inflammatory effects of A. lavenia in vitro and in animal models. The anti-inflammatory effects of ethyl acetate fractions of A. lavenia (EAAL) were stimulated with lipopolysaccharide (LPS) murine macrophages (RAW 264.7) and lung injury in mice. EAAL reduced proinflammatory cytokine responses. Preoral EAAL alleviated LPS-induced histological alterations in lung tissue and inhibited the infiltration of inflammatory cells and protein concentrations in bronchoalveolar lavage fluid (BALF). EAAL prevented protein expression of inducible NO synthase (iNOS) and cyclooxygenase-2 (COX-2); phosphorylation of I κ B- α , MAPKs, and AMP-activated protein kinase (AMPK); and activated anti-oxidant enzymes (catalase, SOD, and GPx), heme oxygenase-1 (HO-1), and nuclear factor E2-related factor 2 (Nrf2) in LPS-stimulated cells and lung tissues. Fingerprinting of EAAL was performed with HPLC to control its quality, and p -coumaric acid was found to be a major constituent. This study suggests that EAAL is a potential therapeutic agent to treat inflammatory disorders. [ABSTRACT FROM AUTHOR]

This study examined factors that influence the tenure choices of households in different counties and cities of Taiwan. Data collected in the Housing Status Survey by the Construction and Planning Agency of the Ministry of the Interior were analyzed using hierarchical generalized linear modeling (HGLM). The study designated the household sector as a unit at level 1 and counties and cities as a unit at level 2, with the difference among the counties and cities accounting for 9% of the total variation in rental and purchase decisions. Based on the empirical results, tenure choice was positively and significantly affected by such level-1 factors as gender, age, educational level, area per capita, number of rooms per capita, private loans, and permanent income. The level-2 attribute variable, the housing price to income ratio, had a significant negative effect on tenure choice; a higher ratio of housing price to income resulted in a higher preference among households toward leasing in their lease-or-buy decisions. With regard to the forecast ability comparison, the hit rate of HGLM (90.10%) was higher than that of the binary logistic regression model (87.26%). In terms of the forecasting accuracy evaluated using four measures of association, HGLM outperformed the traditional binary logistic regression model. Based on tenfold cross-validation, HGLM also showed a better hit rate than the traditional binary logistic regression model, meaning that the evaluation results had both robustness and reliability. [ABSTRACT FROM AUTHOR]

Background: To identify the rate of and risk factors for contralateral inguinal hernia (CIH) after unilateral inguinal hernia repair in adult male patients.Methods: This retrospective cohort study identified from the Taiwan National Health Insurance Research Database (NHIRD). Information on all adult patients who underwent primary unilateral inguinal hernia repair without any other operation was collected using ICD-9 diagnostic and procedure codes. The exclusion criteria were laparoscopic hernia repair, non-primary repair, complicated hernia, other combined procedures, female and undetermined gender.Results: A total of 170,492 adult male patients were included, with a median follow-up of 87 months. The overall CIH rate was 10.5%, with a median time of 48 months to a subsequent hernia operation. The 1-year, 2-year, 3-year and 5-year-recurrent rate was 2.6, 3, 4.3, and 6.7% respectively. Further, 3.7% patients who underwent CIH repair had a complicated inguinal hernia. Multivariate analysis demonstrated that age > 45 y, direct hernia, cirrhosis (HR = 1.564), severe liver disease (HR = 1.663), prostate disease (HR = 1.178), congestive heart failure (HR = 1.138), and history of malignancy (HR = 1.116) had a significantly higher risk of CIH repair.Conclusions: Among adult male patients undergoing long-term follow-up, we identified several significant risk factors for CIH repair. If these risk factors are presented, the surgeon should inform the following risk of CIH repair to patients so that it can be repaired as soon as possible. [ABSTRACT FROM AUTHOR]

Scutellaria baicalensis has been widely used as both a dietary ingredient and traditional herbal medicine in Taiwan to treat inflammation, cancer, and bacterial and viral infections of the respiratory tract and gastrointestinal tract. This paper aims to investigate the in vitro and in vivo anti-inflammatory effects of S. baicalensis. In HPLC analysis, the fingerprint chromatogram of the water extract of S. baicalensis (WSB) was established. The anti-inflammatory effects of WSB were inverstigated using lipopolysaccharide (LPS)-stimulated mouse macrophage (RAW264.7) in vitro and LPS-induced lung injury in vivo. WSB attenuated the production of LPS-induced nitric oxide (NO), tumor necrosis factor-alpha (TNF-, interleukin- (IL-1, and IL-6 in vitro and in vivo. Pretreatment with WSB markedly reduced the LPS-induced histological alterations in lung tissues. Furthermore, WSB significantly reduced the number of total cells and the protein concentration levels in the BALF. WSB blocked protein expression of inducible NO synthase (iNOS), cyclooxygenase-2 (COX-2), phosphorylation of IB- protein and MAPKs in LPS-stimulated RAW 264.7 cells and LPS-induce lung injury was also blocked. This study suggests that WSB possesses anti-inflammatory effects in vitro and in vivo, and the results suggested that WSB may be a potential therapeutic candidate for the treatment of inflammatory diseases. [ABSTRACT FROM AUTHOR]

