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C-type lectins play a crucial role as pathogen-recognition receptors for the dengue virus, which is responsible for causing both dengue fever (DF) and dengue hemorrhagic fever (DHF). DHF is a serious illness caused by the dengue virus, which exists in four different serotypes: DEN-1, DEN-2, DEN-3, and DEN-4. We conducted a genetic association study, during a significant DEN-2 outbreak in southern Taiwan, to explore how variations in the neck-region length of L-SIGN (also known as CD209L, CD299, or CLEC4M) impact the severity of dengue infection. PCR genotyping was utilized to identify polymorphisms in variable-number tandem repeats. We constructed L-SIGN variants containing either 7- or 9-tandem repeats and transfected these constructs into K562 and U937 cells, and cytokine and chemokine levels were evaluated using enzyme-linked immunosorbent assays (ELISAs) following DEN-2 virus infection. The L-SIGN allele 9 was observed to correlate with a heightened risk of developing DHF. Subsequent results revealed that the 9-tandem repeat was linked to elevated viral load alongside predominant T-helper 2 (Th2) cell responses (IL-4 and IL-10) in K562 and U937 cells. Transfecting K562 cells in vitro with L-SIGN variants containing 7- and 9-tandem repeats confirmed that the 9-tandem repeat transfectants facilitated a higher dengue viral load accompanied by increased cytokine production (MCP-1, IL-6, and IL-8). Considering the higher prevalence of DHF and an increased frequency of the L-SIGN neck's 9-tandem repeat in the Taiwanese population, individuals with the 9-tandem repeat may necessitate more stringent protection against mosquito bites during dengue outbreaks in Taiwan. [ABSTRACT FROM AUTHOR]

This is an exploratory research that seeks to investigate how ideology predicts Taiwanese perceptions of cross-strait relations, including attitudes toward Taiwan independence, perceptions of mainland China and Chinese people, Chinese invasion of Taiwan, and Chinese democracy. We took an inductive approach to left-right differences in Taiwan to offer a more systematic empirical understanding of ideology beyond the West. To do so, we conducted a nationally representative survey among adult Taiwan citizens (N = 1,350). Findings revealed that those who identified with the Left (vs. Right) tended to demonstrate more negative perceptions of cross-strait relations. Specifically, the political left is more negative about the outlook of Chinese democracy while favoring Taiwan independence, than the political right. Furthermore, the political left perceives both mainland China and the Chinese people more negatively than the political right. These findings underscore the role of ideology for a full comprehension of cross-strait relations, as they indicated a fundamental difference between the political left vs. right in terms of perceptions of cross-strait relations. The present research extends existing political psychology literature on ideology and international relations, particularly in the East Asian context. [ABSTRACT FROM AUTHOR]

BACKGROUND: To gain a better understanding of how Pyricularia oryzae population shifts is important for selecting suitable resistance genes for rice breeding programs. However, the relationships between P. oryzae pathogenic dynamics, geographic distribution, rice varieties, and timeline are not well studied. RESULTS: Resistance genes Piz‐5, Pi9(t), Pi12(t), Pi20(t), Pita‐2, and Pi11 showed stable resistance to the Taiwan rice blast fungus over 8 years of observations. Furthermore, 1749 rice blast isolates were collected from 2014 to 2021 and categorized into five pathotype clusters based on their correlation analysis between the geographic sources and virulence of Lijiangxintuanheigu monogenic lines. A detailed map of their distributions in Taiwan is presented. Isolates collected from the western region of Taiwan had greater pathotype diversity than those from the east region. Isolates collected from the subtropical region had greater diversity than those from the tropical region. Rice cultivars carrying Pik alleles were highly susceptible to pathotype L4. Cultivars with Piz‐t were highly susceptible to pathotype L5, and those with Pish were highly susceptible to pathotype L1. The geographical distribution of each pathotype was distinct, and the population size of each pathotype fluctuated significantly each year. CONCLUSION: The regional mega cultivars significantly impact the evolution of Pyricularia oryzae in Taiwan within the span of 8 years. However, the annual fluctuation of pathotype populations likely correlate to the rising annual temperatures that selected pathotype clusters by their optimal growth temperature. The results will provide useful information for effective disease management, and enable the R‐genes to prolong their function in the fields. © 2023 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Background: Primary malignant mediastinal germ cell tumors (GCTs) are rare pediatric tumors that have a poorer prognosis compared to GCTs occurring elsewhere in the body. The current study aimed to assess the prognostic factors and treatment outcomes of children with primary malignant mediastinal GCT in Taiwan. Methods: The authors retrospectively reviewed children 0–18 years old who were newly diagnosed with primary malignant mediastinal GCT between January 1, 2005 and December 31, 2019 and were registered in the Taiwan Pediatric Oncology Group patient registry. The impact of presenting characteristics, including sex, age, tumor stage, histology subtype, surgical treatment, and chemotherapy regimens of the patients were analyzed. Results: This study enrolled 52 children with malignant mediastinal GCT who had a median age of 16.0 (range, 6.0–17.9) years at diagnosis. The most common histological subtypes were mixed GCTs (n = 20) and yolk sac tumors (n = 15). Advanced disease stage and choriocarcinoma histology subtype were associated inferior outcomes. Children who received surgical treatment exhibited better outcomes compared to those who did not (5‐year overall survival, 78% vs. 7%, p <.001). After comparing patients who received first‐line cisplatin‐ and carboplatin‐based chemotherapy, no difference in treatment outcomes was observed. Multivariate analysis showed that surgical management was the only independent predictor for superior OS. Conclusions: Surgical treatment is recommended for mediastinal GCT. Cisplatin‐based chemotherapy was not superior to carboplatin‐based chemotherapy as first‐line treatment and may be avoided due to toxicity concerns. Surgical treatment is recommended for pediatric malignant mediastinal germ cell tumors. Cisplatin‐based chemotherapy was not superior to carboplatin‐based chemotherapy as first‐line treatment. [ABSTRACT FROM AUTHOR]

Purpose: Carbon monoxide (CO) poisoning may damage the pancreas, but the effects of CO poisoning on the development of diabetes and on existing diabetes remain unclear. We conducted a study incorporating data from epidemiologic analyses and animal experiments to clarify these issues. Methods: Using the National Health Insurance Database of Taiwan, we identified CO poisoning patients diagnosed between 2002 and 2016 (CO poisoning cohort) together with references without CO poisoning who were matched by age, sex, and index date at a 1:3 ratio. We followed participants until 2017 and compared the risks of diabetes and hyperglycemic crisis between two cohorts using Cox proportional hazards regressions. In addition, a rat model was used to assess glucose and insulin levels in blood as well as pathological changes in the pancreas and hypothalamus following CO poisoning. Results: Among participants without diabetes history, 29,141 in the CO poisoning cohort had a higher risk for developing diabetes than the 87,423 in the comparison cohort after adjusting for potential confounders (adjusted hazard ratio [AHR]=1.23; 95% confidence interval [CI]: 1.18– 1.28). Among participants with diabetes history, 2302 in the CO poisoning cohort had a higher risk for developing hyperglycemic crisis than the 6906 in participants without CO poisoning (AHR = 2.12; 95% CI: 1.52– 2.96). In the rat model, CO poisoning led to increased glucose and decreased insulin in blood and damages to pancreas and hypothalamus. Conclusion: Our epidemiological study revealed that CO poisoning increased the risks of diabetes and hyperglycemic crisis, which might be attributable to damages in the pancreas and hypothalamus as shown in the animal experiments. [ABSTRACT FROM AUTHOR]

