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The deep scattering layer (DSL), a stratum of the marine diel vertical migration (DVM) organisms inhabiting the mesopelagic ocean, plays a crucial role in transporting carbon and nutrients from the surface to depth through the migration of its organisms. Using 18 months of in-situ observations and altimeter sea level data, we reveal for the first time the intraseasonal variations and underlying mechanisms of the DSL and the DVM to the east of the Taiwan Island. Substantial vertical speeds acquired from the Acoustic Doppler Current Profiler were used to examine the distribution and variation of the DVM. Innovatively, the results for the power spectrum analysis of the scattering intensity demonstrated a significant intraseasonal variability (ISV) with an 80- day period in the DSL. Furthermore, the variation in the DVM was closely linked to the DSL and showed an 80-day ISV during the observation. A dynamic relationship between the ISV of the DSL east of Taiwan Island and the westward-propagating mesoscale eddies was established. Anticyclonic (cyclonic) eddy movement toward Taiwan Island triggers downward (upward) bending of the local isotherms, resulting in a layer of DSL warming (cooling) and subsequent upper boundary layer deepening (rising). These findings underscore the substantial influence of mesoscale eddies on biological activity in the mesopelagic ocean, establishing a novel understanding of ISV dynamics in the DSL and their links to eddy-induced processes. [ABSTRACT FROM AUTHOR]

Background: This short term structured, multimodal, home-based, self-help program was designed to reduce frailty of elderly type 2 diabetes mellitus (T2DM) patients, and detect the major predictors of frailty status improvement. Method: This study recruited T2DM patients aged 65 years and older from the DM shared care center in a regional hospital who were frail or prefrail according to Fried Frailty Phenotype. Short term (12 weeks) home-based intervention including an elastic band low resistance exercise, a smart bracelet monitored walking exercise, and nutrition consultation was conducted. Change of frailty status, functional outcomes, body composition and metabolic indices after intervention were analyzed. A logistic regression was applied to determine the predictive factors associated with frailty status improvement. Results: 81 participants were enrolled after they were fully consented. After 12 weeks' intervention, 60 participants completed the program. Since two participants with incomplete data were excluded, there were 58 remaining in the analysis. They were on average 71.7 ± 4.9 years old and 22 persons (36.7%) were male. 46 (79.3%) of them were prefrail and 12 (20.7%) were frail. The average duration between the pre-test and the post-test was 107.1 ± 25.6 days. The average incidence of home-based exercise was 1.4 ± 1.1 times a week. Fried Frailty Phenotype, handgrip strength, muscle quality, HbA1c, and symptomatic hypoglycemic episodes significantly improved. Initial poorer frailty status was the major predictor (OR = 104.446, 95% CI = 7.551-1444.726, p = 0.001) of frailty status improvement. Conclusions: Short term structured, multimodal, interdisciplinary, home-based, self-help program is effective in reducing frailty status among elderly T2DM patients. [ABSTRACT FROM AUTHOR]