Background: Previous prospective, retrospective, and meta-analysis studies revealed that the overall incidence of metachronous contralateral inguinal hernia (MCIH) ranges from 5.76% to 7.3%, but long-term follow-up postoperative data are scant. We identified the incidence and risk factors of MCIH in pediatric patients during the follow-up using the Taiwan National Health Insurance Research Database (NHIRD). Methods: Between 1996/01/01 and 2008/12/31, all pediatric patients with primary unilateral inguinal hernia repair who were born after 1996/01/01 were collected via ICD-9 diagnostic and procedure codes recorded in NHIRD. Patients with another operation during the same admission, complicated hernia, or laparoscopic procedure were excluded. Several reported risk factors, including age, sex, preterm birth, low body weight, and previous ventriculoperitoneal shunt placement, were used for analysis. The primary endpoint was the repairmen of MCIH following the initial surgery. All patients were followed until 2013/12/31 or withdrawal from national health insurance. Results: A total of 31,100 pediatric patients underwent unilateral inguinal hernia repair, and 111.76 months of median follow-up data were collected. The overall rate of MCIH was 12.3%. Among the 31,100 patients who had the hernia repair, 63.6% had MCIH within 2 years and 91.5% had MCIH within 5 years. After initial surgery, the incidence of MCIH gradually and significantly decreased with age up to approximately 6 years. Multivariable analysis showed that age <4 y and girls were risk factors for subsequent MCIH. Conclusions: After 17 years of follow-up, the overall MCIH rate was 12.3%, and 91.7% of patients needed repair for MCIH within the first 5 years after initial surgery. Age <4 years and girls were risk factors for MCIH. The contralateral exploration for inguinal hernia should be considered among these patients. [ABSTRACT FROM AUTHOR]

The Taiwan Strait plays an important role in water and sediment exchange between the East China Sea and the South China Sea. On 13 July 2013, Typhoon Soulik crossed the Taiwan Strait, causing a significant impact on the strait’s marine system. In this article, we document the use of remote-sensing data to study this impact by comparing sea surface temperature (SST), spatial distributions and concentrations of chlorophyll (Chl-a), and total suspended matter (TSM) in the strait over different time periods. During and after the typhoon, the TSM of the waters near the Minjiang estuary dramatically increased, while Chl-aand SST significantly decreased. To the southeast of Pingtan Island, the SST decreased and Chl-asignificantly increased, causing strong upwelling that lasted eight to ten days. To the northwest of Taiwan Island, Chl-aand the TSM of the coastal waters dramatically increased. The strong cyclonic wind-stress of the typhoon enhanced heat exchange between the water and the atmosphere, and a large amount of rainfall and run-off significantly decreased the SST. During the typhoon, the increased sediment discharged into the strait by rivers, and the re-suspension of seafloor sediment, increased the concentration of TSM in the coastal waters. Seawater with relatively high sediment concentration was transported to the middle of the strait after being carried by wind-induced flows. In the waters near the typhoon’s path, especially in the upwelling area, nutrient-rich bottom water stirred by the typhoon promoted an outbreak of aquatic organisms and significantly increased the probability of a red tide occurrence. [ABSTRACT FROM AUTHOR]

A 100-year history of human and natural disturbances in southwestern Taiwan was reconstructed using a suite of molecular markers in four dated sediment cores from the upper slope region off the Gaoping River mouth. Trends in polycyclic aromatic hydrocarbons (PAHs) tracked Taiwan’s industrialization/urbanization starting in the 1970s, and the enactment of environmental regulatory policies thereafter. The predominant pyrogenic sources include vehicular, smelter, and coal combustion but spatial differences are observed among sub-regions of the shelf. Profiles of lignin oxidation products (LOPs) point to a significant increase in terrestrial organic matter inputs driven by land development after the 1970s. Low lignin diagenetic signature ratios [(Ad/Al) v ] in all sediments suggest quick transport of fresh plant material from land to sea via mountainous rivers. Shifts in PAHs, LOPs, and radionuclides in recent sediments reveal the deposition of turbidites resulting from typhoon-induced floods. Multiproxy analysis illustrates the interplay between anthropogenic activities and natural processes. [ABSTRACT FROM AUTHOR]

Abstract: The Hsien-du-shan rock avalanche at Kaohsiung County, Taiwan, was triggered by heavy rainfall brought by Typhoon Morakot in 2009. Heavy rainfall began on the day of August 6, and continued to the morning of August 9 when the slope failure and landslide occurred. In this post-event investigation, physical, mechanical, and hydraulic properties of the rocks/soils at this large landslide site are evaluated. The in situ hydraulic conductivity of the soils at the source area was found to be too low (k=1.48×10−6 m/s) for rainfall to vertically infiltrate to the deep sliding surface, which was found to have a maximum depth of 85.6m. The post-failure simulations using discontinuous deformation analysis (DDA) suggest that the geometry of the sliding surface governs the failure behavior, and two continuous progressing failures likely occurred at the beginning of the Hsien-du-shan rock avalanche. Slope deformation was observed by the local residents before the Hsien-du-shan rock avalanche occurred as a geomorphologic precursor. In addition, water accumulation along the sliding surface governs the behavior of the sliding surface. Therefore, in the future, an early warning system of a rock avalanche can be developed by simultaneously applying high-resolution airborne LiDAR to detect slope deformation and using geo-electric measurements to image the infiltration of surface water to the sliding surface. [Copyright &y& Elsevier]

Abstract: The development of the semiconductor industry depends on its interactions with the environment. Developing countries face more constraints and the environmental interactions seem more complicated. The development process of the semiconductor industry could be better understood with regard to the interactions and social changes. This study proposes a variety-increasing viewpoint based on the concepts of variety increasing and internal learning to analyze the developmental experience of the semiconductor industry in Taiwan. The result shows that the development of Taiwanese semiconductor industry is a continuous variety-increasing process, which is achieved by searching and establishing successful associations in an increasingly wider and complex environment. Implications on the ongoing development of Taiwan''s semiconductor industry and the development experiences of other East Asian countries are discussed. [Copyright &y& Elsevier]

