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Background: Clinical information about bacteremic pneumonia caused by extended-spectrum beta-lactamase (ESBL)-producing organism is limited., Methods: A retrospective study was conducted at two medical centers in Taiwan. From May 2002 to August 2010, clinical information and outcome of adults with bacteremic pneumonia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae were analyzed. The primary outcome is the 30-day mortality., Results: A total of 111 patients with bacteremic pneumonia caused by E. coli (37 patients, 33.3%) and K. pneumoniae (74, 66.7%) were identified. Their mean age was 69.2 years and 51.4% were male patients. Fifty-seven (51.3%) episodes were classified as hospital-acquired infections, 19 (17.1%) as health-care-associated infections, and four (3.6%) as community-acquired infections. Fifty-one (45.9%) patients received appropriate empiric antimicrobial therapy. The 30-day mortality rate was 40.5% (45 patients). In the multivariate analysis, several independent risk factors, including rapidly fatal underlying disease [odds ratio (OR), 5.75; 95% confidence interval (CI), 1.54-21.48; p = 0.009], severe sepsis (OR, 4.84; 95% CI, 1.55-15.14; p = 0.007), critical illness (OR, 4.28; 95% CI, 1.35-13.57; p = 0.013), and receipt of appropriate empirical therapy (OR, 0.19; 95% CI, 0.07-0.55; p = 0.002), were associated with 30-day mortality. The survival analysis consistently found that individuals with appropriate empiric therapy had a higher survival rate (log-rank test, p < 0.001)., Conclusion: ESBL-producing bacteremic pneumonia, especially health-care-associated infections, often occurred in adults with comorbidities. Appropriate empirical therapy was associated with a favorable outcome., (Copyright © 2014. Published by Elsevier B.V.)

Surface data of meteorological parameters (wind speed, wind direction, and mixing height) and air pollutant concentrations (O3, NO, and NO2) were collected for a 92-day period associated with typhoon formation in 2005. The influence of typhoons on O3 concentration were defined by azimuth and distance from Taiwan, and Types A, B, and C correspond to typhoons less than 1,500 km from Taiwan and located between azimuths 45° and 135°, 135° and 225°, and 225° and 45°, respectively. Type D corresponds to typhoons more than 1,500 km from Taiwan. Titration reactions were conducted at three temporal phases: 2000-0700, 0800-1100, and 1200-1400 LST (Local Standard Time). The air pollution model (TAPM) was used to simulate wind fields and trajectories of air masses. It was determined that typhoon position affected O3 concentration, temporal and spatial patterns of O3 titration and vertical meteorological characteristics, which were not all at the statistically significant level.

Purpose: Gluten sensitivity (GS) is related to the pathogenesis of sporadic or hereditary ataxia., Methods: Total of 194 healthy controls and patients with either hereditary ataxia (n=207) or sporadic ataxia (n=361) were tested for the circulating gluten-related autoantibodies which serve as biomarkers to interpret the existence of GS., Results: The incidences of GS in each population were 1% in normal subjects, 2% in hereditary ataxia patients and 9% in sporadic ataxia patients. High serum level of anti-gliadin IgG/IgA and t-transglutaminase IgA were disclosed at the sporadic ataxia patients compared with normal subjects. However, the anti-gliadin IgG is more specific to the disease of sporadic ataxia., Conclusion: Relatively higher incidence of GS was found in the population of sporadic ataxia patients but not in either normal subjects or hereditary ataxia patients in Taiwan. Anti-gliadin IgG still is a very powerful indicator to implicate the immune-related sporadic ataxia and we conclude that GS-related sporadic ataxia exists in Taiwan with linkage to autoimmune events.

We investigated the molecular epidemiology and OXA-type carbapenemase genes of 83 imipenem-resistant Acinetobacter spp. collected from 2 university hospitals (hospitals A and B) and a regional hospital (hospital C) during 2007 in Taiwan. Genotyping by pulsed-field gel electrophoresis identified 51 pulsotypes. None of the pulsotypes established predominance throughout the 3 hospitals. Multiplex polymerase chain reaction of blaOXA genes showed that 100% (18/18), 91%(31/34), and 100% (31/31) of the Acinetobacter spp. collected from hospital A, B, and C, respectively, possessed blaOXA-51-like genes. None of the strains carrying blaOXA-23-like and blaOXA-24-like genes were found in hospital A. The coexistences of blaOXA-51-like/blaOXA-23-like and blaOXA-51-like/blaOXA-24-like genes detected in hospitals B and C were 26% (9/34) and 12% (4/34) and 58% (18/31) and 3% (1/31), respectively. Among blaOXA-23-like gene-carrying isolates collected from hospitals, clonal spread of strains carrying the blaOXA-23 gene was detected in the regional hospital but not the other 2 university hospitals. The results suggest that interhospital dissemination of imipenem-resistant Acinetobacter spp. was not found in these hospitals. The increasing percentage of OXA-23 in OXA-type carbapenemases in Acinetobacter spp. from the regional hospitals to medical centers deserves further attention in Taiwan., (2010 Elsevier Inc. All rights reserved.)