Copyright of Irrigation & Drainage is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rice blast is one of the most devastating diseases that threatens rice production in Taiwan. A rice blast forecasting model is required to guide the precise application of fungicide. Therefore, BlastGRU-TW model based on deep learning algorithms was developed in this study. The input data comprised approximately 1000 rice blast surveys, collected from 50 fields throughout Taiwan between 2014 and 2021, and the corresponding weather data retrieved from weather observation network in Taiwan. Common and easily accessible meteorological factors, i.e. temperature, humidity, precipitation, and wind, were converted into 20 daily meteorological features which were coupled with different time intervals between 1 and 30 days before survey (DBS) to train the model. The results showed that seven meteorological features (daily maximum temperature, daily mean temperature, daily minimum temperature, daily mean humidity, daily mean WV and daily mean Wu) and the interval from −4 to −24 DBS were informative in disease prediction, thereby indicating that the proposed model could predict the risk of rice blast by using meteorological data 4–24 days before new disease symptoms appeared. The proposed BlastGRU-TW model achieved an accuracy of 87.3%. Furthermore, on adding the 3 day forecast weather data from Weather Research and Forecasting (WRF) model in the proposed model, the forecast extended to 7 days ahead of the appearance of new symptoms. Moreover, the BLASTAM model developed in Japan was implemented and validated in Taiwan to evaluate its applicability in different geographical areas. Finally, a rice blast early warning system (https://mycolab.pp.nchu.edu.tw/blast%5fforecast/index%5fen.php) equipped with an interactive web-based map is now available for real-time forecasting of the risk of rice blast in paddy field across Taiwan. • Input data from 1000 rice blast surveys in Taiwan for 2014–2021. • BlastGRU-TW model for deep learning-based rice blast prediction • The model achieves an accuracy of 87.3% • The BLASTAM model developed in Japan was the first to be implemented and validated outside Japan. • Forecast results can be visualized on a user-friendly, interactive web-based map. [ABSTRACT FROM AUTHOR]

Groundwater contamination remains a global threat due to its toxic effects to humans and the environment. The remediation of contaminated groundwater sites can be costly, thus, identifying the priority areas of concern is important to reduce money spent on resources. In this study, we aimed to identify and rank the priority groundwater sites in a contaminated petrochemical district by combining alternative, non-animal approaches – chemical analysis, cell-based high throughput screening (HTS), and Toxicological Priority Index (ToxPi) computational toxicology tool. Groundwater samples collected from ten different sites in a contaminated district showed pollutant levels below the detection limit, however, hepatotoxic bioactivity was demonstrated in human hepatoma HepaRG cells. Integrating the pollutants information (i.e., pollutant characteristics and concentration data) with the bioactivity data of the groundwater samples, an evidence-based ranking of the groundwater sites for future remediation was established using ToxPi analysis. The currently presented combinatorial approach of screening groundwater sites for remediation purposes can further be refined by including relevant parameters, which can boost the utility of this approach for groundwater screening and future remediation. [Display omitted] • Prioritization of groundwater sites in Taiwan using the ToxPi ranking tool. • Groundwater quality was assessed by coupled chemical analysis and bioassays. • No chemical contamination was found but some sites displayed high bioactivity. • ToxPi predicted the priority sites of concern by integrating chemical and toxicity data. • The approach and results can be beneficial for future groundwater management. [ABSTRACT FROM AUTHOR]

To operate a successful and growing business, a retail store manager has to make tough decisions about selectively closing underperforming stores. In this paper, we propose using a three-phase multiobjective mechanism to help retail industry practitioners determine which stores to close. In the first phase, a geographic information system (GIS) and k-means clustering algorithm are used to divide all the stores into clusters. In the second phase, stores can be strategically selected according to the requirements of the company and the attributes of the stores. In the third phase, a neighborhood-based multiobjective genetic algorithm (NBMOGA) is utilized to determine which stores to close. To examine the effectiveness of the proposed three-phase mechanism, a variety of experiments are performed, based partly on a real dataset from a stock-list company in Taiwan. Results from the experiments show that the proposed three-phase mechanism can help efficiently decide which store locations to close. In addition, the neighborhood radius has a considerable influence on the results. [ABSTRACT FROM AUTHOR]

Copyright of Irrigation & Drainage is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Irrigation & Drainage is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There are numerous means to improve the tilapia aquaculture industry, and one is to develop disease resistance through selective breeding using molecular markers. In this study, 11 disease-resistance-associated microsatellite markers including 3 markers linked to hamp2, 4 linked to hamp1, 1 linked to pgrn2, 2 linked to pgrn1, and 1 linked to piscidin 4 (TP4) genes were established for tilapia strains farmed in Taiwan after challenge with Streptococcus inae. The correlation analysis of genotypes and survival revealed a total of 55 genotypes related to survival by the chi-square and Z-test. Although fewer markers were found in B and N2 strains compared with A strain, they performed well in terms of disease resistance. It suggested that this may be due to the low potency of some genotypes and the combinatorial arrangement between them. Therefore, a predictive model was built by the genotypes of the parental generation and the mortality rate of different combinations was calculated. The results show the same trend of predicted mortality in the offspring of three new disease-resistant strains as in the challenge experiment. The present findings is a nonkilling method without requiring the selection by challenge with bacteria or viruses and might increase the possibility of utilization of selective breeding using SSR markers in farms. [ABSTRACT FROM AUTHOR]

Landslides induced by typhoon Morakot during its passage across Taiwan on 7-9 Aug 2009 claimed more than 700 lives and caused heavy economic loss. Unlike earthquake monitoring, precise locations of landslides could not be determined in near-real time because their seismic phases are difficult to identify. Here, we show that large, damaging landslide events are characterized seismically by a distinct waveform pattern of frequent intermixes of P and S waves over a time window of several tens of seconds. The predominant frequency band during these time windows ranges from 0.5 to 5 Hz. The high-frequency content is clearly deficient relative to that of local earthquakes by about one to two orders. We also demonstrate that large landslide events can be located and monitored with algorithms specifically designed for real-time seismic applications. This near-real-time monitoring capability would be particularly useful for emergency responders and government organizations to coordinate effective relief-and-rescue operations. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of the following factors on rider fatality: rider's age, gender, licensing status, accident liability, use of helmet, alcohol consumption, vehicle class, road conditions, presence of passengers, and passenger injuries. Methods: Data on motorcycle accidents in Taiwan between 2006 and 2008 were analyzed. A logistic regression model was used to establish a fatality risk model for motorcyclists and investigate high-risk factors for motorcyclist fatality. Results: Higher fatality rates among motorcycle riders correlate with the following factors: male, older, unlicensed, not wearing a helmet, riding after drinking, and driving heavy (i.e., above 550 cc) motorcycles. In addition, motorcyclists involved in nighttime, nonurban single-vehicle accidents have a higher risk of death, and lone riders have a higher risk of death in accidents than do riders carrying passengers. The seriousness of passenger injury also correlates positively with the rider's risk of death. Conclusions: Nearly 60 percent of all driving fatalities in Taiwan involve motorcycles. Consideration of factors behind the high frequency and risk of motorcycle deaths, specifically rider age above 60 years, not wearing a motorcycle helmet, riding after drinking, and driving without a valid license, could help in the development of effective traffic safety management measures. [ABSTRACT FROM AUTHOR]

