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Objectives: The main aim of this study was to examine the association of sarcopenia and subjective memory complaints with the incidence of dementia in a population-based cohort of cognitively unimpaired older adults. Design: Three-year longitudinal study. Settings and Participants: A total of 2163 community-dwelling persons aged 65 years or older who participated in the National Health Interview Survey in Taiwan, 2017. Measurements: Sarcopenia was determined based on SARC-F, a self-reported symptom-based questionnaire that includes five components: strength, assistance walking, rise from a chair, climb stairs, and falls. Two questions ("Do you have difficulties with your memory or attention?" and "Do you have difficulties with your memory only or attention only or both?") were used to screen for subjective memory complaints (SMCs). The incidence of dementia was determined by data linkage to the Taiwan National Health Insurance claims database from 2018 to 2020. Results: Among the 2163 participants without dementia at baseline, 135 had incident dementia during the 3-year follow-up, giving a crude incidence rate of 6.2% (135/2163). Compared to participants free from sarcopenia and SMCs, the adjusted hazard ratio for incident dementia was 1.83 (95% confidence interval [CI]: 1.23–2.72) for SMCs alone, 2.40 (95% CI: 1.17–4.93) for sarcopenia alone, and 2.49 (95% CI: 1.21–5.11) for coexisting SMCs and sarcopenia. Conclusions: Our results indicate that sarcopenia screened with SARC-F and SMCs independently predict the cognitively unimpaired older adults at risk of incident dementia. Our findings highlight the importance of screening not only for cognitive but also muscle deficits to identify those at increased risk of incident dementia. [ABSTRACT FROM AUTHOR]

Women with terminal cancer are assumed to choose hospice care over aggressive treatment at the end of life. With new chemotherapy and target therapy options, it becomes more difficult to decide between hospice care and aggressive management. It is also crucial to consider the cost increases leading to severe financial burdens on healthcare systems. To better understand treatment options at the individual level, this study set out to describe trends in end-of-life care for the four leading cancers in women in Taiwan. This was a population-based retrospective cohort study. The data source was obtained between January 1, 2000, and December 31, 2013, from Taiwan's National Health Insurance Research Database. We identified 98,575 women with a diagnosis of breast (18,596), colorectal (23,734), liver and biliary (28,795) or lung (27,450) cancer who had died during the study period. Hospital data for services provided in the last 6 months of life, including hospice services and aggressive managements (chemotherapy, frequent hospitalisation, emergency room [ER] visits, intensive care unit [ICU] admission and endotracheal intubation), were collected. Hospice utilisation increased over the study period, with 25.85%, 25.34%, 21.23% and 26.55% of female patients with breast, colorectal, liver and biliary, and lung cancer receiving hospice care, respectively. However, the number of women undergoing aggressive treatments in the last 6 months of life remained high, with the breast cancer group having the highest chemotherapy rate, the colorectal cancer group having frequent hospitalisation and the liver and biliary cancer group having frequent ER visits and ICU admissions. Increasing hospice utilisation among women with the four most common cancers in Taiwan indicates that hospice services have gradually become well accepted over the past 13 years; however, the real focus is on the ineffective treatment preceding hospice care, and late referral was also a notable problem. • Women with terminal cancer are assumed to choose hospice care over aggressive treatment at the end of life. • Increasing hospice utilisation was observed in all four leading cancer groups in women between 2000 and 2013, partly owing to the shared-care programme. • Aggressive treatments preceding hospice care did not decrease with the increase in hospice utilisation. • Late referral to hospice care remains high. [ABSTRACT FROM AUTHOR]

Male secondary sexual characters are diverse in Taiwanese Lithobius. We describe two new species with their male secondary sexual characters, Lithobius (Ezembius) keelungensis sp. nov. and Lithobius (Monotarsobius) qingquanensis sp. nov.. In L. (E.) keelungensis, male 14-15th femora and tibiae are markedly thick, the femora have a deep furrow on each dorsal surfaces, and the tibiae are oval, with a wide shallow excavation on each dorsal surfaces. In L. (M.) qingquanensis, a small wart-like outgrowth bearing about 15 slightly curved setae is present on the dorsoposterior surface of the male 15th femur. [ABSTRACT FROM AUTHOR]

Summary: Background: Acral melanoma (AM) is the most common histopathological subtype of malignant melanoma in Asians. However, differences in the mutational profiles underlying AM and nonacral cutaneous melanoma (NAM) in Asians are not well understood. Objectives: To augment the understanding of the prevalence, patterns and associations of various mutations between different subtypes of melanoma. Methods: We performed comprehensive genomic profiling of 409 cancer‐associated genes, using next‐generation sequencing, in 66 primary melanomas comprised of 45 AMs and 21 NAMs. Results: Most of the AMs (n = 27/45; 60%), but only five of 21 (24%) NAMs, were triple wild‐type (triple‐WT) tumours. Compared with AMs, NAMs exhibited a significantly higher frequency of BRAF mutations. The frequencies of NRAS/KRAS mutations, cell‐cycle aberrations, copy number gains in BIRC2,BIRC3 and BIRC5, and gains of receptor tyrosine kinase genes were significantly higher in AMs. Ulceration was found at significantly higher rates in the AMs and NAMs with cell‐cycle aberrations and gains of receptor tyrosine kinase genes. Notably, cell‐cycle aberrations and copy number gains in BIRC2,BIRC3 and BIRC5 were significantly associated with poor melanoma‐specific survival in the 66 patients with melanoma and especially in the 45 patients with AM. Multivariate analysis showed that lymph node metastasis and cell‐cycle aberrations were independent prognostic factors of melanoma‐specific survival. Conclusions: This study strengthens our understanding of the patterns and clinical associations of oncogenic mutations in AMs and NAMs in Asians. What's already known about this topic? Mutation frequencies of driver genes vary between melanoma subtypes.Acral melanoma is the most common subtype of melanoma in Asians.KIT mutations and copy number variations occur more frequently in the acral subtype of melanoma than in the nonacral subtype What does this study add? NRAS/KRAS mutations, cell‐cycle aberrations, copy number gains in BIRC2, BIRC3 and BIRC5, and amplifications of receptor tyrosine kinase genes were significantly enriched in acral melanoma and could be potential targets for treatment.Melanomas with cell‐cycle aberrations and gains in receptor tyrosine kinase genes were significantly more likely to contain ulceration. What is the translational message? Cell‐cycle aberrations and copy number gains in BIRC2, BIRC3 and BIRC5 were significantly associated with poor melanoma‐specific survival.These observations should be explored further for future drug development. Linked Comment: Johansson. Br J Dermatol 2020; 182:1085. Plain language summary available online [ABSTRACT FROM AUTHOR]

Types of sugar-sweetened beverages (SSB) can differ greatly between countries, with greater consumption of sweetened tea in Asia. This study aimed to understand changes in SSB consumption by adolescents in Taiwan over 18 years and their association with demographic characteristics and clinical outcome. This study used survey data from the 1993–1996 and 2010–2011 Nutrition and Health Surveys in Taiwan. Participants were high school students aged 13 to 18 years. Data were weighted and analysed using SUDAAN 11.0 and SAS 9.4. Participants were asked about intake frequencies of SSB and were grouped into four different SSB intake groups based on the combination of high or low frequency (including moderate frequency) of intake of sweetened tea and soda/sports/energy drinks. Results indicated over 99 % of teens reported having at least one SSB in the past week. Smoking status was significantly associated with SSB intake types with high tea intake (high tea and low soda (HL) group, OR 7·56, P < 0·001; high tea and high soda (HH) group, OR 9·96, P < 0·001). After adjustment for potential confounders, adolescents in the low tea and high soda (LH) group (β = 0·05, P = 0·034) had significantly higher mean serum uric acid values. In conclusion, sugary tea remains the SSB of choice for Taiwanese adolescents. Those with a frequent intake of soda/sports/energy drinks had a higher chance of being hyperuricaemic. [ABSTRACT FROM AUTHOR]

During major earthquake disasters, a lack of preparedness on the part of both officials and citizens can result in serious injuries and fatalities. Indeed, due to the unequal distribution of responsibility, decision-making processes differ sharply between disaster management planners and the general population. Although the potential relationship between earthquake risk perception and adjustment behavior remains subject to debate, humans are indeed capable of responding to disasters and further reducing their risk. Previous discussions emphasized engineering or seismological efforts to mitigate earthquake disaster while attributing less responsibility to government preparedness and individuals’ subjective resilience, although both of these could place people at greater risk of earthquake damage. Therefore, the purpose of this study is to explore and compare the spatial patterns of earthquake disaster probability, subjective resilience, and governmental preparedness. The results show that there are significantly unequal distributions of both subjective resilience on the part of citizens and low preparedness on the part of officials, which might result in serious impacts in a future earthquake disaster. In particular, it is imperative that subjective resilience and governmental preparedness be increased in the northern and southern regions along the Houchiali Fault. [ABSTRACT FROM AUTHOR]