The hazard of subsequent arterial embolism and thrombosis (SAET) in patients with lower leg fractures is not yet well demonstrated. The purpose of this study is to determine the correlation between lower leg fracture and SAET in Taiwan. A total of 134,844 patients with lower leg fractures (ICD-9-CM: 823) and chronological diagnosis as SAET (ICD-9-CM: 444.22) was matched (1:1) to the non-fracture cohort according to their propensity score (data coming from the National Health Insurance database between January 2000 to December 2012). Patients were matched by age, gender, and comorbidities. The incidence of SAET and correlation between SAET development and lower leg fracture was statistically analyzed, and subgroup analysis categorized by characteristics and comorbidities was conducted as well. The cumulative incidence of SAET was calculated by Kaplan–Meier analysis. Kaplan–Meier analysis plot showed that, by the end of the ten-year follow-up period, the cumulative incidence of SAET was significantly higher for the lower leg fracture cohort than for the non-fracture cohort (log-rank test: p < 0.001). The lower leg fracture, male, elder age (45–64-year-old; ≥65-year-old), hypertension, diabetes mellitus, and gout were significantly associated with lower extremity SAET risk compared with the matched group. There was an inseparable correlation between the lower leg fracture group and the risks of SAET; subgroup analysis by gender (male, female), age (age < 40 years, age 40–64 years, and age > 65 years) and comorbidities (hypertension, diabetes mellitus, and gout) show compatible results as well. Patients with lower leg fracture have a significantly increased risk of SAET since then two years after the fracture. The hazard of SAET was significantly higher in patients with lower leg fracture than in the non-fracture cohort, and the high incidence was found since then two years after fracture. Further studies are warranted. [ABSTRACT FROM AUTHOR]

The article examines the logic behind the policy of Beijing, China on Taiwan. According to the author, the main reason of Beijing's attitude toward Taiwan is the territorial integrity and sovereignty of China. He analyzes that the leadership of Beijing does not embrace the democratization effort of Taiwan. Furthermore, he expresses that if Taiwan would insist on declaring independence, Beijing would use all means to stop it, but it is less likely to use military force. Moreover, the author foresees that Chinese and Taiwanese people will be able to solve the conflict in the long run.

Taiwan's economy mainly relies on the export of agricultural products. If even the suspicion of a pest is found in the crop products after they are exported, not only are the agricultural products returned but the whole batch of crops is destroyed, resulting in extreme crop losses. The species of mealybugs, Coccidae, and Diaspididae, which are the primary pests of the scale insect in Taiwan, can not only lead to serious damage to the plants but also severely affect agricultural production. Hence, to recognize the scale pests is an important task in Taiwan's agricultural field. In this study, we propose an AI-based pest detection system for solving the specific issue of detection of scale pests based on pictures. Deep-learning-based object detection models, such as faster region-based convolutional networks (Faster R-CNNs), single-shot multibox detectors (SSDs), and You Only Look Once v4 (YOLO v4), are employed to detect and localize scale pests in the picture. The experimental results show that YOLO v4 achieved the highest classification accuracy among the algorithms, with 100% in mealybugs, 89% in Coccidae, and 97% in Diaspididae. Meanwhile, the computational performance of YOLO v4 has indicated that it is suitable for real-time application. Moreover, the inference results of the YOLO v4 model further help the end user. A mobile application using the trained scale pest recognition model has been developed to facilitate pest identification in farms, which is helpful in applying appropriate pesticides to reduce crop losses. [ABSTRACT FROM AUTHOR]

Background: Approximately 25% of patients with early-stage breast cancer experience cancer progression throughout the disease course. Alterations in TMEM240 in breast cancer were identified and investigated to monitor treatment response and disease progression. Methods: Circulating methylated TMEM240 in the plasma of breast cancer patients was used to monitor treatment response and disease progression. The Cancer Genome Atlas (TCGA) data in Western countries and Illumina methylation arrays in Taiwanese breast cancer patients were used to identify novel hypermethylated CpG sites and genes related to poor hormone therapy response. Quantitative methylation-specific PCR (QMSP), real-time reverse transcription PCR, and immunohistochemical analyses were performed to measure DNA methylation and mRNA and protein expression levels in 394 samples from Taiwanese and Korean breast cancer patients. TMEM240 gene manipulation, viability, migration assays, RNA-seq, and MetaCore were performed to determine its biological functions and relationship to hormone drug treatment response in breast cancer cells. Results: Aberrant methylated TMEM240 was identified in breast cancer patients with poor hormone therapy response using genome-wide methylation analysis in the Taiwan and TCGA breast cancer cohorts. A cell model showed that TMEM240, which is localized to the cell membrane and cytoplasm, represses breast cancer cell proliferation and migration and regulates the expression levels of enzymes involved in estrone and estradiol metabolism. TMEM240 protein expression was observed in normal breast tissues but was not detected in 88.2% (67/76) of breast tumors and in 90.0% (9/10) of metastatic tumors from breast cancer patients. QMSP revealed that in 54.5% (55/101) of Taiwanese breast cancer patients, the methylation level of TMEM240 was at least twofold higher in tumor tissues than in matched normal breast tissues. Patients with hypermethylation of TMEM240 had poor 10-year overall survival (p = 0.003) and poor treatment response, especially hormone therapy response (p < 0.001). Circulating methylated TMEM240 dramatically and gradually decreased and then diminished in patients without disease progression, whereas it returned and its levels in plasma rose again in patients with disease progression. Prediction of disease progression based on circulating methylated TMEM240 was found to have 87.5% sensitivity, 93.1% specificity, and 90.2% accuracy. Conclusions: Hypermethylation of TMEM240 is a potential biomarker for treatment response and disease progression monitoring in breast cancer. [ABSTRACT FROM AUTHOR]