Since the first outbreak of COVID-19 in December 2019, numerous countries have experienced waves of outbreaks that have had severe social, economic, and political effects. Many medical and anthropological studies have suggested that tribes and elders in rural and indigenous villages became isolated from the outside world due to a lack of resources and because of cultural constraints. On January 22, 2020, the first confirmed case of COVID-19 in Taiwan was discovered. As of October 23, 2022, 7,476,478 confirmed cases have been reported; of these, only 64,298 were in Taitung County, making it the region with the fewest cases in Taiwan. In this ethnographic study, I visited indigenous tribes in Taiwan that were less affected during the pandemic, conducted indepth interviews with tribal-care providers, and collected secondary data from reports and social media regarding pandemic prevention on tribes in Taitung County. I also explored the difficulties created by the suspension of tribal-care services due to pandemic-related social distancing and isolation measures, and how care providers overcame these challenges. COVID-19 is not the first and nor will it be the last virus to threaten humans. Thus, it is important to gain insight into how care networks and connections were rebuilt through innovative measures that enabled tribal elders to receive culturally sensitive care and maintain their health during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Human adenovirus 7 (HAdV-7) was responsible for a significant number of fatalities during the 2011 community outbreak in Taiwan. The mechanisms underlying the pathogenesis of severe adenovirus infections in non-immunocompromised individuals remain unclear. Adenovirus pneumonia was associated with pleural effusion in a number of patients from the 2011 outbreak suggesting that similar to bacterial pneumonia, patients diagnosed with adenovirus pneumonia who have pleural effusion are more severely and systemically infected, and may have a more protracted disease course. We hypothesized that the host immunological response determines the severity of adenoviral infection.Methods: This retrospective case series study included patients diagnosed with severe lower respiratory tract infections at the National Cheng Kung University Hospital in southern Taiwan between December 2010 and October 2011. The main inclusion criteria were 1) presence of multifocal patchy infiltrates, lobar consolidation or reticular interstitial opacities in chest X-rays, and 2) presence of adenovirus isolated from respiratory specimens. All patients had adenovirus isolated from respiratory specimens, and were negative for other viruses. Pleural effusion was confirmed in all patients using chest echography. Clinical features and laboratory data were compared in patients with (n = 12) and without (n = 15) parapneumonic effusion.Results: Presence of parapneumonic effusion was significantly associated with a longer febrile duration, more complicated clinical management, and a greater risk of extrapulmonary involvement, notably hepatitis. Patients without pleural effusion had significantly higher numbers of WBCs, platelets, and absolute segment cell counts (ASCs) compared to patients with pleural effusion (all p < 0.05). Patients without pleural effusion had significantly higher counts of CD4+, CD8+, and CD20+ T cells (all p < 0.05) compared to patients with pleural effusion.Conclusion: Our data indicated that presence of parapneumonic effusion in adenoviral pneumonia was associated with longer febrile duration, more complicated clinical management, a greater risk of hepatitis, and suppression of host cellular immunity. Further prospective, large-scale studies are needed to validate our results. [ABSTRACT FROM AUTHOR]

Background Clinical manifestations of enterovirus 71 (EV71) range from herpangina, hand-foot-andmouth disease (HFMD), to severe neurological complications. Unlike the situation of switching genotypes seen in EV71 outbreaks during 1998-2008 in Taiwan, genotype B5 was responsible for two large outbreaks in 2008 and 2012, respectively. In China, by contrast, EV71 often persists as a single genotype in the population and causes frequent outbreaks. To investigate genetic changes in viral evolution, complete EV71 genome sequences were used to analyze the intra-genotypic evolution pattern in Taiwan, China, and the Netherlands. Results Genotype B5 was predominant in Taiwan's 2008 outbreak and was re-emergent in 2012. EV71 strains from both outbreaks were phylogenetically segregated into two lineages containing fourteen non-synonymous substitutions predominantly in the non-structural protein coding region. In China, genotype C4 was first seen in 1998 and caused the latest large outbreak in 2008. Unlike shifting genotypes in Taiwan, genotype C4 persisted with progressive drift through time. A majority of non-synonymous mutations occurred in residues located in the non-structural coding region, showing annual increases. Interestingly, genotype B1/B2 in the Netherlands showed another stepwise evolution with dramatic EV71 activity increase in 1986. Phylogeny of the VP1 coding region in 1971-1986 exhibited similar lineage turnover with genotype C4 in China; however, phylogeny of the 3D-encoding region indicated separate lineage appearing after 1983, suggesting that the 3D-encoding region of genotype B2 was derived from an unidentified ancestor that contributed to intra-genotypic evolution in the Netherlands. Conclusions Unlike VP1 coding sequences long used for phylogenetic study of enteroviruses due to expected host immune escape, our study emphasizes a dominant role of non-synonymous mutations in non-structural protein regions that contribute to (re-)emergent genotypes in continuous stepwise evolution. Dozens of amino acid substitutions, especially in nonstructural proteins, were identified via genetic changes driven through intra-genotypic evolution worldwide. These identified substitutions appeared to increase viral fitness in the population, affording valuable insights not only for viral evolution but also for prevention, control, and vaccine against EV71 infection. [ABSTRACT FROM AUTHOR]

The article presents a study which explores parental knowledge, concerns, and management of fever during childhood in Taiwan. The study uses the cross-sectional survey and self-administered questionnaire to investigate the parents with children, who are attending pediatric clinics of kindergartens in Tainan City. Results show that the lack of knowledge concerning fever in parents is caused by their dissatisfaction with provided information.