Follicular lymphoma (FL) is a common lymphoma entity in adults but is rare in children. As opposed to adult cases, pediatric FL is characterized by a high-grade histology, low-stage disease, a lower frequency of both bcl-2 protein expression and BCL2 gene rearrangement, and a more favorable prognosis. During the authors' previous study of pediatric Burkitt lymphoma, they identified 3 cases of pediatric FL. Here the authors present the first series of pediatric FL from Taiwan. The patients were 2 boys and 1 girl, aged from 7 to 14. The presentation sites were cervical lymph node in 2 and tonsil in 1. All cases showed large neoplastic nodules comprising sheets of centroblasts, corresponding to grade 3b FL. Two of the 3 tumors weakly expressed bcl-2 protein. Fluorescence in situ hybridization for IGH, BCL2, BCL6, CCND1, and MYC loci showed that the only chromosomal translocation was rearranged IGH in 1 case. Two patients were at stage I, and 1 at stage III. All were treated with combination chemotherapy and achieved long-term complete remission. Literature review including the current cases showed that 45%% cases of pediatric FL expressed bcl-2 protein and 9%% cases carried BCL2 gene rearrangement, suggesting an alternate molecular pathogenesis of pediatric FL as compared to their adult counterparts. [ABSTRACT FROM AUTHOR]

Abstract: Managers in call centers use metrics to measure organizational performance; unfortunately, these metrics only reveal how well service agents process calls. To achieve substantial quality improvement, managers need to obtain in-depth information from operational metrics such as first call resolution (FCR). This research incorporated rough set theory (RST) in analyzing FCR to produce decision rules. RST has been known to reduce the number of attributes and attribute values without affecting the original results. Data from a tariff (industry segment) call center in Taiwan were used in this study, and a four-step process was used to produce the final decision rules. The results were verified by a 10-fold cross-validation process against the decision rules produced without applying RST. The decision rules produced with RST are as effective as those produced without, but with reduced number of attributes and attribute values. This reduced decision rule set can help managers analyze the current operator procedures more efficiently and subsequently improve the call center efficiency. Without affecting effectiveness, the RST application reduces the needed number of attributes and attribute values to produce a more compact decision rule set, and this increased efficiency, in turn, allows managers to delve deeper into the operational factors. [Copyright &y& Elsevier]

Objective: To evaluate whether variations in the CD103 gene could be associated with Graves'' ophthalmopathy (GO) in patients with Graves'' disease. Design: Case-control study. Participants: A total of 484 Chinese patients with Graves'' disease in Taiwan, including 203 patients with GO and 281 patients without GO, were enrolled. Methods: Five single nucleotide polymorphisms (SNPs) in CD103 were genotyped using an assay-on-demand allelic discrimination assay and detection system according to the manufacturer''s instructions. Main Outcome Measures: Association of SNPs in CD103 with the development of GO. Results: The CD103 SNP rs11652878 was associated with GO, which may decrease the risk of GO by 1.57-fold (P = 0.029). The Ht5-GCGCG haplotype, composed of 5 SNPs in the CD103 gene (rs1716, rs3744679, rs11652878, rs16953477, and rs9905739), were protective haplotypes (P = 0.010). Moreover, the heterozygous genotype (Ht5/non-Ht5) was correlated with a reduced risk of GO and high grades of goiter as compared with the non-Ht5/non-Ht5 genotype (P = 0.006 and P = 0.048, respectively). Logistic analysis confirmed the contribution of CD103 rs11652878 to the protection of GO. Conclusions: These data suggest that patients with Graves'' disease in the presence of the G allele of SNP rs11652878, especially Ht5-GCGCG, in CD103 are less susceptible toward the development of GO. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Abstract: We compile a comprehensive list of hypocentral locations and source parameters for earthquakes occurred in the Taiwan region. The collected database is used to construct 3D patterns of seismic deformation that are associated with various tectonic processes such as subduction and collision between the Philippine Sea plate and Eurasia. Specifically, we divide the entire Taiwan region into a 3D grid of 10km interval and the amount of seismic moment released at each point is the sum of all individual events in the vicinity. In case when the physical dimension of an earthquake is larger than 10km, the corresponding seismic moment is distributed across multiple grid points. This quantitative approach gives a better depiction on many first-order features in the region. The most intriguing one is that a significant deficit in the total amount of released seismic moment can be clearly identified around the Chi-Chi source region before the big earthquake occurred in 1999. The deficit trough is then filled by the seismic moment of the Chi-Chi earthquake sequence. This deficit-then-fill pattern in a region''s seismic moment distribution can be used as an indicator to pinpoint the locations of large earthquakes in the foreseeable future. Following this argument, we suggest that disastrous earthquakes with magnitudes comparable to that of the Chi-Chi earthquake are due for the two regions adjacent to the Chi-Chi source area (i.e., the Miaoli-Hsinchu domain to the north and the Chiayi domain to the south). [Copyright &y& Elsevier]

Background/purpose: A better understanding of the risk factors for medical malpractice is essential for implementing long-term prevention strategies. Certain physician characteristics have been reported to be associated with malpractice litigation. However, patient characteristics have not been fully investigated.Methods: We conducted a hospital-based case-control study. We reviewed a total of 147 cases in the inpatient risk management file (RMF) and 44,045 inpatient controls. The RMF was opened if the patient's complaint may have led to legal action. We compared demographic data of RMF cases and controls to investigate the risk factors for filing a complaint. Outcomes of the RMF cases were classified as resolution, compensation, and lawsuit.Results: RMF cases were associated with admission via the emergency room (odds ratio [OR]=1.62, p=0.005), surgical specialty (OR=1.86, p=0.001) and living in an urban area (OR=1.93, p<0.001). Once RMF cases were filed, living in an urban area was the only independent factor for filing a lawsuit (OR=4.10, p=0.007). RMF cases with medical injury were more likely to reach compensation (OR=10.51, p<0.001) and to receive significantly higher compensation (p=0.007). The severity of medical injury was correlated positively with the likelihood of reaching compensation and the amount of compensation. Only 15.0% of RMF cases entered the litigation phase.Conclusion: Patients with certain characteristics tend to file complaints, receive compensation, or bring a case to court. Understanding of patient characteristics may be useful for predicting occurrence and outcome of complaints against physicians. [ABSTRACT FROM AUTHOR]

Objectives The natural course of Parkinson’s disease (PD), as measured on the Hoehn-Yahr (H-Y) scale, and the impact that early detection would have on prognosis for those with the disease, has barely been addressed since the introduction of L-dopa. This study aimed to elucidate the natural history of PD and effectiveness of early detection in reducing advanced disability and mortality. Method A total of 21 362 participants aged 40 years or older were invited to two community-based programmes for the early detection of PD. The step-by-step annual progression rates from H-Y stage I to stage IV or V, and cumulative survival rates, by the H-Y scale, were estimated and applied to simulated data to assess the impact of different screening intervals upon stage at diagnosis and subsequent survival. Results The average duration in stages I, II and III was estimated as 2.83, 6.62 and 1.41 years, respectively. The average delay time before deteriorating into H-Y stage III was 9.45 year. Application of these parameters to simulated model predicted a 36% (95% CI: 28–39%), 26% (95% CI: 20–32%) and 19% (95% CI: 13–24%) reduction in death for annual, 5-yearly and 10-yearly screening programmes, respectively. Conclusion The present study recommended a 5-yearly screening programme, with 74% of PD cases prevented from progressing to H-Y stage III or worse within 10 years of diagnosis, and leading to a corresponding 26% reduction in mortality. [ABSTRACT FROM AUTHOR]

