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Medical technology is undergoing rapid transformations, and the classifications of medical devices have also expanded greatly; therefore, it is necessary to develop appropriate reimbursement policies and pricing mechanisms in a timely manner. This paper aims to introduce the reimbursement coverage and pricing rules for medical devices in Taiwan. In addition, this paper identifies and evaluates available health technology assessments (HTA) and literature on published websites concerning medical device decision-making processes and pricing systems in South Korea and Japan, which are near Taiwan and have similar reimbursement coverage processes. Reimbursement policy and pricing mechanisms are constantly being revised in Taiwan, Japan, and South Korea. Recently, all three countries attempted to establish new reimbursement coverage decision-making and pricing rules, adopting a differentiated approach based on the level of evidence required for the appropriated reimbursement in terms of a feasible evaluation mechanism for providing patients with more effective medical devices. This article is expected to contribute to providing references to new reimbursement coverage decision-making and pricing rules. [ABSTRACT FROM AUTHOR]

Background There is a lack of evidence that shows whether a report card can improve health outcomes in terms of infection rates or unscheduled readmission by using rigorous methods to evaluate its impact. Methods We used the National Health Insurance Administration's claims database from 1 January 2004 to 30 December 2013 and a time series analysis to evaluate the impact of the quality report card initiative on three negative outcomes of total knee replacement for each quarter of the year, including the rates of superficial infection of a knee replacement, deep infection of knee arthroplasty and unplanned readmissions for surgical site infection. Results These negative outcomes (original scale) do not show significant decreases in terms of superficial infection (−0.05‰, −0.63 to 0.53‰, P = 0.87), deep infection (−0.003‰, −0.19 to 0.18‰, P = 0.97) and unscheduled readmission (0.02‰, −0.21 to 0.25‰, P = 0.88). Conclusion The total knee replacement public report card initiative did not improve the rate of infection and unscheduled readmission for surgical site infection. This report card in Taiwan should involve physicians' participation in the design and be tailored to be suitable for reading by patients in order to further enhance the chance of improvement in these negative outcomes. [ABSTRACT FROM AUTHOR]

Context: Evidence is mixed regarding the impact of advance directives (ADs) on the utilization of end-of-life treatments.Objectives: This study evaluated the effect of AD on the utilization of end-of-life treatments during the last month of life in older patients.Methods: Taipei City Hospital initiated an advance care planning program to promote AD for admitted patients in 2015. This prospective study recruited deceased older patients who completed advance care planning communication between 2015 and 2016. Multiple logistic regression was used to determine the association of AD completion with utilization of life-sustaining treatments.Results: Of 1307 deceased older patients, overall mean age was 84.1 years and 78.7% of the subjects had AD completion. During the study follow-up period, 31 older patients received life-sustaining treatments during the last month of life, including 17 patients (1.7%) with AD completion and 14 patients (5.0%) without AD completion. After adjusting for the sociodemographic factors and co-morbidities, older patients with AD completion were less likely to receive life-sustaining treatments during the last month of life (adjusted odds ratio [AOR] = 0.32, 95% confidence interval [CI]: 0.16-0.67). Considering type of life-sustaining treatments, AD completion was associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.21, 95% CI: 0.06-0.70) as well as intubation and mechanical ventilation support (AOR = 0.32, 95% CI: 0.14-0.70) during the last month of life in older patients.Conclusion: AD completion was associated with a lower likelihood of receiving life-sustaining treatments during the last month of life in older patients. These findings support the continued use of AD in older population. [ABSTRACT FROM AUTHOR]

Objectives To determine the magnitude and temporal aspect of the effect of poor dental health and periodontal disease ( PD) on dementia. Design Retrospective cohort study Setting Taiwan National Health Insurance Research Database. Participants Individuals with newly diagnosed PD (N = 182,747) Measurements Participants were followed from January 1, 2000, to December 31, 2010. Participants were assigned to dental prophylaxis, intensive periodontal treatment, tooth extraction, or no treatment, according to International Classification of Diseases codes and PD treatment codes. The incidence rate of dementia of the groups was compared. The association between PD and dementia was analyzed using Cox regression, with adjustments for age, sex, monthly income, residential urbanicity, and comorbidities. Results The incidence of dementia was significantly higher in the group with PD that did not receive treatment (0.76% per year) and in the group that had teeth extracted (0.57% per year) than in the group that underwent intensive PD treatment (0.35% per year) and the group that received dental prophylaxis (0.39% per year) ( P < .001). After adjusting for confounders, the Cox proportional hazards model revealed a higher risk of dementia in the group with PD who did not undergo treatment (hazard ratio ( HR) = 1.14, 95% confidence interval ( CI) = 1.04-1.24) and the group that had teeth extracted ( HR = 1.10, 95% CI = 1.04-1.16) than in the group that received dental prophylaxis. Conclusion Subjects who had more severe PD or did not receive periodontal treatment were at greater risk of developing dementia. [ABSTRACT FROM AUTHOR]