Background Central obesity in relation to insulin resistance is strongly linked to the development of type 2 diabetes. However, data regarding the association between pericardial and peri-aortic adiposity, a potential estimate of visceral adipose tissue burden, and pre-diabetes status remains unclear. The aim of this study was to examine whether the degree of pericardial and thoracic periaortic adipose tissue, when quantified by multi-detector computed tomography (MDCT), differs significantly in a normal, pre-diabetic, and overtly diabetic population. Methods We studied 562 consecutive subjects including 357 healthy, 155 pre-diabetic, and 50 diabetic patients selected from participants who underwent annual health surveys in Taiwan. Prediabetes status was defined by impaired fasting glucose or impaired glucose intolerance according to American Diabetes Association guidelines. Pericardial (PCF) and thoracic periaortic (TAT) adipose tissue burden was assessed using a non-contrast 16-slice multi-detector computed tomography (MDCT) dataset with off-line measurement (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA). Body fat composition, serum highsensitivity C-reactive protein (hs-CRP) level and insulin resistance (HOMA-IR) were also assessed. Results Patients with diabetes and pre-diabetes had greater volume of PCF (89 ± 24.6, 85.3 ± 28.7 & 67.6 ± 26.7ml, p < 0.001) as well as larger TAT (9.6 ± 3.1 ml vs 8.8 ± 4.2 & 6.6 ± 3.5ml, respectively, p < 0.001) when compared to the normal group, although there were no significant differences in adiposity between the diabetic and pre-diabetic groups. For those without established diabetes in our study, increasing TAT burden, but not PCF, appear to correlate with insulin resistance (HOMA-IR) and hs-CRP in the multivariable models. Conclusions Pre-diabetic and diabetic subjects, compared to normoglycemia, were associated with significantly higher pericardial and peri-aortic adipose tissue burden. In addition, visceral fat accumulation adjacent to the thoracic aorta seemed to exert a significant impact on insulin resistance and systemic inflammation. [ABSTRACT FROM AUTHOR]

Background Early diagnosis of dengue virus infection during the febrile stage is essential for adjusting appropriate management. This study is to identify the predictive markers of clinical and laboratory findings in the acute stage of dengue infection during a major outbreak of dengue virus type 1 that occurred in southern Taiwan during 2007. A retrospective, hospital-based study was conducted at a university hospital in southern Taiwan from January to December, 2007. Patient who was reported for clinically suspected dengue infection was enrolled. Laboratory-positive dengue cases are confirmed by enzyme-linked immunosorbent assay of specific dengue IgM, fourfold increase of dengue-specific IgG titers in convalescent serum, or by reverse transcription-polymerase chain reaction (RT-PCR) of dengue virus. Results The suspected dengue cases consist of 100 children (⩽ 18 years) and 481 adults. Among the 581 patients, 67 (67%) children and 309 (64.2%) adults were laboratory-confirmed. Patients who had laboratory indeterminate were excluded. Most cases were uncomplicated and 3.8% of children and 2.9% of adults developed dengue hemorrhagic fever or dengue shock syndrome (DHF/DSS). The overall mortality rate in those with DHF/DSS was 7.1%, and the average duration of hospitalization was 20 days. The most common symptoms/signs at admission were myalgia (46.8%), petechiae (36.9%) and nausea /vomiting (33.5%). The most notable laboratory findings included leukopenia (2966 ± 1896/cmm), thrombocytopenia (102 ± 45 × 103/cmm), prolonged activated partial thromboplastin time (aPTT) (45 ± 10 s), and elevated serum levels of aminotransferase (AST, 166 ± 208 U/L; ALT, 82 ± 103 U/L) and low C - reactive protein (CRP) (6 ± 11 mg/L). Based on the clinical features for predicting laboratory-confirmed dengue infection, the sensitivities of typical rash, myalgia, and positive tourniquet test are 59.2%, 46.8%, and 34.2%, while the specificities for above features are 75.4%, 53.5% and 100%, respectively. The positive predictive value (PPV) for combination of leukopenia, thrombocytopenia (< 150 × 103/cmm), elevated aminotransferase (AST/ALT > 1.5) and low CRP (< 20 mg/L) is 89.5%, while the negative predictive value is 37.4%. Furthermore, the PPV of the combination was increased to 93.1% by adding prolonged aPTT (>38 secs). Conclusions Leukopenia, thrombocytopenia, elevated aminotransferases, low CRP and prolonged aPTT, were useful predictive markers for early diagnosis of dengue infection during a large outbreak in southern Taiwan. [ABSTRACT FROM AUTHOR]

The article presents a study conducted to analyze death cases in Taiwan that can be attributed on the use of methylenedioxymethampethamine (MDMA) drug from January 2001 to December 2008. Through the use of gas chromatography-mass spectrometry, the study analyzed the postmortem whole blood of 59 fatalities which are positive for MDMA. Results showed that 28 of the death cases have Ketamine and among the 59 deaths, 39 were men. The study revealed the popularity of MDMA in the country.