Background: Botulinum toxin type A (BoNT-A) for the treatment of patients with various forms of migraine has been studied, but there is a paucity of data regarding the use of BoNT-A in Asian headache patients. Our study was designed to evaluate the efficacy of BoNT-A in the treatment of transformed migraine (TM) in a population of Taiwanese patients. Methods: We retrospectively analyzed 30 patients who underwent BoNT-A treatment for TM from July 2003 to May 2004. Of 30 patients, 14 had palpable muscle tenderness (or tender points) in the pericranial region and 16 did not. All patients received injections into the corrugator, procerus, frontalis, and temporalis muscles (a total of 30 U), while a subset of TM patients with tender points (6 of 14 patients) also received injections to additional muscles based on a follow-the-tenderness approach (mean dose, 45 U). Results: Twenty-seven of the 30 patients (90%) surveyed reported effective relief of their symptoms with BoNT-A treatment (at least a 50% reduction in the number of headache days or in headache intensity). The greatest reduction in headache days per month and headache intensity was found in TM patients with tender points who received a mean dose of 45 U compared to those who received fixed-site dosing of 30 U. Conclusion: Our results suggest that BoNT-A may be an effective prophylactic treatment for TM in Taiwanese patients. Interestingly, similar efficacy was demonstrated in TM patients with tender points compared to those without tender points when an additional dose of BoNT-A was injected into the tender muscles in the former. [Copyright &y& Elsevier]

Abstract: To compare the health-related quality of life (HRQL) for patients with epilepsy and health subjects, we collected the clinical and demographic data and information on health states by using the Taiwan version of World Health Organization quality of life (WHOQOL)-BREF questionnaire in 296 patients (aged 19–73 years) with confirmed active epilepsy visiting the clinic of National Taiwan University Hospital, and 296 age-, gender-, municipal- and education-matched Taiwanese healthy subjects sampled from a national health interview survey. Multiple regression analyses with stepwise selection strategy were conducted to study risk factors for impairment of HRQL. Patients with epilepsy have poorer HRQL than the healthy population in physical, psychological and social domains but not in environment domain (p &#60;0.005). Patients with less than 4 attacks during the previous 1 month had a better score in the availability and quality of health and social care in environment domain than healthy subjects (p &#60;0.05). After controlling other determinants, seizure frequency, and comobid with other diseases are the important factors in predicting HRQL for epilepsy patients. Patients with employment and married had a significantly better HRQL. Effective control of seizure frequency and thoughtful promotion of positive attitudes in community are essential to improve the HRQL of epilepsy patients. [Copyright &y& Elsevier]

An epidemic of enterovirus 71 (EV71) infection compatible with hand, foot and mouth disease and associated with high morbidity and mortality occurred in Taiwan in 1998. We recruited 90 patients (50 males, 40 females) with definite EV71 infections for clinical and laboratory analysis. The neurological signs and symptoms, all of which occurred during the febrile period, in patients with central nervous system (CNS) involvement (aseptic meningitis, encephalitis or myelitis) were myoclonic jerks (23/33), vomiting (10/33), ataxia (7/33), lethargy (6/33), seizure (4/33) and tremor (2/33). Patients with CNS involvement had longer durations of fever (4.6 ± 0.2 vs. 3.1 ± 0.3 d; p< 0.01) and a higher white blood cell count (12,512 ± 658 vs. 10,607 ± 409 cells/mm[sup 3]; p= 0.01) than patients without CNS involvement. The case fatality rate in patients with CNS involvement was 4/33 (12%), whereas no fatalities (0/57) occurred in patients without CNS involvement. Six of 11 patients subjected to MRI showed a high intensity T2-weighted signal in the brainstem. A nested fluorescent RT-PCR for detection of virus in throat and stool specimens showed higher sensitivity than viral culture. Viremia was detectable using RT-PCR in 20% of cases (3/15), whereas no virus was isolated from culture or detected by RT-PCR in cerebrospinal fluid. [ABSTRACT FROM AUTHOR]

Busulfan has been used as a conditioning regimen in allogeneic hematopoietic cell stem transplantation (HSCT). Owing to a large inter-individual variation in pharmacokinetics, therapeutic drug monitoring (TDM)-guided busulfan dosing is necessary to reduce graft failure and relapse rate. As there exists no TDM of busulfan administration for HCT in Taiwan, we conducted a pilot study to assess the TDM-dosing of busulfan in the Taiwanese population; Seven patients with HCT from The Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, received conditioning regimens consisting of intravenous busulfan and other chemotherapies. After the initial busulfan dose, blood samples were collected for busulfan TDM at 5 min, 1 h, 2 h, and 3 h. Busulfan was extracted and detected by performing stable-isotope dilution LC–MS/MS. Plasma busulfan concentration was quantified and used for dose adjustment. Potential adverse effects of busulfan, such as mucositis and hepatic veno-occlusive disease (VOD), were also evaluated; The LC–MS/MS method was validated with an analyte recovery of 88–99%, within-run and between-run precision of <15%, and linearity ranging from 10 to 10,000 ng/mL. Using TDM-guided busulfan dosing, dose adjustment was necessary and performed in six out of seven patients (86%) with successful engraftments in all patients (100%). Mild mucositis was observed, and VOD was diagnosed in only one patient; This single-center study in Taiwan demonstrated the importance of busulfan TDM in increasing the success rate of HCT transplantation. It is also necessary to further investigate the optimal busulfan target value in the Taiwanese population in the future. [ABSTRACT FROM AUTHOR]

Background & Aims: Previous observational studies reported that concomitant use of clopidogrel and proton pump inhibitors (PPIs) in patients with prior acute coronary syndrome (ACS) was associated with adverse cardiovascular outcomes. We investigated whether H2-receptor antagonist (H2RA) is an alternative to PPI in patients with ACS. Methods: We conducted a population-based retrospective cohort study of 6552 patients in Taiwan discharged for ACS between 2002 and 2005. Patients were divided into 5 cohorts: clopidogrel plus H2RA (n = 252), clopidogrel plus PPI (n = 311), clopidogrel alone (n = 5551), H2RA alone (n = 235), and PPI alone (n = 203). The primary outcome was rehospitalization for ACS or all-cause mortality within 3 month of rehospitalization. Results: The 1-year cumulative incidence of the primary outcome was 26.8% (95% CI: 21.5%–33.0%) in the clopidogrel plus H2RA cohort and 33.2% (95% CI: 27.8%–39.4%) in the clopidogrel plus PPI cohort, compared with 11.6% (95% CI: 10.8%–12.5%) in the clopidogrel alone cohort (P < .0001). No significant difference was observed between the PPI alone cohort (11.0%; 95% CI: 7.1%–16.8%), the H2RA alone cohort (11.8%; 95% CI: 8.2%–16.8%), and the clopidogrel alone cohort in terms of the primary outcome. The number needed to harm was 7 with concomitant H2RA and 5 with concomitant PPI. On multivariate analysis, concomitant H2RA and PPI were independent risk factors predicting adverse outcomes (adjusted hazard ratios, 2.48 and 3.20, respectively; P < .0001). Conclusions: Concomitant use of clopidogrel and H2RA or PPI after hospital discharge for ACS is associated with increased risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: In order to evaluate the impacts of lifestyles on the newly developed Type 2 Diabetes and ensuing development of primary preventive interventions in high risk people, a nationally standardized, multi-professionally integrated, evidence-based and patient-center healthcare program-DCMP 2001 was implementing in a medical center, Mid-Taiwan. Materials and methods: From Jan. 2003 to Jan. 2004, 5404 diabetes beneficiaries were randomly and cumulatively recruited in DCMP 2001 via monthly outpatient visits. Accordingly, the lifestyle measurements (lifestyle I: no smoking, no alcoholic and regular exercise; lifestyle II: smoking and/or alcoholic and/or no exercise), total daily caloric intakes, macronutrient consumptions and dietary recommendations were tri-monthly recorded following adequate dietary history taking in each diabetes patient after seeing physician. From this cohort, all the newly developed diabetes (n=837) were randomly sorted out and further divided up into 6 groups with different age of onset of disease, ≤ 40 years, < 40 to ≤ 50 years, < 50 to ≤ 60 years, < 60 to ≤ 70 years, < 70 to ≤ 80 years and over 80 years for study. Comparisons between groups were performed by using Chi-Square test. The significant level was set at p<0.05. Results: The case and percentage distributions of lifestyle I and II at different age ranges in this newly developed T2DM cohort were shown on Table 1. It were statistically significant to demonstrate that the younger onset of diabetes, more than 70% of patients living on lifestyle If, whereas the older onset of diabetes, greater than 60% of patients sticking on lifestyle I ( p<0.0001). Comparison between exercisers and non-exercisers also shown that non-exercisers developed diabetes were significantly earlier than the exercisers (p<0.001). Conclusions: The aforementioned results clearly indicated that lifestyles and regular physical activity had significant impact on the development of diabetes. Therefore, for the primary prevention of the development of diabetes in high risk population, early lifestyle intervention would be strongly recommended. [ABSTRACT FROM AUTHOR]