Abstract: Fragility curves can be developed using analytical or empirical methods. When the actual building damage records and the associated ground motion data are available, empirical methods are often adopted. Traditionally, district-based records of building damage are analyzed for developing such fragility curves. In this paper, a new procedure based on the concept of “isointensity-isoexposure” is developed. The new procedure is demonstrated through a case study of the building damage records collected from the 1999 Chi-Chi, Taiwan earthquake. The results show that the fragility curves developed with the proposed procedure are more in-line with observations than with the traditional district-based procedure. The developed fragility model may be used for earthquake loss estimation and future emergency planning in the study area. The limitations of the proposed approach include: (1) the developed fragility curves are area-specific and may not be readily applicable to other regions, and (2) ground motion intensity data may not be available at every location in an area of interest. [Copyright &y& Elsevier]

Abstract: Typhoon Morakot, which first made landfall in central Taiwan on Aug. 7th and then in Fujian on Aug. 9th after crossing through the Taiwan Strait was the strongest typhoon to impact the East China Sea (ECS) in 2009. Two surveys were conducted, respectively on Aug. 1st and Aug. 12th, in the mud deposition center off the Zhejiang–Fujian coast to study the impacts of the typhoon on the marine environment and sediment transport. Continuous in-situ hydrographic data (water temperature, salinity, depth and turbidity) were recorded at 29 stations during the first survey and 23 stations during the second survey. The water and surface sediment samples were collected at the same time. A comparison of the measurements from the two surveys shows that significant variations in temperature, salinity and turbidity distributions occurred in the water column. The upper water layer was well-mixed after the passage of Morakot. The water temperature and salinity dropped approximately 0.2–1.4°C and 0.3–3.3psu, respectively, while the water turbidity increased from less than 1FTU to 1–30FTU. In the bottom layer, the temperature increased approximately 2.5–4.0°C, and the salinity dropped approximately 0.2–0.6psu due to the water mixing. The water turbidities generally increased to greater than 50FTU (greater than 150FTU in some locations), which were several times to more than tenfold greater than those in the first survey, which were generally between 10 and 60FTU. The thermocline, which existed at a depth of approximately 10m during the first survey, disappeared after the typhoon. A halocline appeared at approximately 10m depth in the near-shore area due to abundant fresh water supply, whereas the salinity was generally homogeneous during the first survey. Concurrently, the relatively warm and fresh water extended downward to the whole medial water layer due to the water mixing. The turbidity and volume of the bottom turbid layer was greatly increased at the second survey compared with the first survey. The intrusion of the low-temperature and high-salinity deep water (below 50m depth) was significantly reduced at the same time. [Copyright &y& Elsevier]

Energy consumption is a crucial aspect in wastewater treatment plants. Biological processes using aeration systems contribute significantly to energy usage. Tao-bay plants in northern Taiwan are recent plants that have not introduced automated control on aeration systems yet. The use of numerical methods aims to predict optimized airflow rate and energy consumption and to provide references for the first-phase plant operation. In this study, a steady-state modeling using GPS-X 7.0 is presented. Measured monthly data in a yearly basis for parameters such as BOD, COD, total N, N–NH 4 +, and total P were used as the input data. The measured effluent concentrations for these parameters were compared with numerically calculated values for calibration purposes. An empirical correlation is also proposed for an alternative calculation of airflow and relative electricity consumption. A supervisory control and data acquisition (SCADA) system that consisted of current and water quality sensors with an online interface was developed to monitor the aeration system of the case-study plant. Selected real-time data for DO and electricity usage related to the biological treatment were recorded in the cloud server and used for verifying and compensating existing data measured in the plant. According to the monthly energy-consumption data for Tao-bay plant in 2018, the energy-saving rate predicted using the GPS-X model was approximately 20%, which is consistent with the global values (18–21%) of the plant operating in the range of 50,000–10,000 CMD. Moreover, when adjusting DO every 1 mg/L to fit a sewage-discharge criterion, the energy-saving rate was approximately 5–7%. • This research is for the prediction of the optimized airflow rate and energy usage. • SCADA system with real-time monitoring interface is built to collect the electricity in SQL database. • To adjust DO every 1 mg/L improves energy-saving rate about 5-7%. [ABSTRACT FROM AUTHOR]

Background: Given the rising prevalence of depression among older adults and the associated increase in caregiving responsibilities, understanding factors influencing caregiver burden is crucial. Previous research has not extensively explored the impact of caregivers' attributional styles, that is, how individuals interpret the causes of life events, on their care burden., Aim: This study examined the relationship between caregivers' attributional styles and their care burden for older patients with depression., Methods: This cross-sectional study enrolled older adults aged ≥ 65 years diagnosed with depression and their caregivers. Depression was diagnosed according to the DSM-V criteria for Major Depressive Disorder or Persistent Depressive Disorder. Caregivers completed the Chinese Depression Caregiver Burden Scale (CDCBS) to assess care burden, the Hamilton Depression Rating Scale (HAM-D) to evaluate patient symptom severity, the Center for Epidemiological Studies Depression Scale (CES-D) for measuring caregivers' depression, and the Chinese Depression Patient Caregiver Attribution Style Scale (CDPCAS) to assess attributional styles. Hierarchical regression analysis was used to identify the factors independently associated with the caregiver's subjectively assessed care burden., Results: The sample included 146 caregivers of geriatric patients with depression. Most depression patients were women (74.7%) with a mean age of 74.3 years, whereas the mean age of caregivers was 57.7 years. Hierarchical regression analysis identified that caregivers' gender (β = - 0.14, p = .044), educational level (β = 0.19, p = .008), caregivers' own depression assessed by the Center for Epidemiological Studies Depression Scale (β = 0.41, p < .001), and attributional styles, particularly manipulation (β = 0.29, p < .001) and illness/stress attributional style (β = 0.23, p = .002) as independent factors associated with care burden. Patient symptom severity assessed using the Hamilton Depression Scale was not significantly correlated with care burden after controlling for attributional styles., Conclusions: Certain attributional styles, particularly the manipulation and illness/stress attributional styles, significantly increased self-reported care burden. These findings highlight the need for educational resources to change the attribution style, along with support systems and accessible mental health services for caregivers to potentially ease the care burden., (© 2024. The Author(s).)