Summary: While alendronate inhibits atherosclerosis experimentally, its effect on lower limb ischemia risk is unknown. Our results suggest that alendronate reduces the risk of lower limb ischemic vascular events requiring surgical interventions, including amputation. Our results are relevant for patients at risk of lower limb ischemia undergoing fragility fracture treatment. Introduction: This study aimed to determine the association between alendronate therapy and the risk of lower limb ischemic vascular events (i.e., bypass surgery, endovascular stenting, and major lower limb amputation for lower limb ischemia). Methods: We used a nationwide population-based cohort of patients aged over 50 years diagnosed with a vertebral or hip fracture between January 1999 and June 2010. We compared the risk of lower limb ischemic vascular events between patients undergoing treatment with alendronate ( n = 3,731) and an age- and sex-matched comparison group ( n = 7,462) over 5 years of follow-up. Hazard ratios (HR) were estimated using Cox proportional regression analysis with adjustment for treatment status, comorbidities, and other variables. Results: Ten patients (0.3 %) in the alendronate treatment group had a lower limb ischemic vascular event compared with 51 patients (0.7 %) in the comparison group. The incidence of lower limb ischemic vascular events was 8.4 (95 % CI, 4.0-15.5) per 10,000 person-years in the alendronate group and 21.8 (95 % CI, 16.2-28.7) per 10,000 person-years in the comparison group. The risk of a lower limb ischemic vascular event in the alendronate treatment group was lower (adjusted HR, 0.41; 95 % CI, 0.21-0.82). Conclusion: Alendronate treatment was associated with a reduced risk of lower limb ischemic vascular events among hip or vertebral fragility fracture patients. [ABSTRACT FROM AUTHOR]

New variants of porcine epidemic diarrhoea virus ( PEDV), which emerged in Taiwan in late 2013, have caused a high morbidity and mortality in neonatal piglets. To investigate the molecular characteristics of the spike (S) gene of the emerging Taiwan PEDV strains for a better understanding of the genetic diversity and relationship among the Taiwan new variants and the global PEDVs, full-length S genes of PEDVs from nine 1-7 day-old piglets from three pig farms in the central and southern Taiwan were sequenced and analysed. The result of phylogenetic analysis of the S gene showed that all the Taiwan PEDV strains were closely related to the non-S INDEL strains from US, Canada and China, suggesting a common ancestor for these strains. As compared with the historic PEDVs and CV777-based vaccine strains, the nine Taiwan PEDV variants shared almost the same genetic signatures as the global non-S INDEL strains, including a series of insertions, deletions and mutations in the amino terminal as well as identical mutations in the neutralizing epitopes of the S gene. The high similarity of the S protein among the Taiwan and the globally emerged non-S INDEL PEDV strains suggests that the Taiwan new variants may share similar pathogenesis and immunogenicity as the global outbreak variants. The development of a novel vaccine based on the Taiwan or the global non-S INDEL strains may be contributive to the control of the current global porcine epidemic diarrhoea outbreaks. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemia increases prevalence of metabolic syndrome (MetS), type 2 diabetes (T2D) and cardiovascular disease (CVD). But the role of normoglycemia on the development of T2D and CVD in elderly population remains unclear. Aim: To determine an optimal cut-off for fasting plasma glucose (FPG) to predict MetS and subsequent risk of T2D and CVD in an elderly Taiwanese population with normal FPG levels. Design: Two stages included cross-sectional (Stage 1) and prospective (Stage 2) cohort study. Methods: In Stage 1 18 287 subjects aged ≥60 years were enrolled; of these, 5039 without T2D and CVD advanced to Stage 2 and a mean follow-up of 3.8 years. MetS components were analysed, and in Stage 1, FPG cut-offs for MetS risk were calculated using receiver operating characteristic (ROC) curve analyses. In Stage 2, subjects without T2D and CVD in Stage 1 were classified into high-FPG and low-FPG groups based on cut-offs, and sex specific differences in incidence for T2D and CVD were calculated. Results: ROC curve analysis gave an optimal FPG cut-off for MetS of 93 mg/dl and 92 mg/dl for males and females, respectively. The high-FPG group had a 1.599- and 1.353-fold higher chance of developing T2D compared with the low-FPG group for males and females, respectively (95% CI: 1.606-2.721 and 1.000-1.831, P = 0.015 and 0.05). The high-FPG group had a 1.24-fold higher chance of developing CVD for females (95% CI: 1.015-1.515, P = 0.035); however, there was no difference for males. Conclusions: Our results suggest that FPG within the normal range was associated with MetS, and elderly subjects with high normal levels have a higher incidence of developing T2D for both sexes, and CVD for females, over the short-term. [ABSTRACT FROM AUTHOR]

Background: A nationwide population-based cohort was used to examine the severity of liver cirrhosis and risk of mortality from oral cancer. Methods: The cohort consisted of 3583 patients with oral cancer treated by surgery between 2008 and 2011 in Taiwan. They were grouped on the basis of normal liver function (n = 3471), cirrhosis without decompensation (n = 72) and cirrhosis with decompensation (n = 40). The primary endpoint was mortality. Hazard ratios of death were also determined. Results: The mortality rates in the respective groups were 14.8 per cent, 20.8 per cent and 37.5 per cent at one year (p < 0.001). The adjusted hazard ratios of death at one year for each group compared to the normal group were 2.01 (p = 0.021) for cirrhotic patients without decompensation, 4.84 (p < 0.001) for those with decompensation and 2.65 (p < 0.001) for those receiving chemotherapy. Conclusion: Liver cirrhosis can be used to predict one-year mortality in oral cancer patients. Chemotherapy should be used with caution and underlying co-morbidities should be managed in cirrhotic patients to reduce mortality risk. [ABSTRACT FROM AUTHOR]

To determine the factors of learning effectiveness in English vocabulary learning when using a calibration scheme, this study developed a freshman English mobile device application (for i Phone 4) for students with low levels of English proficiency to practise vocabulary in the beginning of their Freshman English course. Data were collected and validated from 243 subjects for confirmatory factor analysis and structural equation modeling. The findings revealed that Internet cognitive failure (i.e., trait cognitive disability) was positively correlated to Internet cognitive fatigue (i.e., state cognitive disability). Both types of Internet cognitive disability were negatively correlated to self-regulation in English vocabulary learning ( SREVL). SREVL was positively correlated to the degree of learning improvement. The findings implied that the use of a calibration design for mobile English vocabulary learning could benefit students with low levels of Internet cognitive disability but high levels of SREVL. [ABSTRACT FROM AUTHOR]

Background and purpose Recent genome-wide association studies have shown associations between multiple genetic variants and primary restless legs syndrome ( RLS). Their roles in end stage renal disease ( ESRD) related secondary RLS are not clear and studies in Asian populations are scarce. The association between candidate genetic variants and uremic RLS was investigated in a large cohort of Taiwanese dialysis patients. Methods Sixteen RLS-related genetic variants at six loci, including MEIS1, BTBD9, MAP2K5/ SKOR1, PTPRD, TOX3/ BC034767 and the intergenic region of chromosome 2p14, in a total of 993 ESRD patients (259 subjects with and 734 subjects without RLS) were genotyped using TaqMan® genotyping assays. Multivariate logistic regression analysis was used to test for associations between the genotypes and RLS in ESRD. Power calculations were completed using the CATs Genetic Power Calculator with settings of a multiplicative genetic model. Results A modest association between the PTPRD variant rs4626664 and uremic RLS (odds ratio 1.52, 95% CI 1.03-2.23, P = 0.03) and a trend that TOX3/ BC034767 variant rs3104767 may associate with the occurrence of RLS were observed in our dialysis population (odds ratio 1.74, 95% CI 0.97-3.11, P = 0.06). No associations between other genetic variants and risk and severity of RLS were observed in our ESRD cohort. Conclusions The genetic variants of primary RLS candidate genes did not play a major role in our uremic RLS populations. The ethnic difference and heterogeneous etiologies underlying renal failure may partly explain the minor genetic contribution to uremic RLS in our populations. Further studies for other ethnicities will be of worth. [ABSTRACT FROM AUTHOR]