Abstract: We integrated a regional tomography model, 20-year seismicity and earthquake focal mechanisms of the 4 March 2010 M L 6.4 Jiashian earthquake source region to delineate the seismogenic structure and mechanics of a relatively rare damaging inland earthquake that occurred in the southwestern fold-and-thrust belt of Taiwan. The main shock of the Jiashian earthquake occurred at a depth of 23km beneath the slate belt of the southern Central Range with a sinistral thrust mechanism. Based on seismic tomography and seismicity, the Jiashian earthquake sequence occurred in the Chishan transfer fault zone, which we interpret to be located near the transition zone between the subducted Eurasian plate to the south and the arc–continent Taiwan collision to the north. The distribution of the Jiashian aftershocks define a WNW-ESE striking fault plane that dips 30–40° NNE which is consistent with the optimal fault plane of the GPS-derived coseismic slip model. Focal mechanisms and inverted stress results of the earthquake sequence indicate both thrust and strike–slip motions with the maximum compressive stress at nearly 90° to the regional compressive stress and thus sub-parallel to the strike of the Taiwan orogen. We propose that the 2010 Jiashian earthquake resulted from rupturing of a buried oblique fault within the Chishan transfer fault zone at the subduction–collision transition zone in southern Taiwan. The orogen-parallel P-axis of the 2010 Jiashian earthquake represents collision-related lateral compression, although a local stress deviation is also possible. [Copyright &y& Elsevier]

Abstract: In this paper, we proposed a modified turbulent particle swarm optimization (named MTPSO) method for the temperature prediction and the Taiwan Futures Exchange (TAIFEX) forecasting, based on the two-factor fuzzy time series and particle swarm optimization. The MTPSO model can be dealt with two main factors easily and accurately, which are the lengths of intervals and the content of forecast rules. The experimental results of the temperature prediction and the TAIFEX forecasting show that the proposed model is better than any existing models and it can get better quality solutions based on the high-order fuzzy time series, respectively. [Copyright &y& Elsevier]

Abstract: The TAIFEX (Taiwan Stock Index Futures) forecasting problem has attracted some researchers’ attention in the past decades. Several forecast methods for the TAIFEX forecasting based either on the statistic theorems have been proposed, but their results are not satisfied. Fuzzy time series is used to doing forecasting but the forecasted accuracy still needs to be improved. In this paper we present a new hybrid forecast method to solve the TAIFEX forecasting problem based on fuzzy time series and particle swarm optimization. The experimental results show that the new proposed forecast model is better than any existing fuzzy forecast models and is more precise than four famous statistic forecast models. [Copyright &y& Elsevier]

The aim of this study was to investigate the association of intima media thickness (IMT) and plaque with risk factors for atherosclerosis in asymptomatic subjects in Taiwan. Between 1998 and 2001, the study recruited 1781 asymptomatic subjects (1131 men and 650 women [mean age, 49 years; range 18–85 years]). These were examined by B-mode ultrasound to measure the IMT at the far wall of the common carotid artery (CCA) and the extent of plaque formation. A wide range of vascular risk factors including age, gender, smoking, body mass index, blood chemistry, and previous history were surveyed. The mean (±S.D.) IMT observed was 0.68 (±0.12) and 0.66 (±0.11) mm for men and women, respectively, (P=0.0008). The mean (S.D.) IMT of the CCA was 0.66 (±0.12) mm on the right side and 0.68 (±0.12) mm on the left side (P=0.0004). IMT increased with aging, according to the equation IMT=(0.005×age in years)+0.043. Higher IMT was associated with male gender, and IMT was greater in the left CCA. About 36.9% of subjects had carotid plaques. The percentage of plaque increased with aging. The plaque prevalence was positively associated with IMT. The value of IMT over the cut point of 0.68 mm correlated with obviously increased risk of carotid atherosclerosis. Age, systolic blood pressure and fasting blood sugar were independent risk factors related to both carotid atherosclerosis and thick IMT. [Copyright &y& Elsevier]

Mopeds are a popular mode of transportation in Taiwan, yet collision accidents often lead to abrasion requiring medical attention. While hydrofiber foam dressing (HFD) have proven to help control exudates, reduce the frequency of dressing changes, and preserve more viable tissue, there is currently no established clinical guideline for the treatment of abrasion wounds with dressings. Therefore, the aim of this study was to investigate the clinical outcomes of abrasions treated with hydrofiber foam dressings. A total of 127 patients treated with HFDs between June 2018 and January 2021 were included in this study. Abrasions were categorized into 3 grades: grade I (n = 0) involving the epidermal layer, grade II (n = 89) involving the dermal layer, and grade III (n = 38) involving subcutaneous layer, bone or tendon. Statistical analysis showed that there was a significant difference in healing time (P < 0.001) and the number of outpatient department (OPD) visits (P = 0.013) between grade II and grade III. However, there was no significant difference in the number of dressing pieces used. This study offers a clinical reference for the use of hydrofiber foam dressings in treating different grades of abrasion wounds caused by moped accidents., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Human metallothionein-2A (MT2A) protein participates in metal homeostasis, detoxification, oxidative stress reduction, and immune defense. It decreases heavy metal ions and reactive oxygen species (ROS) during injury of cells and tissues. The single nucleotide polymorphisms at the MT2A gene have been associated in various human diseases including cancer. The current study aimed to elucidate associations between MT2A genotypes with the clinical, biochemical, and molecular characteristics that potentially related to lowered MT2A ex-pression. One hundred and forty-one healthy Taiwanese subjects were enrolled from Changhua Show-Chwan Memorial Hospital. Clinical, biochemical and molecular characteristics including the frequent minor allele SNPs, rs28366003 and rs10636, within the MT2A gene were determined. The genotype distribution of MT2A rs10636 fits the Hardy-Weinberg equilibrium. The significant associations with gradually decline of mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were identified with MT2A rs10636 and rs28366003 using analysis of variance (ANOVA) with Tukey's analysis as a post hoc test. We further validated the correlations between the expressions of genes in erythropoiesis, cholesterol synthesis, platelet synthesis, insulin with MT2A using the web-based Gene Expression Profiling Interactive Analysis (GEPIA) databases. The results revealed that hypoxia-inducible factor 1α (HIF-1α), erythropoietin (EPO), lipoprotein lipase (LPL), and lecithin-cholesterol acyltransferase (LCAT) mRNA ex-pression are significantly correlated with MT2A mRNA expression. In conclusion, these results suggested that genetic variations of MT2A rs10636 and rs28366003 might be an important risk factor for erythropoiesis in the Taiwanese general population., (© 2023. The Author(s).)