Some studies showed that when distant metastasis or locally advanced tumors were observed, the participation of 2 or more operating surgeons (combined surgery) in the operation could improve the prognosis of patients. The multispecialty operative team would perform combined surgery in colon cancer patients with some complications since 2015. The goal of this study is to confirm performing combined surgery would improve the outcomes of colon cancer patients. A retrospective observational study was conducted, which involved all colon cancer patients between November 2015 and December 2019 at one would-be medical center. Patients were divided into 3 cohorts: those with complicated cases and had combined surgery (C&#95;2S), those with complicated cases and had surgery performed by a single surgeon (C&#95;1S), and those with uncomplicated cases and had surgery performed by a single surgeon (NC&#95;1S). Overall survival and disease-free survival were compared among the 3 groups. A total of 296 colon cancer patients during the study period. Among them, 35 were C&#95;2S, 87 were C&#95;1S, and 174 were NC&#95;1S. Patients in the NC&#95;1S group had significantly higher 12-, 24-, and 36-month OS rates compared to those in the C&#95;1S group (P < .01). In contrast, there was no significant difference in overall survival among patients in the NC&#95;1S and C&#95;2S group (P =.15). The quality of surgery must be impact the prognosis, especially in the individual who was complicated case, the survival in patients who had surgery performed by multispecialty operative team would be improved., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

The Pure Dew (Cypress Hydrolat), which could be extracted from the waste material after the extracting essential oil from Taiwan cypress, has a good bactericidal effect. However, due to the high cost on quality control and concentration measurement of the Pure Dew, its application was restricted. This research tries to find suitable spectral frequencies through which the absorbance detected by the spectrometer could be used as the index of the pure dew concentration. This study used Gas Chromatography-Mass Spectrophotometer (GC-MS) to analyze the composition of Taiwan cypress hydrolat. After obtaining the composition, the raw liquor of cypress hydrolat was diluted to 100, 50, 25 and 0% v/v with pure water. The test samples were then tested by a simple spectrophotometer. After the spectrographic detection of absorbance using a simple spectrophotometer, it is confirmed that the spectrum of wavelength between 205-350 nm is the most representative. The absorptance and the pure dew concentration was roughly in linear relation which suggested that a simple spectrophotometer can be used to develop a low-cost and high.

Background: The major adverse cardiovascular events (MACE) risk is unclear among Asian obese patients with obstructive sleep apnea (OSA) who undergo bariatric surgery (BS) or uvulopalatopharyngoplasty (UPPP)., Objectives: We aimed to evaluate differences between Asian obese patients with OSA who underwent BS or UPPP regarding MACE., Setting: The Longitudinal Health Insurance Database, a subset of the NHI Research Database (NHIRD) originated from the National Health Insurance (NHI) program in Taiwan, which comprises information from 2 million randomly sampled individuals between 2000 and 2015., Methods: Participants aged 18-55 years whose diagnoses corresponded with codes in the International Classification of Diseases, Ninth Revision, Clinical Modification for BS, UPPP, obesity, and OSA were included in this population-based, matched cohort study of Taiwan's insurance claims data gathered between 2000 and 2015. Obese patients with OSA who underwent BS or UPPP were propensity score matched; the study's outcome was MACE., Results: A total of 1336 patients, comprising 668 in each of the BS and UPPP cohorts, were enrolled. After a mean follow-up period of 8.51 years, 166 patients, comprising 52 in the BS cohort and 114 in the UPPP cohort, experienced MACE. The adjusted hazard ratio (aHR) for MACE was .592 (95% confidence interval [CI] = .324-.789; P < .001). The BS cohort had lower risks of stroke (aHR = .663; 95% CI = .312-.890; P < .001), myocardial infarction (aHR = .116; 95% CI = .052-.135; P < .001), and mortality (aHR = .779; 95% CI = .423-.948; P = .001) than the UPPP cohort., Conclusion: BS may provide greater protection against MACE than UPPP in Asian obese patients with OSA. Additional mechanistic research is needed to clarify differences between BS and UPPP in these patients., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: The present study aimed to investigate bariatric surgery's effects on pregnancy in obese women., Materials and Methods: The source of the data was the Taiwan National Health Insurance Research Database. We extracted female patients aged 18 to 45 years who had been diagnosed with obesity from 2005 to 2010. Two groups were formed based on bariatric surgery, according to the medical procedure codes of ICD-9-2001. The propensity score match of 1:1 was coordinated, based on the age, previous delivery, and the existence of comorbidities in patients. The primary endpoint was regarded as a pregnancy, including abortion, ectopic pregnancy, and delivery. The follow-up was performed until the end of 2013, or death., Results: There were 689 patients placed in each group, with a median of 64.8 follow-up months. Following multivariate analysis of the data, bariatric surgery resulted in significantly higher chances for pregnancy (aHR 2.886, p < 0.001) and resulted in a higher chance of successful delivery (aHR 2.775, p < 0.001) and vaginal delivery (aHR = 6.426, p < 0.001) compared with NS group. Moreover, we identified BS has a significantly higher proportion of vaginal delivery (BS 44.74% vs. NS 20%, p = 0.025) with significantly lower overall complications during labor (BS 9.21% vs. NS 33.3%, p = 0.006)., Conclusion: Patients suffering from obesity who undergo bariatric surgery have higher chances of pregnancy, successful delivery, vaginal delivery, and lower maternal complications during labor. Bariatric surgery did increase the possibility of pregnancy in obese patients.