Background and Objective Mechanical stretching modulates extracellular matrix ( ECM) protein synthesis by periodontal ligament ( PDL) cells. However, the mechanoregulation of lysyl oxidase ( LOX), a key enzyme for collagen cross-linking, is not fully understood. In the present study, we hypothesized that low-level and high-level mechanical stretching differentially regulates collagen deposition and the expression of LOX and the enzymes responsible for ECM degradation, such as MMP-2 in PDL cells. Material and Methods Human PDL cells were cultured on flexible-bottom culture plates and subjected to cyclic mechanical stretching (3% and 10% elongation at 0.1 Hz) for 24 and 48 h in a Flexercell FX-4000 strain unit. The levels of expression of type I collagen alpha 1 ( COL1A1), type III collagen alpha 1 ( COL3A1), lysyl oxidase ( LOX), MMP2 and TIMP2 mRNAs were analyzed using an RT-PCR technique. The cell layer and the culture medium were separately collected and processed for detection of the following ECM-related molecules: (i) total collagen content using a Sircol dye-binding method; (ii) LOX protein expression by western blotting; (iii) LOX activity using a fluorometric assay; and (iv) MMP-2 enzyme activity by gelatin zymography. Results Low-level (3%) mechanical stretching of PDL cells upregulated the expression of COL1A1, COL3A1 and LOX mRNAs, enhanced the production of collagen and increased the LOX activity but did not change the level of expression of MMP2 or TIMP2 mRNA. The collagen content and LOX activity showed obvious elevation in the medium, but not in the cell layer. High-level (10%) mechanical stretching downregulated COL1A1 mRNA but upregulated COL3A1 mRNA; however, the effect on COL3A1 was smaller, and occurred earlier, compared with the effect on the COL1A1 gene. High-level mechanical stretching upregulated the expression of MMP2 and TIMP2 mRNAs but did not change collagen production or LOX activity. Moreover, high-level mechanical stretching increased the level of pro-MMP-2, especially in the cell layer. Conclusions This study substantiates the mechanoregulation of the expression of ECM-related molecules in PDL cells. High-level mechanical stretching upregulated the expression of MMP2 and TIMP2 mRNAs, but did not affect collagen production or LOX activity. In addition to increasing the transcription of COL1A1, COL3A1 and LOX genes, low-level mechanical stretching enhanced total collagen production and LOX activity, which should favor ECM stabilization. As an effective regulator of ECM remodeling, mechanical stretching can be exploited in periodontal regeneration and ligament tissue engineering via application of appropriate mechanical stimulation. [ABSTRACT FROM AUTHOR]

Background and purpose Restless legs syndrome ( RLS) is an underestimated movement disorder in patients with end-stage renal disease ( ESRD). Several clinical and laboratory factors were inconsistently reported to associate with RLS. We aim to perform a large-scale multicenter study to investigate the possible associated risk factors of RLS in patients with ESRD in Taiwan, a country with the highest incidence of uremia in the world. Methods From October 2009 to October 2011, we constitutively recruited 1130 patients with ESRD from 17 hemodialysis centers. Demographic, laboratory data, presence and severity of RLS were collected. Odds ratios ( ORs) were estimated by logistic regression models. Results We found the prevalence of RLS to be 25.3% in patients with ESRD. Having type 2 diabetes [OR = 3.61 (2.27-5.77), P < 0.01], low serum transferrin saturation [OR = 1.42 (1.01-2.03), P < 0.05] and duration of dialysis [OR = 1.09 (1.03-1.14), P < 0.01] were associated with RLS. In contrast, high serum hemoglobin level was inversely associated with RLS [OR = 0.61 (0.40-0.89), P < 0.05]. RLS has a significant impact on sleep quality in dialysis patients. Among patients with RLS, history of type 2 diabetes [OR = 4.04 (1.65-10.79), P < 0.05], low serum hemoglobin level [OR = 5.41 (2.43-13.12), P < 0.01] and duration of dialysis [OR = 1.01 (1.01-1.02), P < 0.01] were associated with increased severity of RLS. Conclusions Our findings demonstrated that RLS is common in Taiwanese dialysis patients. Clinicians should have a high suspicion for the presence of RLS symptoms in patients with ESRD, especially those with type 2 diabetes, anemia, low serum iron status and long duration of dialysis. [ABSTRACT FROM AUTHOR]

Aim To investigate factors affecting smoking cessation in male smokers with coronary artery disease. Design A descriptive, correlation, cross-sectional study was conducted. Methods Data were collected using a questionnaire constructed by a literature review of research on smoking cessation in male smokers including demographics and smoking background, as well as psychological, interpersonal and environmental factors. A total of 130 male patients with coronary artery disease were recruited from the cardiac clinic at a regional hospital in Taiwan from August to December 2008. The response rate was 93% ( n = 121). Descriptive statistics, chi-square, t-tests and logistic regression analysis were conducted. Results During the survey, 64.5% of the respondents reported that they had stopped smoking after a coronary event. Five factors were significantly associated with smoking cessation after diagnosis of coronary artery disease: age, the severity of heart diagnoses, antismoking norms (perceived that smoking was against the social norms), nicotine dependence level, and contrary views of smoking (perceived negative expectancy of smoking). Multivariate analysis revealed antismoking norms to be the most important predictor ( AOR = 4.27; P < .05) after adjusting age. Conclusion The study highlights the need to develop smoking cessation interventions that specifically counsel patients with coronary artery disease about these information, such as the disease risk and development, health consequences of smoking, and dependence therapy. Additionally, government support for tobacco control programmes in hospitals and elsewhere is designed to have a beneficial effect on patients' smoking behaviours primarily by increasing antismoking norms. [ABSTRACT FROM AUTHOR]

Background The aims of our study were to evaluate (i) the relationship between cardiac T2* values and cardiac complications in Asian β-thalassaemia major ( TM) patients, and (ii) the association between cardiac T2* values and other parameters currently used to predict cardiac complications as a result of transfusion iron overload. Methods We examined the myocardial iron loads of 88 TM patients from Taiwan with cardiac T2* magnetic resonance imaging ( MRI) and assessed the correlation between cardiac T2* values and serum ferritin levels, liver iron concentration and left ventricular ejection fraction ( LVEF). We also determined the predictive value of these measurements for the development of arrhythmia. Results and conclusion In our group of Taiwanese patients, the relative risk for arrhythmia was 10·36 when cardiac T2* values were less than 10 ms (compared with ≥10 ms) and 1·98 when serum ferritin levels increased >2500 ng mL−1 (compared with ≤2500 ng mL−1). Serum ferritin levels correlated with cardiac T2* values in patients with abnormal myocardial iron loads ( T2* < 20 ms, r = −0·48, P = 0·004, n = 34), but LVEF (measured by echocardiography) gave no indication of excess myocardial iron deposition ( r = −0·07, P = 0·52) or of the risk of developing arrhythmia. [ABSTRACT FROM AUTHOR]

Background: For both dengue and scrub typhus, acute respiratory failure (ARF) is a serious complication. The present study was carried out in order to investigate the clinical courses and outcomes of adult dengue and scrub typhus patients with ARF, and to identify the clinical differences between adult dengue and scrub typhus patients with ARF. Methods: We conducted a retrospective study of the serologically confirmed adult dengue or scrub typhus patients admitted between 1998 and 2008 at Kaohsiung Chang Gung Memorial Hospital. A total of 980 dengue and 102 scrub typhus adult patients were included in our study. Results: Eighteen of the 980 adult dengue patients and 8 of the 102 adult scrub typhus patients had ARF. There were significant differences that existed for eschar ( P = 0.001; dengue 0%; scrub 62.5%), cough ( P = 0.016; dengue 55.6%; scrub typhus 100%), white blood cell (WBC) count [ P = 0.026; dengue 7.40 ± 5.74; scrub typhus 11.84 ± 4.95 (×10/μL)], platelet count [ P = 0.008; dengue 42.2 ± 33.9; scrub typhus 104.1 ± 93.3 (×10/L)], prothrombin time (PT) [ P = 0.007; dengue 12.82 ± 1.36; scrub typhus 10.74 ± 0.98 (s)], activated partial thromboplastin time (APTT) [ P = 0.002; dengue 50.81 ± 10.08; scrub typhus 37.44 ± 4.06 (s)], blood urea nitrogen (BUN) [ P < 0.001; dengue 64.6 ± 43.2; scrub typhus 20.9 ± 9.1 (mg/dL)], creatinine [ P < 0.001; dengue 3.77 ± 3.37; scrub typhus 1.05 ± 0.37 (mg/dL)], admission day (A-day) [ P = 0.027; dengue 2.9 ± 1.3; scrub typhus 5.4 ± 2.6 (days)], and ventilator duration [ P = 0.022; dengue 9.4 ± 14.0; scrub typhus 14.8 ± 10.4 (days)] between both groups. Conclusions: This study provides relatively rare data regarding the clinical differences between adult dengue and scrub typhus patients with ARF. [ABSTRACT FROM AUTHOR]