This article presents an analysis conducted on the patterns related to therapeutic inertia with the aim of uncovering how variables at the patient level and the healthcare provider level influence the intensification of therapy when it is clinically indicated. A cohort study was conducted on 899,135 HbA1c results from 168,876 adult diabetes patients with poorly controlled HbA1c levels. HbA1c results were used to identify variations in the prescription of hypoglycemic drugs. Logistic regression and hierarchical linear models (HLMs) were used to determine how differences among healthcare providers and patient characteristics influence therapeutic inertia. We estimated that 38.5% of the patients in this study were subject to therapeutic inertia. The odds ratio of cardiologists choosing to intensify therapy was 0.708 times that of endocrinologists. Furthermore, patients in medical centers were shown to be 1.077 times more likely to be prescribed intensified treatment than patients in primary clinics. The HLMs presented results similar to those of the logistic model. Overall, we determined that 88.92% of the variation in the application of intensified treatment was at the within-physician level. Reducing therapeutic inertia will likely require educational initiatives aimed at ensuring adherence to clinical practice guidelines in the care of diabetes patients. [ABSTRACT FROM AUTHOR]

Context: Socioeconomic status (SES) is an important determinant of disparities in health services and may affect the utilization of hospice care services during end-of-life (EOL) treatment in patients with cancer. However, previous studies evaluating the association between SES and utilization of hospice care services among patients with cancer revealed inconsistent findings.Objectives: This study aimed to determine the association between SES and utilization of hospice care services during the last year of life in patients with cancer.Methods: From January 1, 2006 to December 31, 2016, we identified adults with cancer diagnoses from the Registry for Catastrophic Illness in Taiwan. The cancer diagnoses in study subjects were proved by the pathohistological reports. The utilization of hospice care services during the last year of life in patients with cancer included hospice inpatient care, hospice-shared care, and hospice home care.Results: In the follow-up period, 28.6% of 516,409 patients with cancer used hospice care services during the last year of life. After adjusting for other covariates, low SES significantly reduced the utilization of hospice care services by 18% during the last year of life in patients with cancer. Moreover, a positive trend between decreasing levels of SES and lower utilization of hospice care during EOL treatment was noted (P < 0.001).Conclusion: Low SES was associated with lower utilization of hospice care services during EOL care in patients with cancer. Our data support the need to target low SES patients with cancer in efforts to optimally increase hospice care services during EOL care. [ABSTRACT FROM AUTHOR]