Purpose: This study aims to determine whether bariatric surgery (BS) decreases the risk of respiratory tract infections (RTIs) in obese patients., Materials and Methods: This retrospective, population-based, matched cohort study utilized data from the Taiwan National Health Insurance Research Database. All patients 18 to 55 years of age with obesity diagnosed between 2005 and 2010 were enrolled. Patients were separated into two groups based on whether they underwent BS. Two groups were selected using 1:1 propensity score matching according to age, sex, and comorbidities. The general population was also enrolled for comparison. The primary endpoint was the incidence of RTIs, including pneumonia, influenza, and bronchitis. All patients were followed up until the end of 2013, the primary endpoint, or death., Results: Compared to the non-surgery group, the BS group was at significantly lower risk for RTIs (aHR 0.432, 95% CI 0.340-0.549, p < 0.001) with shorter length of hospital stay (LOH) and lower cost. Regardless of the RTI-related mortality, pneumonia, influenza, and bronchitis rates, BS did have significant protective effects on the non-surgery group. Compared to the general population, the BS group was at higher risk for RTIs (aHR 3.601, 95% CI 2.742-4.728, p < 0.001) with similar LOH and lower cost., Conclusion: Patients with obesity who underwent BS were at significantly lower risk for RTIs than obese patients who did not undergo BS but were at higher risk for RTIs than the general population. BS may result in a long-term reduction of the RTI risk.

A large-scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID-19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory-Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID-19 designated hospitals. At the survey's conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12-1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09-1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06-1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12-1.33, P < 0.001) (iii) COVID-19 designated hospital (OR: 1.24, 95% CI 1.11-1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17-1.36; P < 0.001) and (iv) COVID-19-related departments (OR: 1.16, 95% CI 1.04-1.29, P = 0.006, emotional exhaustion only). To date, this is the first large-scale study to report the rates of trauma and burnout for nurses during the COVID-19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID-19 designated hospitals, and departments involved with treating COVID-19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes., (© 2020 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc.)

Objective: The current treatment for acute retrograde type A intramural haematoma (IMH) remains challenging. Aortic remodelling in both the ascending aorta (AA) and descending thoracic aorta (DTA) was evaluated and the 30 day and mid term outcomes were determined in patients who underwent thoracic endovascular aneurysm repair (TEVAR) for retrograde type A IMH with a primary intimal tear or ulcer like projection in the DTA METHODS: This was a retrospective, multicentre observational study. Clinical data, including post-operative mortality and adverse event, aorta related re-intervention, aortic remodelling, and the survival rate of 18 non-consecutive patients with acute retrograde type A IMH undergoing TEVAR between June 2006 and March 2018 were reviewed., Results: The median age at repair was 58.1 years (range 38-86) and 14 (78%) were men. Eight patients (44%) presented with haemopericardium, and 10 (56%) underwent TEVAR within 24 h. The mean IMH thickness and AA diameter were 10.4 ± 3.6 and 45.7 ± 4.6 mm, respectively. Among all patients with acute retrograde type A IMH, 11 patients presented with classical type B aortic dissection and seven with type B IMH. All procedures were technically successful. The median follow up was 28.7 months (range 7-78). No 30 day mortality was observed. Three patients developed post-procedure adverse events. Of these, two patients had neurological events, with one each having cerebrovascular and spinal cord infarction individually, and the third patient required long term haemodialysis with ventilator support. The overall survival rate was 100%. The maximum diameter of the AA and the IMH in the AA significantly decreased after TEVAR. Aortic remodelling was also observed in the DTA along the length of TEVAR coverage., Conclusion: In selected patients with acute retrograde type A IMH, TEVAR offered a treatment alternative to open surgical grafting and medical follow up., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Background: Gene silencing by aberrant DNA methylation of promoter regions remains the most dominant phenomenon occurring during tumorigenesis. Improving the early diagnosis, prognosis, and recurrence prediction of colorectal cancer using noninvasive aberrant DNA methylation biomarkers has encouraging potential. The aim of this study is to characterize the DNA methylation of the promoter region of TMEM240, as well as gene expression and its effect on cell biological functions and its applications in early detection and outcome prediction., Results: Highly methylated CpG sites were identified in the TMEM240 gene by Illumina methylation 450K arrays in 26 Taiwanese patient paired samples and 38 paired samples from The Cancer Genome Atlas (TCGA) colorectal cancer dataset. Transient transfection and knockdown of TMEM240 were performed to demonstrate the role of TMEM240 in colorectal cancer cells. The data showed that TMEM240 could lead to G1 cell cycle arrest, repress cancer cell proliferation, and inhibit cancer cell migration. The quantitative methylation-specific real-time polymerase chain reaction (PCR) results revealed that 87.8% (480 of 547) of the colorectal cancer tumors had hypermethylated TMEM240, and this was also found in benign tubular adenomas (55.6%). Circulating cell-free methylated TMEM240 was detected in 13 of 25 (52.0%) Taiwanese colorectal cancer patients but in fewer (28.6%) healthy controls. In 72.0% (85/118) of tissue samples, TMEM240 mRNA expression was lower in Taiwanese CRC tumor tissues than in normal colorectal tissues according to real-time reverse transcription PCR results, and this was also found in benign tubular adenomas (44.4%). The TMEM240 protein was analyzed in South Korean and Chinese CRC patient samples using immunohistochemistry. The results exhibited low protein expression in 91.7% (100/109) of tumors and 75.0% (24/32) of metastatic tumors but exhibited high expression in 75.0% (6/8) of normal colon tissues. Multivariate Cox proportional hazards regression analysis found that mRNA expression of TMEM240 was significantly associated with overall, cancer-specific, and recurrence-free survival (p = 0.012, 0.007, and 0.022, respectively)., Conclusions: Alterations in TMEM240 are commonly found in Western and Asian populations and can potentially be used for early prediction and as poor prognosis and early-recurrence biomarkers in colorectal cancer.