The associated risk of phthalate exposure, both parent compounds in the home and their metabolites in urine, to childhood allergic and respiratory morbidity, after adjusting for exposures of indoor pollutants, especially bioaerosols, was comprehensively assessed. Levels of five phthalates in settled dust from the homes of 101 children (3-9 years old) were measured, along with their corresponding urinary metabolites. Other environmental risk factors, including indoor CO2, PM2.5, formaldehyde, 1,3-β- d-glucan, endotoxin, allergen and fungal levels, were concomitantly examined. Subject's health status was verified by pediatricians, and parents recorded observed daily symptoms of their children for the week that the home investigation visit took place. Significantly increased level of benzylbutyl phthalate, in settled dust, was associated with test case subjects (allergic or asthmatic children). Higher levels of dibutyl phthalate and its metabolites, mono- n-butyl phthalate, and mono-2-ethylhexyl phthalate were found to be the potential risk factors for the health outcomes of interest. Similarly, indoor fungal exposure remained a significant risk factor, especially for reported respiratory symptoms. The relative contribution from exposure to phthalates and indoor biocontaminants in childhood allergic and respiratory morbidity is, for the first time, quantitatively assessed and characterized. Practical Implications For asthmatic and allergic children living in subtropical and highly developed environments like homes in Taiwan, controlling environmental exposure of phthalates may be viewed as equally important as avoiding indoor microbial burdens, for the management of allergy-related diseases. It is also recognized that multidisciplinary efforts will be critical in realizing the true underlying mechanisms associated with these observations. [ABSTRACT FROM AUTHOR]

Objectives: Systemic sclerosis (SSc) has been associated with high cancer risk. We compared the cancer risk among SSc patients with that among the general Taiwanese population. Methods: The catastrophic illness registry of the Taiwan National Health Insurance Research Dataset (NHIRD) was used to identify patients diagnosed with SSc and cancer in Taiwan during 1996-2008. The standardized incidence ratio (SIR) for cancer was calculated, and mortality was ascertained using the data from the National Death Registry. Results: Data analysis revealed that 2053 (472 men, 1581 women) Taiwanese individuals were diagnosed with SSc during the study period and 83 (30 men, 53 women) had cancer. The incidence of cancer was 6.9/1000 person-years. The most common cancer sites in male SSc patients were the lung (n == 10), oral cavity and pharynx (n == 8), and gastrointestinal tract (n == 4), and those in female patients were the breast (n == 11), lungs (n == 11), and blood (n == 6). Compared to the Taiwanese population of 1996, the all-cancer SIR for SSc was 1.63 [95%% confidence interval (CI) 1.31-2.01]. Cancer risk was elevated for cancers of the lung (SIR 4.20), oral cavity and pharynx (SIR 3.67), and blood (SIR 3.50). A cancer diagnosis in SSc patients was associated with a hazard ratio (HR) of 2.15 (95%% CI 1.30-3.53). Among cancer patients, a diagnosis of SSc was not associated with increased mortality. Conclusions: SSc patients are at high risk of developing cancer, especially of the lung, oral cavity and pharynx, and blood. [ABSTRACT FROM AUTHOR]

Background and purpose: The association between glucocerebrosidase ( GBA) mutations and Parkinson's disease (PD) is attracting increased attention worldwide. In patients of Chinese ethnicity, other than the common L444P mutation, a few mutations have been reported. However, the contribution of GBA to PD can be answered only by a thorough investigation of its mutations in a unique large population. Methods: We enrolled 1747 participants: 967 PD patients and 780 healthy individuals. We screened entire GBA coding regions and exon-intron boundaries in 30 randomly chosen PD patients, followed by testing five variants (L444P, D409H, R120W, L174P, and Q497R) in all participants. The G2385R and R1628P in LRRK2 had been previously studied in almost all participants. Results: In total, 36 patients (3.72%) carried a heterozygous mutant GBA allele (27 L444P, 7 Rec NciI, and 2 D409H). Only two controls (0.26%) carried heterozygous GBA mutation (1 L444P and 1 Rec NciI). In PD group, the mean age at onset in carriers was younger than in non-carriers. The difference in percentage of mutation frequencies between patients and controls was highly significant for the L444P mutation ( P < 0.0001). One L444P carrier was also associated with LRRK2 G2385R variant, but no atypical Parkinsonism was observed. Conclusions: The present study ascertains that L444P mutation in GBA gene may contribute to an earlier onset of development of PD in Han/Chinese population. Following LRRK2 variants, GBA is the second most frequent mutations indicated for sporadic PD development in the Han/Chinese population. These GBA carriers are associated with an earlier onset of Parkinsonism. [ABSTRACT FROM AUTHOR]

Objectives: There have been few nationwide population studies of systemic sclerosis (SSc). We describe the epidemiological features of SSc in Taiwan. Methods: The catastrophic illness registry of the Taiwan National Health Insurance Research Dataset (NHIRD) and the National Death Registry of Taiwan were used to calculate estimates of the incidence, prevalence, and mortality of SSc. Results: A total of 1479 persons (325 males, 1154 females) with incident SSc were enrolled in the study. The annual incidence of SSc in Taiwan was found to be 10.9 cases (4.7 males, 17.4 females) per million population. During 2002-2007, the mean prevalence was 56.3 cases per million population. There were 204 deaths (70 males, 134 females) during the study period; 1-, 2-, and 5-year survival rates were 94.9, 92.0, and 83.2%%, respectively. SSc patients had a standardized mortality ratio (SMR) of 3.24 [95%% confidence interval (CI) 2.82-3.71] for all-cause mortality, as compared with the national population in 2002. There was excess mortality from neoplasms (SMR 1.50, 95%% CI 1.03-2.11), cardiovascular diseases (2.23, 1.52-3.16), kidney disease (4.67, 2.66-7.64), gastrointestinal diseases (2.50, 1.27-4.46), and pulmonary diseases (3.20, 1.89-5.09). In addition to male sex and older age, cancer and end-stage renal disease (ESRD) diagnosis were risk factors for death, with hazard ratios (HRs) of 2.71 (95%% CI 1.27-5.76) and 2.59 (1.14-5.90), respectively. Conclusion: SSc patients had a threefold greater risk of all-cause mortality than the general population of Taiwan. Male sex, older age, diagnosis of cancer, and ESRD were risk factors for death. [ABSTRACT FROM AUTHOR]

Background A few studies had pointed out the relationship between a single allergic disease and children's psychosocial problems; however, all of these researchers considered the allergic diseases separately. Therefore, this study aimed to investigate the relationship between collective allergic diseases and psychosocial problems among 4- to 12-year-old children in Taiwan. Methods The data were generated from the 2005 Taiwan National Health Interview Survey. A total of 2955 parents or guardians completed the answers for their 4- to 12-year-old children. We used logistic regressions to investigate the association of allergic diseases and the psychosocial problems. Results About 40.62% children had at least one allergic disease in the past year, and 17.75% children had a score of psychosocial problems higher than or equal to the 75th percentile. After controlling for demographic factors, the risk of having high-level psychosocial problem for children with any allergic disease was 1.84 times of those without allergy. For those who had one, two or more than two allergic diseases, the risks of having psychosocial problems were 1.56, 2.20 and 3.39 times of those had no allergy disease respectively. Children with asthma, dermatitis and rhinitis simultaneously had the highest psychosocial impact (odds ratio = 5.10). Conclusions Collective allergic diseases were associated with psychosocial problems in children, and the effect was gradient. Parents and paediatricians should pay attention to psychosocial problems in children with allergic diseases and vice versa. [ABSTRACT FROM AUTHOR]

Since large-scale reports of pulmonary infarction in systemic lupus erythematosus (SLE) are limited, a retrospective study was performed for this manifestation in 773 hospitalized patients in southern Taiwan from 1999 to 2009. Pulmonary infarction was defined as the presence of pulmonary embolism, persistent pulmonary infiltrates, and characteristic clinical symptoms. Demographic, clinical, laboratory, and radiological images data were analyzed. There were 12 patients with pulmonary embolism and 9 of them had antiphospholipid syndrome (APS). Six patients (19 to 53 years, average 38.2 ± 12.6) with 9 episodes of lung infarction were identified. All cases were APS and four episodes had coincidental venous thromboembolism. There were four episodes of bilateral infarction and seven episodes of larger central pulmonary artery embolism. Heparin therapy was routinely prescribed and thrombolytic agents were added in two episodes. Successful recovery was noted in all patients. In conclusion, there was a 0.8% incidence of pulmonary infarction in patients with SLE, all with the risk factor of APS. Differentiation between pulmonary infarction and pneumonia in lupus patients should be made; they have similar chest radiography with lung consolidation but require a different clinical approach in management. Although this report is a retrospective study with relatively small numbers of lupus patients with lung infarcts, our observation might provide beneficial information on the clinical features and radiological presentations during the disease evolution of pulmonary infarction in SLE with APS. [ABSTRACT FROM AUTHOR]