Background: Epidemiological evidence regarding the association between air pollution and resting heart rate (RHR), a predictor of cardiovascular disease and mortality, is limited and inconsistent., Objectives: We used wearable devices and time-series analysis to assess the exposure-response relationship over an extended lag period., Methods: Ninety-seven elderly individuals (>65 years) from the Taipei Basin participated from May to November 2020 and wore Garmin® smartwatches continuously until the end of 2021 for heart rate monitoring. RHR was defined as the daily average of the lowest 30-min heart rate. Air pollution exposure data, covering lag periods from 0 to 60 days, were obtained from nearby monitoring stations. We used distributed lag non-linear models and linear mixed-effect models to assess cumulative effects of air pollution. Principal component analysis was utilized to explore underlying patterns in air pollution exposure, and subgroup analyses with interaction terms were conducted to explore the modification effects of individual factors., Results: After adjusting for co-pollutants in the models, an interquartile range increase of 0.18 ppm in carbon monoxide (CO) was consistently associated with increased RHR across lag periods of 0-1 day (0.31, 95 % confidence interval [CI]: 0.24-0.38), 0-7 days (0.68, 95 % CI: 0.57-0.79), and 0-50 days (1.02, 95 % CI: 0.82-1.21). Principal component analysis identified two factors, one primarily influenced by CO and nitrogen dioxide (NO 2 ), indicative of traffic sources. Increases in the varimax-rotated traffic-related score were correlated with higher RHR over 0-1 day (0.36, 95 % CI: 0.25-0.47), 0-7 days (0.62, 95 % CI: 0.46-0.77), and 0-50 days (1.27, 95 % CI: 0.87-1.67) lag periods. Over a 0-7 day lag, RHR responses to traffic pollution were intensified by higher temperatures (β = 0.80 vs. 0.29; interaction p-value [P&#95;int] = 0.011). Males (β = 0.66 vs. 0.60; P&#95;int < 0.0001), hypertensive individuals (β = 0.85 vs. 0.45; P&#95;int = 0.028), diabetics (β = 0.96 vs. 0.52; P&#95;int = 0.042), and those with lower physical activity (β = 0.70 vs. 0.54; P&#95;int < 0.0001) also exhibited stronger responses. Over a 0-50 day lag, males (β = 0.99 vs. 0.96; P&#95;int < 0.0001), diabetics (β = 1.66 vs. 0.69; P&#95;int < 0.0001), individuals with lower physical activity (β = 1.49 vs. 0.47; P&#95;int = 0.0006), and those with fewer steps on lag day 1 (β = 1.17 vs. 0.71; P&#95;int = 0.029) showed amplified responses., Conclusions: Prolonged exposure to traffic-related air pollution results in cumulative cardiovascular risks, persisting for up to 50 days. These effects are more pronounced on warmer days and in individuals with chronic conditions or inactive lifestyles., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Population aging is emerging as an increasingly acute challenge for countries around the world. One particular manifestation of this phenomenon is the impact of osteoporosis on individuals and national health systems. Previous studies of risk factors for osteoporosis were conducted using traditional statistical methods, but more recent efforts have turned to machine learning approaches. Most such efforts, however, treat the target variable (bone mineral density [BMD] or fracture rate) as a categorical one, which provides no quantitative information. The present study uses five different machine learning methods to analyze the risk factors for T-score of BMD, seeking to (1) compare the prediction accuracy between different machine learning methods and traditional multiple linear regression (MLR) and (2) rank the importance of 25 different risk factors., Methods: The study sample includes 24 412 women older than 55 years with 25 related variables, applying traditional MLR and five different machine learning methods: classification and regression tree, Naïve Bayes, random forest, stochastic gradient boosting, and eXtreme gradient boosting. The metrics used for model performance comparisons are the symmetric mean absolute percentage error, relative absolute error, root relative squared error, and root mean squared error., Results: Machine learning approaches outperformed MLR for all four prediction errors. The average importance ranking of each factor generated by the machine learning methods indicates that age is the most important factor determining T-score, followed by estimated glomerular filtration rate (eGFR), body mass index (BMI), uric acid (UA), and education level., Conclusion: In a group of women older than 55 years, we demonstrated that machine learning methods provide superior performance in estimating T-Score, with age being the most important impact factor, followed by eGFR, BMI, UA, and education level., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2023, the Chinese Medical Association.)

This paper describes the reimbursement policy for immune checkpoint inhibitors in Taiwan and provides a perspective to improve the quality, consistency, and transparency of decision making. Global trends for cancer treatment have shifted from chemotherapies to targeted therapies and immuno-oncology (IO) medicine, leading to significant increases in treatment costs. To enhance the accessibility of advanced therapy, the Taiwan National Health Insurance Administration announced two pathways for high-cost medicine: the managed entry agreement and a set of general rules of reimbursement submission for high-cost drugs. To further manage the financial burden on Taiwan's national health insurance system, the policy makers introduced novel inhibitory drugs for cancer immune checkpoints, subject to a maximum annual budget of NT$800 million (≈US$26.7 million). In April 2019, a national registry was established for patients undergoing cancer immunotherapy. Clinical characteristics, treatment duration, toxicity, and the outcome of the postcheckpoint inhibitor treatments were recorded. By analyzing real-world data, we assess the therapeutic effect of IO treatment in Taiwanese patients, thereby enabling payers to adjust payment regulations and rules for reimbursement. The Health Technology Assessment Team plays an important role in drawing upon the evidence to support policy making. Under an implemented cost-management mechanism, Taiwan's high-cost drug policy has enabled patients to access new medicines and maximized patient benefits.