The aim of the study discussed here was to determine the associations among the urban heat island (UHI), air quality, and hospital respiratory admissions in the warm center of an urban area. The authors collected and analyzed the data regarding air quality parameters, meteorological parameters, and the daily hospital respiratory admissions in the Taichung metropolis in the autumns of 2003 and 2004. By collecting the vertical meteorological parameters and air pollutant concentrations via the tethersonde balloon technique, the authors simulated convergence in Dali using The Air Pollution Model (TAPM) for the atmospheric conditions. The authors also examined the hypotheses with Duncan's Multiple Range test, and analyzed spatial patterns vis-à-vis air temperature, air quality, and hospital respiratory admissions with GIS. The results indicated that the UHI phenomenon-which generates convergence and then transports air pollutants to a metropolitan area-increases hospital respiratory admissions in the warm center of an urban area.

The objective of this study was to assess the temporal and spatial patterns of air quality during Asian dust storm (ADS) events between 2000 and 2004, as well as their correlation with the frequency of respiratory admissions in the clinics and hospitals of metropolitan Taipei, Taiwan. The daily air pollutant concentrations and the respiratory admissions on the "index days" were compared with those on the "comparison days". A Geographical Information System (GIS) was used to map the distributions of the air pollutant concentrations and the respiratory admissions. The results showed that short duration ADS events caused a larger Revised Air Quality Index (RAQI) than the long duration ADS events. PM10 and O3 concentrations significantly increased on the first two days of ADS events. The areas showing significant increases in respiratory admissions did not match well with the areas with the most significant air quality deterioration.

Air pollution indices are commonly used to indicate the level of severity of air pollution to the public. The Pollution Standards Index (PSI) was initially established in response to a dramatic increase in the number of people suffering respiratory irritation due to the deteriorating air quality. The PSI was subsequently revised and implemented by the USEPA in 1999, and became known as the Air Quality Index (AQI) that includes data relating to particle suspension, PM2.5, and a selective options of either 8-hour or 1-hour ozone concentration during increased O3 periods. Yet, the costs of launching a network of PM2.5 monitoring stations are prohibitively high for many countries to implement the AQI from the PSI system in the foreseeable future. Therefore, the purpose of this research is to discuss the optimal method of assessing air quality using the latest developed Revised AQI (RAQI), a system that serves as an alternative to the PSI and AQI systems. The feasibility, effectiveness, and the differences between RAQI, AQI, and PSI in their applications to several air pollution conditions are also studied in this research. The results show that southern Taiwan's suspended particulates have significantly greater impact on PM2.5/PM10 ratios than in central and northern metropolitan areas, and that the ratios are higher in Taiwan as a whole compared to many other countries. We also found that the RAQI shows more significant results compared to the PSI and AQI as it has a wider coverage of the range of pollutant concentration levels.

Objectives: We investigated whether mutation of mitochondrial DNA (mtDNA) affects the copy number of the mitochondrial genome in patients with mitochondrial myopathy encephalopathy with lactic acidosis and stroke-like episodes (MELAS) and those with myoclonic epilepsy with ragged-red fiber (MERRF) syndromes., Materials and Methods: Forty-eight Taiwanese patients with MELAS syndrome and 20 patients with MERRF syndrome were recruited in this study., Results: In relation to controls, the copy numbers of mtDNA in leukocytes of patients with MELAS or MERRF syndrome were significantly higher at a young age but lower at an advanced age. In addition, MELAS patients harboring higher proportions of mtDNA with A3243G transition had lower mtDNA copy numbers. The MELAS or MERRF patients with multi-system disorders had lower mtDNA copy numbers in leukocytes. Furthermore, higher proportions of mtDNA with 4977 bp deletion were found in leukocytes of MERRF patients with multi-system involvement., Conclusion: In leukocytes, alteration in the copy number of mtDNA is related to the proportion of mtDNA with a point mutation or large-scale deletion, which may serve as a biomarker in the pathogenesis and disease progression of MELAS and MERRF syndromes.

The COII/tRNA(Lys) intergenic 9-bp deletion (MIC9D) of mitochondrial DNA (mtDNA) has been established as a genetic polymorphism for Asian-Pacific populations. We investigated whether this small mtDNA deletion is co-transmitted with human diseases such as mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) and myoclonic epilepsy with ragged-red fibers (MERRF) syndromes. Forty unrelated Taiwanese families, including 12 families with MERRF and A8344G mtDNA mutation and 28 families with MELAS and A3243G mutation of mtDNA, respectively, were recruited in this study. In addition, 199 healthy subjects were recruited as control. We found that the frequency of occurrence of mtDNA with the MIC9D polymorphism in healthy subjects was 21% (41/199). However, the incidence of the MIC9D polymorphism was 67% (8/12) among the probands of all the families with MERRF syndrome (P = 0.001; OR = 8) and 39% (11/28) among the probands of the families with MELAS syndrome (P = 0.038; OR = 2). This finding indicates that the frequency of occurrence of mtDNA with the MIC9D polymorphism in patients with MERRF or MELAS syndrome is higher than that of healthy subjects. The prevalence of mitochondrial encephalomyopathies in relation to the MIC9D polymorphism of mtDNA in Taiwanese population is discussed.

Sulphur dioxide (SO2) is one of the main atmospheric pollutants in central Taiwan. This article analyses the SO2 concentration seasonal variations and spatial distribution using data obtained from ten air quality monitoring stations and the Taiwan Weather Bureau. It reveals that SO2 concentration is high in winter and low in summer and that high concentration centers are located south of the Taichung coal-fired power plant, the main source of SO2 emissions in the region. The location of high concentration centers changes with different prevailing winds. SO2 variations due to wind direction are not unique. During short periods, when meteorological conditions are constant, variation in the pollution sources cause variations in the spatial distribution. This has been deduced by appreciation of 'Intervention analysis' to time series of hourly data.