Rice blast caused by Magnaporthe oryzae is a dangerous threat to rice production and food security worldwide. Breeding and proper deployment of resistant varieties are effective and environmentally friendly strategies to manage this notorious disease. However, a highly dynamic and quickly evolved rice blast pathogen population in the field has made disease control with resistance germplasms more challenging. Therefore, continued monitoring of pathogen dynamics and application of effective resistance varieties are critical tasks to prolong or sustain field resistance. Here, we report a team project that involved evaluation of rice blast resistance genes and surveillance of M. oryzae field populations in Taiwan. A set of International Rice Research Institute-bred blast-resistant lines (IRBLs) carrying single blast resistance genes was utilized to monitor the field effectiveness of rice blast resistance. Resistance genes such as Ptr (formerly Pita2 ) and Pi9 exhibited the best and most durable resistance against the rice blast fungus population in Taiwan. Interestingly, line IRBLb-B harboring the Pib gene with good field protection has recently shown susceptible lesions in some locations. To dissect the genotypic features of virulent isolates against the Pib resistance gene, M. oryzae isolates were collected and analyzed. Screening of the AvrPib locus revealed that the majority of field isolates still maintained the wild-type AvrPib status but eight virulent genotypes were found. Pot3 insertion appeared to be a major way to disrupt the AvrPib avirulence function. Interestingly, a novel AvrPib double-allele genotype among virulent isolates was first identified. Pot2 repetitive element-based polymerase chain reaction (rep-PCR) fingerprinting analysis indicated that mutation events may occur independently among different lineages in different geographic locations of Taiwan. This study provides our surveillance experience of rice blast disease and serves as the foundation to sustain rice production.

Background: Patients with childhood cancer are at increased risk for the development of second cancers., Methods: A national multicenter survey of second cancers conducted by the Taiwan Pediatric Oncology Group retrieved retrospective data from the database at the Children Cancer Foundation in Taiwan beginning in 1995. The characteristics of second cancers and associations of patient demographic and clinical characteristics with time to death due to a second cancer were analyzed., Results: We examined the records of 8782 patients with a primary cancer diagnosed between January 1, 1995 and December 31, 2013, and a total of 99 patients with a second cancer were identified. The most common type of second cancer was acute myeloid leukemia (n = 35), followed by acute lymphoblastic leukemia (n = 15), central nervous system (CNS) tumors (n = 15), and sarcomas (n = 10). Secondary hematological malignancies occurred earlier than other secondary cancers. The frequencies of second CNS tumors and second bone cancers and sarcomas were notably increased when prior radiation doses increased from zero, low dose to high dose. The overall 5-year survival of patients with a second cancer was poor (33.7%). Multivariate survival analysis revealed that the year of primary diagnosis ≤2002, secondary hematological malignancies, and age at second cancer diagnosis ≤9.3 years or >26.8 years increased the risk of death following second cancer., Conclusion: Children who develop a second cancer have an unfavorable outcome. Early detection and improved treatment for second cancers are needed., Competing Interests: Declaration of competing interest The authors confirm that there is no conflict of interest to declare., (Copyright © 2021. Published by Elsevier B.V.)

There are numerous means to improve the tilapia aquaculture industry, and one is to develop disease resistance through selective breeding using molecular markers. In this study, 11 disease-resistance-associated microsatellite markers including 3 markers linked to hamp2 , 4 linked to hamp1 , 1 linked to pgrn2 , 2 linked to pgrn1 , and 1 linked to piscidin 4 ( TP4 ) genes were established for tilapia strains farmed in Taiwan after challenge with Streptococcus inae . The correlation analysis of genotypes and survival revealed a total of 55 genotypes related to survival by the chi-square and Z-test. Although fewer markers were found in B and N2 strains compared with A strain, they performed well in terms of disease resistance. It suggested that this may be due to the low potency of some genotypes and the combinatorial arrangement between them. Therefore, a predictive model was built by the genotypes of the parental generation and the mortality rate of different combinations was calculated. The results show the same trend of predicted mortality in the offspring of three new disease-resistant strains as in the challenge experiment. The present findings is a nonkilling method without requiring the selection by challenge with bacteria or viruses and might increase the possibility of utilization of selective breeding using SSR markers in farms.

Improvement in outcomes of children with acute myeloid leukemia (AML) is attributed to several refinements in clinical management. We evaluated treatment outcomes of Taiwanese pediatric AML patients in the past 20 years. Overall, 860 de novo AML patients aged 0-18 years and registered in the Childhood Cancer Foundation of R.O.C during January 1996-December 2019 were included. Survival analysis was performed to identify factors that improved treatment outcomes. Regardless of treatment modalities used, patients during 2008-2019 had better 5-year event-free survival (EFS) and overall survival (OS) rates than patients during 1996-2007. For patients received the TPOG-AML-97A treatment, only 5-year OS rates were significantly different between patients diagnosed before and after 2008. Patients with RUNX1-RUNX1T1 had similar relapse-free survival rates, but 5-year OS rates were better during 2008-2019. However, the survival of patients who received hematopoietic stem-cell transplantations (HSCT) did not differ significantly before and after 2008. For patients without relapse, the 5-year OS improved during 2008-2019. Non-relapse mortality decreased annually, and cumulative relapse rates were similar. In conclusion, 5-year EFS and OS rates improved during 2008-2019, though intensities of chemotherapy treatments were similar before and after 2008. Non-relapse mortality decreased gradually. Further treatment strategies including more intensive chemotherapy, novel agents' use, identification of high-risk patients using genotyping and minimal residual disease, early intervention of HSCT, and antibiotic prophylaxis can be considered for future clinical protocol designs in Taiwan.

Thyroid function may alter carbohydrate metabolism via influence of insulin, which may in terms of derangement of thyroid function and insulin function result in the development of type 2 diabetes mellitus (T2D). We investigated the association of thyroid disorders with T2D by a cohort study of the Taiwan nationwide health insurance database.A sub-dataset of the National Health Insurance Research Database (NHIRD) was used in this study. The thyroid disease (both hyper- and hypo-thyroidism) group was chosen from patients older than 18 years and newly diagnosed between 2000 and 2012. The control group consisted of randomly selected patients who never been diagnosed with thyroid disease and 4-fold size frequency matched with the thyroid disease group. The event of this cohort was T2D (ICD-9-CM 250.x1, 250.x2). Primary analysis was performed by comparing the thyroid disease group to the control group and the second analysis was performed by comparing the hyperthyroidism subgroup, hypothyroidism subgroup, and control group.The occurrence of T2D in the thyroid disease group was higher than the control group with hazard ratio (HR) of 1.23 [95% confidence interval (CI) = 1.16-1.31]. Both hyperthyroidism and hypothyroidism were significantly higher than control. Significantly higher HR was also seen in female patients, age category of 18 to 39-year-old (y/o) and 40 to 64 y/o subgroups. Higher occurrence of T2D was also seen in thyroid disease patients without comorbidity than in the control group with HR of 1.47 (95% CI = 1.34-1.60). The highest HR was found in the half-year follow-up.There was a relatively high risk of T2D development in patients with thyroid dysfunctions, especially in the period of 0.5 to 1 year after presentation of thyroid dysfunctions. The results suggest performing blood sugar tests in patients with thyroid diseases for early detection and treatment of T2D.