Understanding the feasibility of applying the Team Climate Inventory (TCI) in non-Western cultures is essential for researchers attempting to understand the influence of culture on workers' perceived climate. This study describes the application of the TCI in such a setting using data from 203 administrators employed in a Taiwanese medical center. Reliability and factor analyses were performed to establish the feasibility and psychometric properties of the TCI Taiwan version. Reliabilities of both the four- and five-factor solutions exceeded .80. Factor analyses indicated a satisfactory four-factor structure, despite some variations in comparison with the U.K. version. The TCI Taiwan version is feasible and has acceptable psychometric properties. Further research is warranted regarding the degree to which disparities result from cultural differences and the specific nature of organizational systems in Chinese communities. [ABSTRACT FROM AUTHOR]

Reticulate hybridization is a complicated and creative mechanism in plant evolution that can cause interference in phylogenetic studies. Based on observations of intermediate morphology, low pollen fertility, and overlapping distributions of putative parent species, Yang and Wang (Proceedings of the cross-strait symposium on floristic diversity and conservation. National Museum of Natural Science, Taichung, Taiwan, pp 183–197, ) first proposed reticulate hybridization of Alpinia in Taiwan. In the present study, molecular tools were used to explore relationships between four parental species and their homoploidy hybrids, and the impact of hybridization on phylogeny reconstruction. Based on DNA markers, maternal heritance of the chloroplast genome, and additivity of nuclear ribosomal internal transcribed spacer, the present results provide strong support for the hybridization hypothesis. Co-existence of parental ribotypes within hybrids revealed that these hybridization events were current, while reciprocal and introgressive hybridization were inferred from chloroplast DNA data. Furthermore, iterative hybridizations involving more than two parental species may occur in notorious hybrid zones. Ecological, phenological, and physiological evidence provides insight into why such frequent hybridization occurs in Taiwanese Alpinia. In the phylogenetic tree of the Zerumbet clade reconstructed in this study, the chloroplast sequences from one hybrid species were not grouped into a subclade, implying instability caused by hybridization. Failure to find morphological apomorphies and biogeographical patterns in this clade was likely partially due to reticulate hybridization. [ABSTRACT FROM AUTHOR]

An outbreak of human metapneumovirus (hMPV) among children in southern Taiwan in 2004 prompted the investigation of the molecular epidemiology of hMPV from September 2003 to August 2005. Respiratory specimens that were culture negative for a panel of respiratory viruses were examined for the presence of hMPV by RT-PCR. The results indicated that 59 out of 546 (10.8%) children were hMPV-positive. The majority of these hMPV-positive children were less than 2 years old (59.4%), females (61%), and inpatients (67.8%). Infections occurred throughout the year, but peaked during the spring and/or summer months. Sequence analysis of the fusion gene from the isolates revealed two phylogenetic groups with five possible lineages (A1, A2a/A2b, B1, and B2). Among these co-circulating strains, A2 strains were most frequently observed and demonstrated the greatest divergence. Deduced amino acid sequence analysis identified several variant amino acids specific to the A2 lineage. Lineage-specific amino acid substitutions were noted at aa233, aa286, aa312, aa348, and aa296. This study indicated that genetically divergent strains of hMPV which caused respiratory disease and hospitalization were circulating among children in Taiwan. [ABSTRACT FROM AUTHOR]

The article investigates the case history and toxicological findings of fatalities caused by paramethoxymethamphetamine (PMMA) in Taiwan. It claims that a fluorescence polarization immunoassay screening test was adopted for the initial identification of all specimens gathered. Samples which were found positive for PMMA were likewise confirmed and quantitated by gas chromatography-mass spectrometry. Moreover, the case also involved other drugs like ketamine, hydroxymidazolam, and pentobarbital.