The crisis level in the worldwide suicide rate has revealed a severe suicide problem in Taiwan that is now well above the world average of 16 per 100 000 individuals. Many countries have relied on suicide care volunteers training programmes to conduct suicide prevention programmes. However, there is a dearth of research evaluating the effect of volunteers on psychological distress and the impact of volunteer experience level. An evaluation of the impact of experienced and novice volunteers in alleviating psychological distress of suicide survivors was conducted. A supervised programme trained 15 volunteers at Years 1 and 2. Year 1 volunteers completed 400 h of service with continuing education. Programme evaluation occurred after Year 2 volunteers had completed training. Eighty-two suicide survivors were recruited. With 60 suicide survivors completing 3 month of volunteer care, a significant group difference with time interaction in suicide survivors who exhibited moderate to severe distress between the veteran care and novice care groups was found. Compared with novice volunteers, veteran volunteers with at least 1 year of experience are more effective with suicide survivors reporting higher psychological distress. [ABSTRACT FROM AUTHOR]

As very few large scale publications of invasive fungal infection (IFI) have been reported in lupus patients from individual medical centers, a retrospective study was performed from 1988 to 2009 in southern Taiwan. Demographic characteristics, clinical and laboratory data, and mycological examinations were analyzed. Twenty cases with IFI were identified in 2397 patients (0.83% incidence). There were 19 females and one male with an average age of 31.8 ± 12.6. Involved sites included eight disseminated cases, six central nervous system, four lungs, one abdomen and one soft tissue. IFI contributed to a high mortality with 10 deaths (50%), and there were no survivors for the disseminated cases and Candida-infected patients. High activity (Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) >8) was noted in 50% of IFI episodes. The survival from IFI diagnosis to death was only 7.7 ± 4.2 days, all in a rapid course. No statistical difference was found between survivors and nonsurvivors when comparing their SLEDAI. Eighty-five percent of IFI episodes under high dosages of corticosteroids therapy and 95% of patients had lupus nephritis. There was an increased risk of IFI in the lupus patients receiving high daily dosage of prednisolone therapy. Critical information from analyses of the present large series could be applied into clinical practices to reduce the morbidity and mortality in such patients. [ABSTRACT FROM AUTHOR]

Eur J Clin Invest 2010; 40 (3): 220–225 Background The previous studies regarding the association between endogenous dehydroepiandrosterone (DHEA) sulphate level and metabolic syndrome are inconsistent. This study aimed to investigate such relationship in elderly Taiwanese men. Materials and methods Five hundred and eighty-five elderly Taiwanese men (mean age 68·7 ± 8·3 years) were enrolled as the baseline cohort population in 2000. In addition to a questionnaire, body mass index (BMI), blood pressure, fasting blood glucose, lipids, albumin and serum DHEA-S levels were measured for each participant. Metabolic syndrome was based on the definition by the America Heart Association/National Heart Lung Blood Institute. Results The prevalence of metabolic syndrome was 33·3%. Using multivariate logistic regression analyses with adjustments for age, smoking, alcohol, physical activities, albumin and BMI, there was a positive relationship between serum DHEA-S level and metabolic syndrome. The highest DHEA-S quartile group had increased risk for metabolic syndrome (odds ratio = 2·68, 95% confidence interval: 1·44–5·01, P < 0·01) compared with the lowest quartile group. The mean serum DHEA-S level increased with increasing number of metabolic syndrome components. Conclusions The prevalence of metabolic syndrome increases with elevated DHEA-S levels among elderly Taiwanese men. Thus, elevated serum DHEA-S level should be treated as an important risk factor for metabolic syndrome in elderly men. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 295–302 (2010) Aims Cigarette smoking is a well-known risk factor associated with diabetic nephropathy. The objective of this study was to further investigate the dose–response effect of tobacco exposure on proteinuria in males with Type 2 diabetes. Methods Five hundred and nine males with Type 2 diabetes were selected from a cohort participating in a glucose control study in Taiwan. Pack-years of cigarette smoking were calculated to define tobacco exposure. Proteinuria was identified if albumin-to-creatinine ratio was ≥ 30 mg/g in at least two of three consecutive urine tests. Logistic regression and trend tests were used to delineate the association between smoking status and proteinuria. Results Compared with non-smokers, those who had smoked 15–30 or more than 30 pack-years were respectively 2.78 (95% CI 1.34–5.76, P < 0.01) and 3.20 (95% CI 1.74–5.86, P < 0.001) times more likely to develop proteinuria. The dose–response effect of tobacco exposure on the development of proteinuria is highly significant in all subjects ( P = 0.001) and in subgroups with relatively short duration of diabetes mellitus ( P < 0.001), good blood pressure control ( P = 0.001) and those of young age ( P = 0.007). Conclusions The current study shows a clear dose–response effect of cigarette smoking on development of proteinuria in male Type 2 diabetic patients. These findings reinforce the urgent need to encourage diabetic patients to stop smoking regardless of age, duration of diabetes mellitus or status of blood pressure control. [ABSTRACT FROM AUTHOR]

In this study, water samples were collected from 86 water treatment plants for analysis of haloacetic acids (HAAs) and trihalomethanes (THMs) from February to March, 2007 and from July to August, 2007. Both seasonal and geographical variations of disinfection by-products (DBPs) in drinking water of Taiwan were presented. The results showed that the five HAA concentrations (HAA5) were 1.0–38.9 μg/L in the winter and 0.2–46.7 μg/L in the summer; and the total THMs were ND-99.4 μg/L in the winter and ND-133.2 μg/L in the summer. For samples taken from the main Taiwan island, dichloroacetic acid (29.4–31.7%) and trichloroacetic acid (25.3–27.6%) were the two major HAA species, and trichloromethane was the major THM species (49.9–62.2%) in finished water. For water treatment plants located on the offshore islands outside of Taiwan, high bromide concentration was found in raw water, and higher percentage of brominated THMs and HAAs were formed in the overall formation. A statistically significant ( P < 0.005) logarithmic linear regression model was found to be useful to describe the correlations between TTHM and HAA5 or nine HAAs (HAA5 = 1.219 ×TTHM 0.754, R2 = 0.658; HAA9 = 1.824 ×TTHM 0.735, R2 = 0.678). No apparent difference was observed for DBPs concentrations between finished water and distribution samples in this study. [ABSTRACT FROM AUTHOR]

Carcinosarcoma of the esophagus is a rare neoplasm with both carcinomatous and sarcomatous components. This study aimed to investigate its clinicopathologic features and endoscopic characteristics. The data of patients diagnosed to have esophageal carcinosarcoma pathologically in the past 30 years (January 1976–December 2007) were reviewed. Of 3318 cases of esophageal malignancy, 12 were diagnosed as esophageal carcinosarcoma, with an incidence of 0.36%. All of the cases were male with a mean age of 62.3 years. Of the 12 tumors, 8 were polypoid type, and 4 were ulcerative type. In the endoscopic ultrasonography examination, the tumors show heterogeneous hypoechoic lesions with irregular outer margins and internal multicystic components. Four patients (33.3%) had previous head and neck squamous cell carcinoma that occurred metachronously. This is the first report about the characteristics of esophageal carcinosarcoma under endoscopic ultrasonography examination. The relationship between esophageal carcinosarcomas and head and neck cancer needs further investigation. [ABSTRACT FROM AUTHOR]

A Giant groupers (Epinephelus lanceolatus) farm in southern Taiwan displayed symptoms of hypoxia with mortality around 3.5%. Wet mount examination revealed mottled gills with abundant oval-shaped cysts as the main characteristic lesions. Sporadic occurrence of diffusely distributed white nodules in the kidney was also observed. Through histopathological examination, basophilic, cytoplasmic cysts were found diffusely scattered in the secondary lamellae. The contents of the cysts produced a dark magenta hue under Macchiavello stain, indicating the presence of chlamydia-like organisms. Focal to multifocal granulomatous, necrotic lesions were observed in the kidney and spleen, and were the result of Vibrio spp. and Photobacterium spp. infection. DNA samples were extracted from the gills and the resulting product was a 298 bp fragment with a nucleotide sequence that was 98% homologous with Simkaniaceae spp. As the result, the final diagnosis was epitheliocystis with secondary bacterial infection. [ABSTRACT FROM AUTHOR]