The impact of diabetes mellitus (DM) on hip fracture (HFx) is still controversial. We used nationwide population-based data in Taiwan to observe postoperative outcomes of HFx in patients with type 2 diabetes mellitus (T2DM) and found that the impact of T2DM may be related to medication of blood glucose control., Objective: Published studies evaluating diabetic patients with HFx have shown controversial outcomes. We assessed the impact of T2DM on postoperative outcomes after HFx in elderly patients using the nationwide population database in Taiwan., Research Design and Methods: We used data from the National Health Research Institute in Taiwan to recruit patients who had undergone operations for HFx between 2000 and 2009. The recruited patients with T2DM were divided into the oral antidiabetic drug (OAD) cohort and the insulin cohort according to the use or non-use of insulin. Patients without DM were propensity score matched in a 1:1 ratio by four variables. We used the χ 2 test, linear regression and Cox proportional hazards model to assess variables, including length of hospital stay, medical cost, complications, early readmission, and 1-year mortality., Results: We identified 5490 subjects in total. The insulin cohort exhibited prolonged hospital stay (11.8 days), higher medical costs, more complications within 30 and 90 after hip surgery, earlier readmission, and higher 1 year mortality rate (25.8%) than the OAD and non-DM cohorts. The OAD cohort had longer hospital stay (10.1 days) and higher readmission rate but fewer complications and mortality rates (14.9%) than the non-DM cohort., Conclusions: After matching confounding factors, the T2DM with OAD control groups were not associated with higher complication or mortality rates but were associated with higher readmission rates. However, diabetic patients with insulin control have poor outcome. The impact of T2DM on the postoperative outcomes of patients with HFx may be related to blood glucose control medication., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study aims to identify the prevalence of Congenital abdominal wall defects (AWD), hospital outcomes, and related congenital abnormalities in Taiwan by using the National Health Insurance Research Database (NHIRD)., Materials and Methods: From 1998 through 2013, all pediatric patients with AWD were collected via ICD-9-CM diagnostic code 756.7x ("congenital anomalies of abdominal wall") or procedure codes (54.71, 54.72 for Gastroschisis repair (GS-repair); 54.63, 53.41, 53.49 for other abdominal wall repair (O-AWD)) recoded in NHIRD. We used public national birth data for calculating the prevalence. We used CDC/BPA coding rubrics to identify accompanying congenital abnormalities., Results: A total 594 babies with AWD, including 179 patients in GS-repair group and 326 patients in O-AWD-repair group, are identified with 113.5 months median followed-up. The overall prevalence for AWD was 1.65 in 10,000 births and decreased over time. The prevalences of GS-repaired and O-AWD-repaired are 0.50 and 0.90 in 10,000 births. The 1-year-mortality rates of GS-repair and O-AWD-repair are 6.15% and 7.23%. 24.58% GS-repair patients and 30.06% O-AWD-repair patients have congenital abnormalities. 8.38% GS-repair patients and 6.44% O-AWD-repair patients received the following groin hernia-repair procedures., Conclusion: Our results showed that the prevalence of AWD was low and decreased over time in Taiwan., Level of Evidence: Level II: Prognosis Study, Retrospective study., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate the influence of bariatric surgery on gallstone disease in obese patients., Materials and Methods: This large cohort retrospective study was conducted based on the Taiwan National Health Insurance Research Database. All patients 18-55 years of age with a diagnosis code for obesity (ICD-9-CM codes 278.00-278.02 or 278.1) between 2003 and 2010 were included. Patients with a history of gallstone disease and hepatic malignancies were excluded. The patients were divided into non-surgical and bariatric surgery groups. Obesity surgery was defined by ICD-9-OP codes. We also enrolled healthy civilians as the general population. The primary end point was defined as re-hospitalization with a diagnosis of gallstone disease after the index hospitalization. All patients were followed until the end of 2013, a biliary complication occurred, or death., Results: Two thousand three hundred seventeen patients in the bariatric surgery group, 2331 patients in the non-surgical group, and 8162 patients in the general population were included. Compared to the non-surgery group (2.79%), bariatric surgery (2.89%) did not elevate the risk of subsequent biliary events (HR = 1.075, p = 0.679). Compared to the general population (1.15%), bariatric surgery group had a significantly higher risk (HR = 4.996, p < 0.001). In the bariatric surgery group, female gender (HR = 1.774, p = 0.032) and a restrictive procedure (HR = 1.624, p = 0.048) were risk factors for gallstone disease., Conclusion: The risk for gallstone disease did not increase after bariatric surgery, although the risk was still higher than the general population. The benefit of concomitant cholecystectomy during bariatric surgery should be carefully evaluated.