The article analyzes Brown Mixture (BM) from seven different manufacturers and urine samples from alleged heroin users and volunteers with various ingestion patterns for their morphine and codeine contents. Hydrolysis, trimethylsilylation, and gas chromatography-mass spectrometry analysis were used in the study. The contents of morphine and codeine in the tablets were found to be very consistent, but with significant differences in the two BM solutions.

Background. This study was designed to compare the clinical characteristics, toxin expression, virulence factors, and antimicrobial susceptibilities of staphylococci isolated from Taiwanese children with staphylococcal toxic shock syndrome (STSS) and staphylococcal scalded skin syndrome (SSSS). Methods. Demographic characteristics, hospital course, and outcomes of the children were analyzed. Toxin- specific and virulence genes of the staphylococci were detected by polymerase chain reaction amplification. Antimicrobial susceptibilities were determined by disk diffusion and the Etest. Results. Staphylococcus aureus was isolated from 16 children (6 in the STSS group and 10 in the SSSS group). Children with STSS tended to be older than those with SSSS, had a longer duration of hospitalization, and a much higher mortality rate. Community-associated methicillin-resistant S. aureus was isolated from 11 (68.8%) of 16 children. All of these isolates contained the ermB and mecA genes, but none had the mefA gene. All 16 isolates tested positive for the fnbA gene. The pvl and seb genes were more frequently found among S. aureus from the STSS group, compared with S. aureus from the SSSS group. We found that 67% (4 of 6) of the STSS isolates were genetically related. All of the S. aureus isolates were susceptible to vancomycin, gentamicin, doxycycline, and trimethoprim-sulfamethoxazole. Most isolates were resistant to clindamycin (63%), oxacillin (69%), and clarithromycin (81%). Conclusions. The most distinguishing feature of these isolates is the greater frequency of pvl and seb carriage among those from the STSS group. Most of the isolates were community-associated methicillin-resistant S. aureus that were highly resistant to macro lides but susceptible to trimethoprim-sulfamethoxazole. Vancomycin remains the initial drug of choice for treatment of STSS and SSSS. More studies are needed to determine the efficacy of trimethoprim-sulfamethoxazole in children with these syndromes. [ABSTRACT FROM AUTHOR]

To investigate the factors affecting the outcome of fulminant hepatic failure (FHF) in children in relation to hepatitis B virus (HBV) infection. Retrospective review of a total of 94 cases (61 males and 33 females, aged from 1 month to 15 years) recruited from nine tertiary referral centers in Taiwan from 1985 to 1999. The overall mortality rate was 75%. Patients in the mortality group were of an older age, had higher peak total bilirubin levels, a longer prothrombin time, and a lower percentage of HBV positivity ( P < 0.001, P = 0.003, P = 0.0027 and P = 0.042, respectively). Mortality was 65% in the HBV positive ( n = 42) and 83% in the HBV negative ( n = 52) group ( P = 0.05). In the HBV positive group, the prothrombin time was noted to be the single factor affecting outcome ( P = 0.036). In the HBV negative group, older age and higher peak value of total serum bilirubin were suggestive of poor survival rate ( P < 0.001 and P = 0.006, respectively). Multivariate analysis revealed that total bilirubin was the single factor affecting outcome in the HBV-negative group. The mortality rate of HBV positive children in three consecutive time periods without liver transplantation (1985–1989, 1990–1994, 1995–1999) decreased gradually (91, 67 and 38%, respectively, with P = 0.027). This change was not observed in HBV-negative cases. Hepatitis B virus positive FHF had a lower mortality rate than HBV negative FHF, with each group having different factors affecting mortality. [ABSTRACT FROM AUTHOR]

Evaluates the role of intrapleural streptokinase in the management of complicated parapneumonic effusions in children. Prospective comparative study; Cheng Kung University Hospital, Tainan, Taiwan; Indication that intrapleural fibrinolytic treatment with streptokinase is safe and effective, and it can obviate the need for surgery in most cases.

Examines the prognosis of esophageal squamous cell carcinoma (ESCC) by researchers from Taiwan. Significance of gaining insights about the prognostic factors of cancerous patients on the development of therapeutic strategy; Analysis of clinicopathological and biological factors for patients with ESCC; Significance of the study on the identification of biological markers that have prognostic value for ESCC.