In the past two decades, there has been continuous investment and expansion of semiconductor, photoelectric panel, or solar cell plants in the high-tech industry. For example, establishing a semiconductor plant costs about US$ 3 billion. In addition, the output value of integrated circuits (IC) of Taiwan as a whole is estimated to be about US$ 5.215 billion, and globally of US$ 275.2 billion in 2008. A large amount and a variety of specialty gases or chemicals are applied during processes in high-tech facilities and these chemicals are characterized by inflammability, toxicity, and corrosiveness. Accidents may result once errors or leaks occur in any part of the supply chain, which consists of storage facilities, supply equipment, process machines, and tail gas elimination devices. Personnel casualties can result in serious situations. This study discusses the emergency response procedures and common response defects in semiconductor plants with a view to enhancing emergency response effects and capabilities, avoiding casualties, reducing property loss and shortening operation interruption. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence and risk factors of post-tooth extraction sepsis in patients without locoregional infection. Subjects and Methods: We assessed all claim records of the Taiwanese National Health Insurance program in 2005. Admissions for patients aged ≥16 years containing a discharge diagnosis of sepsis, and who received tooth extraction within 14 days before the admission were identified. Patient charts were reviewed to confirm the diagnosis of sepsis and rule out other infection sources. The relationship between postextraction sepsis (PES) and clinical parameters was analyzed. Results: Thirty-three of the 2 223 971 extraction cases met the criteria of PES, an incidence of 1.48 per 100 000, and seven patients (21.2%) died of the disease. Aging significantly increased the risk of PES ( P < 0.001). Pre-existing comorbidities were found in 20 of the 33 cases, with diabetes mellitus and hematologic diseases the most common. The method, number, and position of extraction had no influence on PES incidence. Blood cultures were positive in 25 patients (75.8%) and isolates included species of the Streptococcus, Actinomyces, Klebsiella, Bacteroides, Prevotella, and Enterococcus genera. Conclusion: Tooth extraction is associated with a low but significant risk of postoperative sepsis, especially in the elderly and patients with underlying diseases. [ABSTRACT FROM AUTHOR]

Aims To investigate whether health-related quality of life (HRQOL) predicts hospital admission in a nationally representative sample of adults with diabetes. Methods We conducted a prospective study on persons aged ≥ 18 years with self-reported physician-diagnosed diabetes ( n = 797) who participated in the National Health Interview Survey in Taiwan, 2001. Of these potential participants, 674 provided consent for data linkage and were successfully linked to the National Health Insurance claims data. We analysed the associations between the Short Form 36 (SF-36) subscales and summaries and the occurrence of hospital admission for any cause during 2002. Results Approximately 23% of participants with diabetes had at least one hospital admission during 2002. After adjusting for demographic characteristics, co-morbidities and diabetics-related attributes, those who had been admitted to hospital had significantly poorer mean scores on each of the physical dimensions, physical components summary (PCS) and social functioning domain of the SF-36 at baseline. In logistic regression models, poorer scores on the PCS [odds ratio (OR) = 1.80; 95% confidence interval (CI) = (1.14–2.86)], duration of diabetes ≥ 10 years [OR = 2.10; 95% CI = (1.14–3.89)] and the presence of heart disease [OR = 1.63; 95% CI = (1.01–2.63)] were significantly associated with an increased risk of hospital admission. Conclusion In people with diabetes, poorer scores on the PCS of the SF-36 at baseline may provide additional information for assessment of hospital admission risk, independent of other measures of health outcomes. [ABSTRACT FROM AUTHOR]

Background and purpose: Sialidosis type 1 (ST-1) is a neurodegenerative disorder with limited long-term follow-up report. This study is to document the chronological profile of ST-1. Methods: We perform serial analysis of 17 Taiwanese patients with ST-1 focusing on evolution of clinical features, electrophysiological findings, genetic studies, and neuroimage examinations. Results: All patients had a mutation at 554A→G in exon 3 of the NEU1 gene causing Ser182Gly substitution. Fifteen patients were homozygous. Two patients were heterozygous with novel mutations, 956C→T causing Ala319Val in one and 163C→T causing Gln55stop codon in the other. The neuraminidase activity was markedly decreased in all 11 available patients. Only three patients (17.6%) manifested the macular cherry-red spot. The majority of patients (82.3%) developed full-blown manifestation of myoclonus, ataxia, and seizures within 5 years. Abnormal somatosensory evoked potentials with giant cortical waves were found in all patients. Prolonged P100 peak latency of the visual evoked potentials (VEPs) were found in 16 patients (94.1%) in the early stage even without visual symptoms. Conclusion: ST-1 in Taiwanese population illustrates distinct characteristics of phenotype with infrequent cherry-red spot. We suggest to screen the NEU1 mutations in patients presenting action myoclonus with abnormal VEPs, even without macular cherry-red spots. [ABSTRACT FROM AUTHOR]

A nationwide susceptibility surveillance of Streptococcus pneumoniae and Haemophilus influenzae isolates collected from patients treated at the intensive care units (ICUs) of ten Taiwanese major teaching hospitals was conducted from September 2005 through November 2005. High rates of resistance (intermediate/resistant) of S. pneumoniae to penicillin (85% resistance), ceftriaxone (46%/20%), and cefepime (43%/15%) by meningitis criteria, and in contrast, non-susceptibilities (intermediate/resistant) to penicillin (0%/0%), ceftriaxone (20%/0%) and cefepime (15%/0%) by non-meningitis criteria were noted ( p values < 0.05) by the Clinical and Laboratory Standards Institute 2008. Resistant rate of S. pneumoniae to azithromycin was also high (63%). S. pneumoniae isolates were significantly more susceptible to ertapenem (87%) than to imipenem (39%) and meropenem (44%) ( p values < 0.05). Rates of non-susceptibilities of H. influenzae isolates to ampicillin and cefaclor were high (55% and 45%, respectively). No β-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae isolates were found. Imipenem has a notably higher MIC90 value (8 μg/ml) for H. influenzae than that of the other two carbapenems. Tigecycline showed good in vitro activities against these two respiratory pathogens. High rates of resistance among isolates of S. pneumoniae and H. influenzae continue to exist in the ICUs of Taiwan. [ABSTRACT FROM AUTHOR]

To determine the antimicrobial resistance profiles among clinical isolates of Enterobacteriaceae in Taiwanese intensive care units (ICUs), a national surveillance of antibiotic resistance among important Enterobacteriaceae was conducted from September 2005 through November 2005 at the ICUs of ten major teaching hospitals in Taiwan. A total of 574 Enterobacteriaceae isolates recovered from various clinical samples of our ICU patients were submitted for in vitro test. Minimum inhibitory concentrations (MICs) of these isolates to 18 antimicrobial agents were determined by the broth microdilution method. The prevalences of Enterobacteriaceae isolates with phenotypic extended-spectrum β-lactamase (ESBL) production were 26% in Klebsiella pneumoniae, 16% in Serratia marcescens, 14% in Escherichia coli, and 13% in Proteus mirabilis, in which a significantly rising prevalence of ESBL production among K. pneumoniae was noted ( p = 0.002) when compared with a previous Taiwanese survey in 2000. Heterogeneous resistance to various fluoroquinolones was found among our Enterobacteriaceae isolates, except for Entetrobacter cloacae. Emergence of ertapenem-resistant isolates of E. coli, K. pneumoniae, E. cloacae, and S. marcescens was noted. Gradually increasing rates of drug-resistant Enterobacteriaceae were noted in Taiwanese ICUs. Periodic surveillance of the evolutionary trend of antimicrobial resistance among ICU isolates is crucial for starting appropriately empirical antimicrobial therapy in the future. [ABSTRACT FROM AUTHOR]

Background and purpose: This study examines whether angiotensin-converting enzyme (ACE) gene polymorphisms are associated with the risk of spontaneous deep intracerebral hemorrhage (SDICH) in Taiwan using a case–control study. Methods: Totally, 217 SDICH patients and 283 controls were recruited. Associations of ACE A-240T and ACE I/D polymorphisms with SDICH were examined under the additive model and adjusted for gender, age, body mass index, total cholesterol level, smoking history, alcohol use, hypertension, and use of ACE inhibitors. Results: Hypertension, diabetes mellitus, family history of spontaneous intracerebral hemorrhage (SICH), and low cholesterol level increase risk of female SDICH, whereas hypertension, alcohol use, smoking history, family history of SICH, and low cholesterol level are an important risk factor for male SDICH. After adjusting for covariates, only haplotype ACE T-D (OR = 2.7, 95% CI, 1.1–6.5, P = 0.02) was associated with female SDICH. Conclusions: This study demonstrates that environmental risk factors play a major role and ACE polymorphisms play a minor role in contributing risk of SDICH in Taiwan. [ABSTRACT FROM AUTHOR]