Background: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan., Methods: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study. The clinical data, treatment course, and outcomes were recorded. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Any intracerebral hemorrhage (ICH) after rt-PA was detected by neuroimaging studies., Results: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA 2 DS 2 -VASc score was 4.50 ± 1.57 and 8 patients (80%) received dabigatran 110 mg twice daily. All patients were treated with 5 g idarucizumab, following which the activated partial thromboplastin time normalized. Intravenous rt-PA (mean dose .78 mg/kg) was initiated a mean time of 11.11 minutes after idarucizumab infusion. The NIHSS score improved significantly after thrombolysis (16.0 ± 6.67 at admission to 9.38 ± 4.75 at discharge, P = .016). ICH developed in 3 patients (30%). Two of them were asymptomatic and 1 patient suffered from symptomatic ICH leading to mortality., Conclusion: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab., (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

The duty of medical personnel is to save lives, cure diseases, relieve suffering, and promote health. Medical personnel care for their patients from birth to death. At the end of terminal care, medical personnel should maintain a religious / holistic commitment to their patients to "remove their suffering and provide happiness" as much as possible. Mackay Hospital opened the first hospice in Taiwan in 1990. Financial coverage of hospice care by the National Health Insurance, the enactment of the Hospice Palliative Act, the attention of Hospital Accreditation to hospice care, and the establishment of the system of clinical chaplaincy have all contributed to the development of hospice palliative care in Taiwan. Application of the Taiwan Coma Scale has been shown to decrease the use of futile life sustaining treatments in the ICU. The author hopes that nurses may further expand community hospice care services to help facilitate the peaceful dying of terminal patients at home.

Objectives: To describe the efficacy of long-term oral steroids in idiopathic sudden sensorineural hearing loss (ISSHL), and to explore potential prognosis factors, the relationship of hearing recovery outcome, and the recovery time-course in ISSHL., Methods: In this retrospective study, we analyzed 215 cases diagnosed with idiopathic unilateral sudden deafness between January 2003 and December 2012 at a regional hospital in southern Taiwan. All of them received oral steroid therapy and were followed for at least 3 months., Results: Young age, the presence of no other disease (diabetes, hypertension, or cardiovascular disease), treatment within 7 days of the onset of ISSHL, mild hearing loss, and audiograms with ascending curves had a statistically significant better hearing recovery. The average pure-tone audiometry (PTA) was 67.8±23.9 dB initially, and was improved between one month (51.6±28.7 dB) and 2 months post treatment (49.7±28.6 dB). The average last-visit PTA was 49.9±29.2 dB., Conclusion: Approximately one third of patients had full recovery in hearing, one third had partial recovery, and approximately one third did not recover from hearing loss. In addition, the hearing level remained relatively stable following 2 months of treatment. More than 2 months of oral steroid therapy for ISSHL is not recommended because no additional benefits were evidenced.

Background: Glucose intolerance in patients with amyotrophic lateral sclerosis (ALS) has been inconsistently reported. Evidence for the association of ALS and diabetes mellitus is limited. We aimed to assess the overall and age- and sex-specific risks of ALS among patients with diabetes in Taiwan., Methods: The study cohort included 615 492 diabetic patients and 614 835 age- and sex-matched subjects as a comparison cohort, followed from 2000 to 2008. We estimated the incidence densities of ALS and calculated the relative hazard ratios (HRs) of ALS (ICD-9-CM 335.20) in relation to diabetes using a Cox proportional hazard regression model, with adjustment for potential confounders, including sex, age, geographic area, urbanization status, Charlson Comorbidity Index, frequency of medical visit, and histories of hypertension, hyperlipidemia, and chronic obstructive pulmonary disease., Results: Over a 9-year period, 255 diabetic and 201 non-diabetic subjects developed ALS, corresponding to incidence densities of 7.42 and 5.06 per 100 000 person-years, respectively. After adjustment for potential confounders, patients with diabetes experienced a significantly elevated HR of 1.35 (95% confidence interval [CI], 1.10-1.67). A higher covariate adjusted HR was noted in men (HR 1.48; 95% CI, 1.13-1.94) than in women (HR 1.17; 95% CI, 0.84-1.64), while men aged ≤65 years showed the most increased HR of 1.67 (95% CI, 1.18-2.36)., Conclusions: This study demonstrated a moderate but significant association of diabetes with ALS onset, and such association is not confounded by socio-demographic characteristics or certain ALS-related co-morbidities. Further studies are warranted to examine whether the findings observed in our study can be replicated.

A human life demand set to emerge in the future is the achievement of sustainability by maintaining a comfortable indoor environment without excessive reliance on energy-consuming air conditioners. The major research processes in this study are: (1) measuring indoor air quality and thermal comfort to evaluate the comfort of an indoor environment; (2) implementing questionnaire survey analysis to explore people's environmental self-perceptions and conducting a meta-analysis of the measurement results for air quality and physical aspects; and (3) constructing an indoor monitoring and management system. The experimental and analysis results of this research reveal that most of the office occupants preferred a cooler environment with a lower temperature. Additionally, because the summers in Taiwan are humid and hot, the occupants of an indoor space tend to feel uncomfortable because of the high humidity and poor indoor air quality. Therefore, Variable Air Volume (VAV), two air intakes, and exhaust plant are installed to improve indoor environment. After improvement, a lower temperature (approximately 21.2-23.9°C) indirectly reduces humidity, thereby making the occupants comfortable. Increasing air velocity to 0.1~0.15 m/s, the carbon dioxide concentrations decrease below the requirement of the WHO. Ninety-five percent of the workers corresponded to the standard comfort zone after this improvement.

Technology-enabled support services for diabetes can fulfill patient demand to care for diabetes independently. Patients benefit from such services after greater adoption of the services in healthcare systems. Unfortunately, conventional service development fails to thoroughly understand patient care support, making it difficult to achieve the desired design, and posing substantial challenges in adopting these services. Thus, previously developed services in many cases are not as patients expected, as evidenced by their low acceptance among patients. To solve this problem, adequate strategies must be developed by incorporating theoretical knowledge as a solid foundation in order to improve service design. This study develops technology-enabled diabetes support services based on the self-care theory. A set of self-care service scenarios is also established and combined with theoretical concepts. The developed services consist of a nurse-led consultation service and a mobile application service. Additionally, user acceptance is confirmed by assessing patient perceptions of the diabetes support services in a group of patients with diabetes (N=27). Results of analysis reveal that patients respond favorably toward the services. Patient preference and perceived ease of use attest to their intention to use the services. Greater adoption of the services can be anticipated, owing to a higher levels of preference and higher perceived ease of use. This study demonstrated that the self-care theory can be linked to nursing informatics research and chronic care clinical practices.

Background: In radiology, it is significantly important to produce adequate diagnostic information while minimally affecting the patient with the lowest amount of dose. A contrast-detail phantom is generally used to study the quality of image and the amount of radiation dose for digital X-ray imaging systems. To evaluate the quality of a phantom image, radiologists are traditionally required to manually indicate the location of the holes in each square in the phantom image. Then, the image quality figure (IQF) of the image can be evaluated. However, evaluation by the human eye is subjective as well as time-consuming, and it differs from person to person., Methods: In this paper, an image processing-based IQF evaluator is proposed to automatically measure the quality of a phantom image. Nine phantom images, each consisting of 2382 × 2212 pixels, were used as test images and were provided by Taichung Hospital, Department of Health, Executive Yuan, Taiwan, Republic of China. The IP-IQF evaluator separates the phantom image into squares and then stretches the contrast of each square to the range 0-255. After that, it splits each square into 3 × 3 equal-sized regions, and recognizes the pattern of the square based on the features computed by mean-difference gradient operation and run length enhancer. Furthermore, a genetic algorithm-based parameter values-detecting algorithm is presented to compute the optimal values of the parameters used in the IP-IQF evaluator., Results: The experimental results demonstrate that CoCIQ and the IP-IQF evaluator can efficiently measure the IQF of a phantom image. The IP-IQF evaluator is more effective than a radiologist and CoCIQ in evaluating the IQF of a phantom image., Conclusions: The proposed IQF evaluator is more sensitive than not only the observation of radiologists but also the computer program CoCIQ. Moreover, a genetic algorithm is provided to compute the most suitable values of the parameters used in the IQF evaluator., (Copyright © 2011 John Wiley & Sons, Ltd.)