Background: Cancer patients receiving Western medical treatment, frequently seek Traditional Chinese Medicine (TCM) to alleviate adverse effects and prolong survival., Objective: This study evaluated the association between the use of TCM and cancer survival rate. Research into the effect of TCM on patient survival is limited, this analysis focused on 3 patterns of TCM use., Methods: Three retrospective cohorts with different patterns of TCM use were selected from the National Health Insurance Research Database of Taiwan and analyzed. Patients with newly diagnosed cancer between 1997 and 2012 were classified into groups of prediagnosis, postdiagnosis, and continuous TCM use associated with awareness of cancer diagnosis. All demographic and clinical data were analyzed., Results: After propensity score matching, longevity of the postdiagnosis and continuous TCM user was significantly longer than the non-TCM user. The adjusted hazard ratios of death in postdiagnosis and continuous TCM use groups (0.59 and 0.61, respectively) were lower than the non-TCM use group., Conclusion: The analysis suggests that cancer patients using TCM in conjunction with Western medical treatment exhibited a higher survival rate than patients not using TCM treatment.

Patients with social phobia commonly resist face-to-face assessments, and a number of alternative assessment methods based on the Internet are being developed. The aim of this study was to identify patients with social phobia on the Internet and characterize their condition, using the Social Phobia Inventory (SPIN). In Stage I, this study recruited 1307 participants from the Internet, most of whom were well-educated young females, who had remained unmarried and unemployed. The Internet-based SPIN demonstrated excellent internal consistency (Cronbach's α=0.937) and good test-retest reliability (intraclass correlation coefficient=0.942). In Stage II, we examined the discriminant validity of the SPIN via structured telephone interviews. The area under the receiver operating characteristic curve used to discriminate social phobia was 0.871 with an optimal cut-off point of 24 on the total score for the SPIN. According to the SPIN scores, 919 of Stage I participants (70.3%) reached the threshold of social phobia, 531 of which (57.8%) had never sought professional help. These results suggest that the Internet is a potential avenue through which to find untreated patients with social phobia., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Aims: To compare the psychometric properties of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument and the St. George's Respiratory Questionnaire (SGRQ), and to examine the association between pulmonary function and domains and items of these questionnaires in patients with chronic obstructive pulmonary disease (COPD)., Methods: The WHOQOL-BREF and the SGRQ were administered to 211 patients. The reliability and validity of, and correlations among, the domain scores were examined. Multiple regression analyses were performed to identify which items were independently associated with subjects' lung functions., Results: Both questionnaires showed good internal consistency (alpha > 0.8), except the SGRQ symptoms domain (alpha = 0.66), minimal ceiling and floor effects, and good item convergent and item discriminant validity. There were moderate correlations between physical domain of the WHOQOL-BREF and activity, impacts and total domains of the SGRQ, and between psychological domain of the WHOQOL-BREF and impacts and total domains of the SGRQ. Eighteen items were significantly associated with lung function, particularly those items relating to mobility/walking and activities of daily living (ADL)., Conclusion: Both the WHOQOL-BREF and the SGRQ showed comparable reliability and validity. Items related to mobility/walking and ADL may be useful in clinical screening for lung function impairment.

Objective: To estimate the direct cost of depression in Taiwanese adults for the years 2000-2002., Methods: The medical claims database of the National Health Bureau was analyzed and the cost of treating adults (>15 years of age) with the diagnosis of depression was calculated., Results: The total direct medical costs of adult depression in the three years 2000, 2001, and 2002 were approximately US dollars 93 million, US dollars 117 million, and US dollars 140million, respectively., Conclusion: The cost of depression increased continuously over the period from 2000-2002. However, the percentage of patients receiving treatment did not increase steadily over the same time period with treatment rates of 1.5% in 2000, 2.3% in 2001, and 2.0% in 2002. The recent annual prevalence of depression in Taiwan has been estimated at 4-5%. Thus, the Taiwanese health authority spends an annual average of US dollars 116.6 million to treat depression (1.2% of total national expenses). In sum, the treatment of depression, while costly, deserves greater attention by public health officials in order to avoid the already significant burden of this disease on both patients and society. Future research will therefore require more accurate statistical data in order to assess the effects of depression-related burdens on individuals and society, especially with respect to the capacity to work.

Purpose: Recently, functional MRI (fMRI) using word generation (WG) tasks has been shown to be effective for mapping the Chinese language-related brain areas. In clinical applications, however, patients' performance cannot be easily monitored during WG tasks. In this study, we evaluated the feasibility of a word choice (WC) paradigm in the clinical setting and compared the results with those from WG tasks., Method: Intrasubject comparisons of fMRI with both WG and WC paradigms were performed on six normal human subjects and two tumor patients. Subject responses in the WC paradigm, based on semantic judgments, were recorded. Activation strength, extent, and laterality were evaluated and compared., Results: Our results showed that fMRI with the WC paradigm evoked weaker neuronal activation than that with the WG paradigm in Chinese language-related brain areas. It was sufficient to reveal language laterality for clinical use, however. In addition, it resulted in less nonlanguage-specific brain activation., Conclusion: Results from the patient data demonstrated strong evidence for the necessity of incorporating response monitoring during fMRI studies, which suggested that fMRI with the WC paradigm is more appropriate to be implemented for the prediction of Chinese language dominance in clinical environments.