Objective. To understand the coping mechanisms of Taiwanese parents whose children have recently been diagnosed with autism. Background. When a child is diagnosed with autism, the family's life changes. Parents of a child with autism have been shown to cope with problem- or emotion-focused coping strategies. However, it is not known how parents in Taiwan adapt and cope with the stresses of taking care of an autistic child, especially in the early period after learning their child's diagnosis and while waiting for free national day care arrangements at hospital. Design. A descriptive qualitative design was used, with in-depth interviews. Methods. Parents of children diagnosed with autism (n = 17) were recruited from a children's psychiatric outpatient clinic at a medical centre in northern Taiwan. The parents were still waiting for free national day care arrangements at hospital. Data were collected through individual, tape-recorded interviews and observations, and transcripts were analysed by content analysis for emerging themes and concepts. Results. The study sample of parents of children with autism described nine main coping mechanisms that fell into three core categories: adjusting to self-change, developing treatments for the autistic child and seeking support. Conclusions. The results of this study could be used by clinicians to help parents of autistic children become aware of whether or not they are using healthy coping mechanisms, and to suggest concrete and healthy coping strategies, particularly in the period after the diagnosis is confirmed and they are waiting for free national day care arrangements at hospital. Relevance to clinical practice. Clinicians in child psychiatry are encouraged to become part of the social support network for parents of autistic children, thus helping them adjust to the long journey of caring for their children. [ABSTRACT FROM AUTHOR]

Aims and Objectives. The aim of this study was to understand the factors related to intention to leave their job among intensive care unit (ICU) nurses in eastern Taiwan and to make between-group comparisons between an intention to leave and an intention to stay as well as to predict the influencing factors that affect ICU staff nurses' intention to leave. Background. Nurses' intention to leave their job may have an important impact on the actual turnover of nurses. The issue has always been of concern to nursing executives. Only limited empirical studies in the area have been investigated in an Asian culture context and particularly the eastern Taiwan region. Methods. A cross-sectional predictive study was performed during 2005 with 130 nurses recruited from two ICUs at a medical centre. A researcher-designed questionnaire based on the Cooper's model with structured interviews was used to determine each nurse's characteristics and their intention to leave their job. Multiple logistic regression analysis was employed to investigate the various factors associated with this. Results. The overall response rate was 100%; 63 (48·9%) revealed that they intended to leave their jobs. The findings were that their self-rated health status, the number of diseases, the level of happiness, the presence of depression, job satisfaction, sleep quality, type of license and their unit were significantly associated with an intention to leave ( p = 0·05-0·001). Depression and sleep quality proved to be the most significant predictors of ICU staff nurses' intention to leave their job. Conclusions. The findings suggest that there is a need to take steps to improve nurses' health-related quality of life and to develop effective strategies to improve nurse retention. Relevance to clinical practice. A succinct validated instrument would help identify the important factors that predict ICU nurses' intention to leave their job, which may result in job disengagement. Predictors found in this study may be used as outcome variables for developing such an effective method of improving nurse retention in ICUs. [ABSTRACT FROM AUTHOR]

The objective of this paper is to estimate the cost of obesity's contribution to the metabolic syndrome diseases in Taiwan. We used individual data from the Cardiovascular Disease Risk Factors Two-Township Study survey and medical use and expenditures data from the Bureau of National Health Insurance (NHI) of Taiwan. By adopting the prevalence-based and population attributable risk (PAR) approaches, direct costs of obesity for six kinds of obesity related metabolic syndrome diseases have been estimated. Comorbidities used in our analysis included ischemic heart diseases, congestive heart failure, cerebrovascular disease accident, diabetes, hyper-cholesterolaemia and hypertension. The results indicate that overweight and obesity are associated with a higher prevalence and costs of the metabolic syndrome related diseases. PAR increases as the obese [body mass index (BMI)] prevalence increases. About 4–9% of the costs of those diseases can be attributed to overweight (24 ≤ BMI < 27) and about 7–13% and 8–19% of such costs are attributable to the first and second degree obesity (27 ≤ BMI < 30 and BMI ≥ 30). The cost of obesity derived from the PAR and medical costs of metabolic syndrome diseases accounts for 2.9% of the national total healthcare expenditure. We therefore conclude that overweight and obesity have increased health costs and resulted in higher prevalence of and greater costs from metabolic syndrome related diseases in Taiwan. These findings provide important support for implementing obesity prevention programs in Taiwan. [ABSTRACT FROM AUTHOR]

Background Familial hypercholesterolaemia (FH) is an autosomal dominant disease associated with a very high risk of coronary vascular disease. The study objective was to identify patients with FH in Taiwan and characterize novel mutations. Materials and methods Fifty-one patients with suspected FH living in Taiwan were screened for mutations in both the low-density lipoprotein (LDL) receptor and the apolipoprotein (apoB) genes using the multiplex polymerase chain reaction and exon-by-exon DNA sequencing technique. Functional consequences on LDL receptor activity were characterized in vitro for novel mutations and family pedigree was also analyzed. Results Thirteen different functional mutations in the LDL receptor gene and one mutation in the apoB gene were found in 21 patients. Among the 13 mutations in the LDL receptor gene, 10 were single-point missense mutations, one was a two-point mutation in the same allele, one was a non-sense mutation and one was a frame-shift mutation. There were three novel mutations, including two missense mutations (M510K and W512R) and one frame-shift mutation (1953 delTA mutation). The characterization of missense M510K retained 36·2% of the activity of the normal receptor. Conversely, frame-shift 1953 delTA and missense W512R led to defective proteins, with only 0–6% of normal receptor activity. Conclusions The study identified 13 LDL receptor gene mutations and characterized three novel mutations causing FH in Taiwan. This facilitated a better understanding of FH among the Chinese population and may enable diagnosis of FH at the molecular level at a presymptomatic, early age. [ABSTRACT FROM AUTHOR]

Chromosome 4q is one of the most common regions with a high frequency of allelic loss in hepatocellular carcinoma (HCC). To identify the HCC-susceptibility locus on chromosome 4q, we have performed linkage and family-based association analyses on Chinese families with HCC from Taiwan, where hepatitis B is hyperendemic. Using 77 microsatellite markers spanning chromosome 4q on 52 multiplex families, we found suggestive evidence of linkage to 4q22.3–28.1 with a maximum two-point heterogeneity LOD (HLOD) score of 2.55 at marker D4S3240 on chromosome 4q25. Multipoint analyses with microsatellite markers in the region 4q22.3–28.1 resulted in a maximum HLOD score of 3.12 and a maximum nonparametric linkage (NPL) Z score of 1.98 (pointwise P=0.0080; region-wide empirical P=0.021) for D4S3240. The evidence for linkage to D4S3240 was seen mostly in a subset of 28 families lacking affected parents, which showed multipoint HLOD and NPL scores of 3.25 and 2.79 (pointwise P=0.0028; region-wide empirical P=0.008), respectively. Family-based association analyses of the 77 microsatellite markers in 191 families (53 multiplex plus 138 singleton families) using the pedigree disequilibrium test provide further support for observed linkage. Additional genotyping in the 52 multiplex families informative for linkage analyses was performed for 29 single-nucleotide polymorphisms around D4S3240. A common haplotype (at markers rs7442180 and rs221330) positioned ∼873 kb away from D4S3240 was associated with HCC, with P=0.0074.Oncogene (2006) 25, 3219–3224. doi:10.1038/sj.onc.1209345; published online 16 January 2006 [ABSTRACT FROM AUTHOR]