Objective: This study evaluates whether B7 molecules (CD80 and CD86) could be used as genetic markers for the development of Graves' ophthalmopathy (GO)., Design: Cross-sectional study., Participants: We included 471 patients with Graves' disease (GD; 200 patients with GO and 271 patients without GO) in a Chinese population in Taiwan., Methods: An endocrinologist with substantial experience in thyroid diseases identified GO. Blood samples were taken for DNA extraction from GD subjects. The gene polymorphism of CD80 and CD86 was genotyped by polymerase chain reaction in each patient., Main Outcome Measures: Genotypes of CD80 and CD86 polymorphism., Results: We found that the frequency of C allele at position rs&#95;9831894 of the CD86 gene is different in patients with GD (with and without GO; chi-square test, P = 0.0017). In addition, the multifactor dimensionality reduction method was used to identify the best gene-gene interaction to predict the risk of GO. We identified an interaction between CD80&#95;rs9289131 and CD86&#95;rs9872483 (sign test, P = 0.0010). Moreover, the G-A haplotype was shown to have a protective effect in the development of ophthalmopathy among patients with GD (odds ratio, 0.63; 95% confidence interval, 0.44-0.90). Moreover, among patients with GO, the patients carrying the G-A haplotype had a lower level of free thyroxine T(4) than those not carrying the G-A haplotype (P = 0.0001)., Conclusions: These results suggest that the polymorphisms of the CD86 gene may be used as genetic markers for making the diagnosis and prognosis of GO. Therefore, GO could be a disease with complex genetic factors, resulting from the existing gene-gene interaction found in the present study., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: the C-type lectin DC-SIGN (CD209) is known to be the major dengue receptor on human dendritic cells, and a single nucleotide polymorphism (SNP) in the promoter region of CD209 (-336 A/G; rs4804803) is susceptible to many infectious diseases. We reason that variations in the DC-SIGN gene might have a broad influence on viral replication and host immune responses., Methods and Findings: we studied whether the rs4804803 SNP was associated with a susceptibility to dengue fever (DF) and/or dengue hemorrhagic fever (DHF) through genotyping analysis in a Taiwanese cohort. We generated monocyte-derived dendritic cells (MDDCs) from individuals with AA or AG genotype of rs4804803 to study the viral replication and immune responses for functional validation. A total of 574 DNA samples were genotyped, including 176 DF, 135 DHF, 143 other non-dengue febrile illnesses (OFI) and 120 population controls. A strong association between GG/AG genotypes of rs4804803 and risk of DHF was found when compared among DF, OFI and controls (p = 0.004, 3×10(-5) and 0.001, respectively). The AA genotype was associated with protection against dengue infection compared with OFI and controls (p = 0.002 and 0.020, respectively). Moreover, MDDCs from individuals with AG genotype with a higher cell surface DC-SIGN expression had a significantly higher TNFα, IL-12p40, and IP-10 production than those with AA genotype in response to dengue infection. However, the viral replication in MDDCs with AG genotype was significantly lower than those with AA genotype. With both genotypes, MDDCs revealed an increase in viral replication following the addition of anti-IP-10 neutralizing antibody., Conclusions/significance: the rs4804803 SNP in the CD209 promoter contributed to susceptibility to dengue infection and complication of DHF. This SNP with AG genotype affects the cell surface DC-SIGN expression related to immune augmentation and less viral replication.

Purpose: To evaluate whether variations in the IL1B gene could be associated with Graves' ophthalmopathy (GO) in patients with Graves' disease (GD)., Method: This case-control study included 471 Taiwan Chinese patients with GD (200 with GO and 271 without GO) and 160 healthy volunteers. Eight single-nucleotide polymorphisms (SNPs) in IL1B were genotyped with an allele-specific extension and ligation assay., Results: In the IL1B SNPs examined, the C allele of rs1143634 was associated with GD, whereas the T/T genotype of the SNPs rs1143634 and rs16944 were less associated with the disease. The A/A genotype of the SNPs rs3917368 and rs1143643, which had the strongest interaction, may increase the risk of GO (P = 0.024 and P = 0.017, respectively). Several GD susceptibility and insusceptibility IL1B haplotypes have been identified, and the Ht4-GCGCCTCC haplotype, composed of eight SNPs and associated with low circulating IL1β levels, may be protective against the development of GO (P = 0.025). Moreover, that the GO-susceptible genotype was associated with lower plasma IL1β concentrations implies that the origin of GO may go beyond the IL1B polymorphism-associated elevation of circulating IL1β., Conclusions: The data for IL1B polymorphisms and the association of GD and GO with plasma IL1β levels show that IL1B polymorphisms may be associated with the development of GD and GO.

Background: Toll-like receptors (TLRs) are a family of pattern-recognition receptors, which plays a role in eliciting innate/adaptive immune responses and developing chronic inflammation. The polymorphisms of TLRs have been associated with the risk of various autoimmune diseases, including systemic lupus erythematosus (SLE), multiple sclerosis and rheumatorid arthritis. The aim of this study was to evaluate whether TLR genes could be used as genetic markers for the development of Graves' ophthalmopathy (GO)., Methods: 6 TLR-4 and 2 TLR-9 gene polymorphisms in 471 GD patients (200 patients with GO and 271 patients without GO) from a Taiwan Chinese population were evaluated., Results: No statistically significant difference was observed in the genotypic and allelic frequencies of TLR-4 and TLR-9 gene polymorphisms between the GD patients with and without GO. However, sex-stratified analyses showed that the association between TLR-9 gene polymorphism and GO phenotype was more pronounced in the male patients. The odds ratios (ORs) was 2.11 (95% confidence interval [CI] = 1.14-3.91) for rs187084 AàG polymorphism and 1.97 (95% CI = 1.07-3.62) for rs352140 AàG polymorphism among the male patients. Increasing one G allele of rs287084 and one A allele of rs352140 increased the risk of GO (p values for trend tests were 0.0195 and 0.0345, respectively). Further, in haplotype analyses, the male patients carrying the GA haplotype had a higher risk of GO (odds ratio [OR] = 2.02, 95% confidence interval [CI] = 1.09-3.73) than those not carrying the GA haplotype., Conclusion: The present data suggest that TLR-9 gene polymorphisms were significantly associated with increased susceptibility of ophthalmopathy in male GD patients.

Purpose: We aimed to quantify the mortality reduction by which the early detection of Parkinson's disease (PD) within a community-based study could reduce the number of advanced cases., Methods: Data used in this study were derived from two community-based surveys and from a clinical series of PD cases identified from a medical centre. The cumulative survival by Hoehn-Yahr (H-Y) scale was estimated and the mortality reduction derived from a community-based survey was predicted., Results: A total of 117 PD patients were detected through two community-based approaches. By comparing the H-Y stage distribution of screen-detected cases with those from the clinical series, a 22.5% excess in the number of early PD (H-Y stage I and stage II) were identified with screening. The risk ratios of being H-Y stage III or severe for community-based detected cases versus clinical series were 0.49 (95% confidence interval: 0.30-0.78). The total death rate adjusted by H-Y stage distribution was 21% and 28% for cases from community and clinical series, respectively., Conclusions: The present study revealed that early detection of PD through a community-based survey may reduce 51% incidence of stage III or more severe PD at diagnosis, leading to a 25% reduction in mortality.