Background: To delineate the epidemiologic trend, clinical characteristics and therapeutic outcomes of bacterial meningitis in young adults in southern Taiwan. Patients and Methods: Over a period of 18 years, 329 cases of culture-proven adult bacterial meningitis were identified at our hospital. Among these 329 cases, 62 were identified as young adults (≥ 40 years) and their clinical features, laboratory data and therapeutic outcomes were reviewed. The prognostic factors between fatal and non-fatal groups were compared. Results: The 62 young adults were 48 men and 14 women, aged 17–40 years. Thirty of the 62 patients belonged to nosocomial infection, and the other 32 belonged to community-acquired infection. A total of 74% (46/62) of the patients had a postneurosurgical state as the underlying condition. Alcoholism (n = 8) was the most common underlying condition of the other 16 patients with spontaneous meningitis. Of these 62 patients, Klebsiella pneumoniae (12) and Pseudomonas aeruginosa (9) were the most common implicated gram-negative pathogens. During the late study period, there was an increase in coagulase-negative staphylococcus and Staphylococcus aureus infections. The therapeutic results of this group of patients are as follows: 13 patients died, 18 had full recovery and 31 had varying degrees of neurologic deficits. Impaired consciousness and thrombocytopenia were significant prognostic factors. Conclusion: A postneurosurgical state is an important preceding event for young adults to develop bacterial meningitis. Of the implicated gram-negative pathogens, K. pneumoniae and P. aeruginosa are common; however, there has been an increase in staphylococcal infection in recent years. Therapeutic results of this specific group of patients showed that 20% (13/62) of the patients died, and 50% (31/61) of the patients in this study had neurologic deficits. However, the small case number and possible bias of case selection has limited the analytical conclusions of this study. Further large-scale studies are needed to delineate the clinical characteristics and therapeutic outcomes of bacterial meningitis in this specific group of patients. [ABSTRACT FROM AUTHOR]

Objective: The research aimed at examining betel nut chewing and other risk factors associated with obesity among Taiwanese male adults.Design: The research analyzed the data obtained by the 2001 National Health Interview Survey in Taiwan that covered all the administrative divisions in Taiwan. Multistage stratified systematic sampling design was adopted for survey. All members of a sampled household received the interview.Subjects: The research analyzed questionnaires answered by nonaboriginal male respondents aged between 20 and 59 years old, and the total number of samples analyzed read 6126. Since very few female subjects chewed betel nut, they were excluded from the analysis.Measurements: Criteria of obesity was defined as body mass index > or = 27 kg/m2. The variables incorporated for analysis included the respondents' status of betel nut chewing, age, educational background, presence of hypertension and diabetes mellitus, drinking and smoking status, exercise status, and demand for physical strength at job. Generalized estimating equations model was employed to estimate the odd ratios (with 95% CI) of obesity of each independent variable.Results: Approximately 16.2% of respondents were obese. The distribution of betel nut chewing was current chewers 15.9%, ex-chewers 4.3%, and nonchewers 79.8%. After controlling above-mentioned independent variables, hypertension, diabetes mellitus, betel nut chewing, never exercising, and sedentary jobs were closely associated with obesity.Conclusion: The research found that betel nut chewing closely associated with obesity. The increased appetite of betel nut chewers is speculated as the underlying cause. The prospective study is needed to clarify this issue. In addition to increasing the risk of developing oral cancer, betel nut chewing seemed to be related with another health hazard: obesity. [ABSTRACT FROM AUTHOR]

Abstract Aims The objective of this study was to evaluate the prevalence and awareness of diabetes mellitus (DM) in Taiwan. Methods The Nutrition and Health Survey in Taiwan for people aged ≥ 4 years was conducted between 1993 and 1996, using a multistaged, stratified, and clustered sampling scheme. Results The prevalence of DM, defined by fasting whole blood glucose ≥ 6.1 mmol/l or diagnosed DM subjects taking hypoglycaemic drugs, was 3.7% in men ≥ 19 years and 6.3% in women. Corresponding to age groups 19–44, 45–64 and ≥ 65 years, the prevalence was 1.5%, 7.9% and 7.8% in men and 0.5%, 12.3% and 19.6% in women, respectively. People in mountainous areas and in Peng-Hu islands had the highest prevalence, but the lowest awareness rates among seven survey strata (regions). Women from metropolitan cities had the lowest DM prevalence and body mass index (BMI) values, but the highest rate of DM awareness among all strata. This phenomenon was not apparent in men. The age, sex, and regional patterns of DM prevalence were consistent with those of BMI. Conclusions The prevalence of DM in Taiwan in 1993–1996 was relatively high, given a mean BMI of 23 kg/m2 in adults. Gender and regional differences were apparent in DM prevalence and awareness and in mean BMI. Diabet. Med. 20, 182–185 (2003). [ABSTRACT FROM AUTHOR]

The objective of this paper is to describe hypertension status in Taiwan using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996, which adopted a clustered stratified multistage sampling scheme. A total of 4838 males and 4876 females aged 4 years and above were interviewed and examined corresponding to a response rate of 74%. Almost all of them (97.5%) had blood pressures measured. The results show that the mean blood pressure of adult males was higher than that of adult females below 45 years of age. After that, the pattern was reversed. When defined by JNC IV criteria (SBP/DBP &ges; 160/95 mm Hg or taking anti-hypertensive drugs), the prevalence was 13% in adult males (&ges; 19 years) and 12% in adult females. When defined by JNC VI criteria (SBP/DBP &ges; 140/90 mm Hg or taking antihypertensive drugs), the prevalence was 26% in adult males and 19% in adult females. The prevalence in the mountainous area, was the highest among the seven survey strata. Under the JNC IV definition, 43% males and 53% females with hypertension knew their disease status, 31% of males and 45% of females took medicine for it, and 15% of males and 22% of females had their blood pressure under control. Percentages of awareness, treatment, and control were much lower with the JNC V definition, which was introduced toward the end of survey period. People in metropolitan areas had the highest rates of awareness, treatment, control, and compliance to medication. [ABSTRACT FROM AUTHOR]

Background: In Taiwan, distributions of body composition are usually generated for children, adolescent, and middle-aged groups. This study describes three anthropometric measures (i.e., height, weight, and body mass index [BMI]) of elderly persons in Taiwan.Methods: The data was derived from a prospective cross-sectional, population-based geriatric survey funded by the National Department of Health in Taiwan in 1991. A total of 2,600 subjects were successfully evaluated. A descriptive analysis was performed to generate distributions of height, weight, and BMI of elderly persons. Based on these descriptive data, the prevalence of overweight and obesity was estimated, and a cross-national comparison on the prevalence of obesity was made.Results: Age-group-specific means and standard deviations for height, weight, and BMI of Taiwanese elderly persons were presented. By gender, the elderly men were taller and heavier than the elderly women: however, the women had a higher mean value of BMI (kg/m2). The prevalence of overweight was 27.3% in men and 34.9% in women; the prevalence of obesity was 3.2% in men and 6.4% in women. The prevalence of obesity for the elderly men and women in Taiwan was lower than in Kuwait, Sweden, the United States, and the Native Americans, but higher than in Japan.Conclusions: The comparison indicates cross-cultural differences existing in the prevalence of obesity, which may be due to aging, nutritional status, or environmental factors. For future research, the relationship of anthropometric data to socioeconomic status and behavioral factors will be examined. [ABSTRACT FROM AUTHOR]

Summary: Melanoma is a life‐threatening type of skin cancer. It affected about 351,800 people worldwide in 2015. Acral melanoma occurs on non‐hairy acral skin (palms, soles, and nail beds) and is not thought to be linked to ultraviolet radiation (e.g. from the sun), unlike other melanoma types (non‐acral melanoma). This study, conducted by researchers based in Taiwan, aimed to find out which mutations (abnormalities) in certain genes underly acral melanoma and non‐acral melanoma in Asians. This is known as 'genomic profiling', and allows scientists to find out about the genetic information related to a person or cell type and the way genes interact with each other. This profiling can be done using a type of genetic testing called next‐generation sequencing. The authors performed comprehensive genomic profiling of 409 cancer‐associated genes in 66 melanomas, comprised of 45 acral melanomas and 21 non‐acral melanomas. The authors found that the non‐acral melanomas showed a significantly higher frequency of a type of mutation called BRAF mutations than the acral melanomas. Meanwhile, the frequencies of other alterations (NRAS/KRAS mutations, cell cycle aberrations, anti‐apoptosis pathway alterations, and receptor tyrosine kinase gene gains) were significantly higher in the acral melanomas. Ulceration, in which the skin on the surface of the melanoma breaks down, was found at significantly higher rates in the acral melanomas and non‐acral melanomas with cell cycle aberrations and receptor tyrosine kinase gene gains. Notably, cell cycle aberrations and anti‐apoptosis pathway alterations were associated with a lower rate of survival in all 66 melanoma patients, and especially in the 45 acral melanoma patients. This study strengthens our understanding of the patterns and repercussions of gene mutations in acral and non‐acral melanoma in Asians. The study revealed that, in addition to treatments called immunotherapies, acral melanoma patients might benefit from treatments that target NRAS/KRAS mutations, cell cycle aberrations, receptor tyrosine kinase gains, and anti‐apoptosis pathways, a possibility which warrants study in the future. This is a summary of the study: Genetic alterations in primary melanoma in Taiwan. Linked Article: Sheen et al. Br J Dermatol 2020; 182:1205–1213 [ABSTRACT FROM AUTHOR]