Background: Previous case reports have demonstrated the occurrence of ischemic optic neuropathy (ION) following intravitreal injections of antivascular endothelial growth factor (anti-VEGF). However, no previous studies have investigated the impact of injection numbers on the risk of ION. The aim of our study was to investigate whether repeated intravitreal injections of anti-VEGF would increase the risk of subsequent ION in patients with neovascular age-related macular degeneration (AMD)., Methods: A population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database was conducted from 2007 to 2013. Neovascular AMD patients receiving intravitreal injections of anti-VEGF during the study period were enrolled in the study cohort. Enrollees were divided into three groups according to the categorized levels of injection number (first level: < 10 times, second level: 10-15 times, and third level: > 15 times). Kaplan-Meier curves were generated to compare the cumulative hazard of subsequent ION among the three groups. Cox regression analyses were used to estimate crude and adjusted hazard ratios (HRs) for ION development with respect to the different levels of injection numbers. The confounders included for adjustment were age, sex, and comorbidities (diabetes, hypertension, hyperlipidemia, ischemic heart disease, and glaucoma)., Results: In total, the study cohort included 77,210 patients. Of these, 26,520, 38,010, and 12,680 were in the first-, second-, and third-level groups, respectively. The Kaplan-Meier method revealed that the cumulative hazards of ION were significantly higher in those who had a higher injection number. After adjusting for confounders, the adjusted HRs for ION in the second- and third-level groups were 1.91 (95% confidence interval [CI], 1.32-2.76) and 2.20 (95% CI, 1.42-3.43), respectively, compared with those in the first-level group., Conclusions: Among patients with neovascular AMD, those who receive a higher number of anti-VEGF injections have a significantly higher risk of developing ION compared with individuals who receive a lower number of injections.

Loss of skeletal muscle mass is common with aging and can cause morbidity and mortality in the elderly. The effects of particulate air pollution on skeletal muscle mass is not known. The study aims to assess the chronic effects of ambient fine particulates (PM 2.5 ) on the body composition of the elderly. From October 2015 to November 2016, a cross-sectional survey on 530 elderly (age > = 65 years) was conducted in the Taipei Basin, Taiwan. The body composition was measured by bioelectrical impedance analysis (InBody 120). One year exposure to air pollution was estimated using the Kriging method at the participant's residence. Multiple linear regression analysis, after adjustments for demographics and co-pollutants, was used to examine the effects of PM 2.5 on body composition indices and force of handgrip. Changes in body composition for an interquartile (1.4 μm/m 3 ) increase in PM 2.5 concentration included a 0.4 kg (95% confidence interval (CI): -0.31, -0.58; p < 0.0001) decrease in skeletal muscle mass (2.0%) and a 0.7 kg (95% CI: 0.47, 0.91; p < 0.0001) increase in body fat mass (3.6%). While PM 2.5 reduced fat free mass in the upper extremities and trunk, but not in the lower extremities, it increased body fat mass in the three parts. There was no significant effect of PM 2.5 on handgrip force. Higher physical activity (versus lower than median) was associated with less detrimental effect of PM 2.5 on skeletal muscle mass and body fat mass (p values for interaction term: 0.009 and 0.013, respectively). Long-term PM 2.5 exposure is associated with decreased skeletal muscle mass and increased body fat mass in the elderly, which can be ameliorated by physical activity.

Objectives: In 2007, Taiwan began conducting health technology assessments (HTA) to support the National Health Insurance Administration (NHIA) in its reimbursement decisions for drugs, medical devices, and medical services., Methods: In this study, the development, missions, and procedures of the implementation of HTA in Taiwan are briefly introduced. Moreover, the value of HTA is examined by reviewing the outcomes and impacts of recent HTA-related research projects, which are classified into five categories: (i) pharmaceutical products, (ii) medical procedures, (iii) medical devices, (iv) health policy, and (v) social care., Results: Overall, the 10-year implementation of HTA has not only supported the government's decision making but also enhanced patient care. Furthermore, patient evidence has been highlighted, and patient care pathways have been transformed through patient involvement in HTA., Conclusions: In conclusion, HTA's value has been determined by both government and social aspects in Taiwan.

Background: Although advance directives (AD) have been implemented for years in western countries, the concept of AD is not promoted extensively in eastern countries. In this study we evaluate a program to systematically conduct advance care planning (ACP) communication for hospitalized patients in Taiwan and identify the factors associated with AD completion., Methods: In this retrospective evaluation of a clinical ACP program, we identified adult patients with chronic life-limiting illness admitted to Taipei City Hospital between April 2015 and January 2016. Trained healthcare providers held an ACP meeting to discuss patients' preference regarding end-of-life care and AD completion. A multiple logistic regression was performed to determine the factors associated with the AD completion., Results: A total of 2878 patients were determined to be eligible for ACP during the study, among which 1798 (62.5%) completed ACP and data was available for 1411 patients (49.1%). Of the 1411 patients who received ACP communication with complete data, the rate of AD completion was 82.6%. The overall mean (SD) age was 78.2 (14.4) years. Adjusting for other variables, AD completion was associated with patients aged ≥ 85 years [adjusted odds ratio (AOR) = 1.80, 95% CI 1.21-2.67], critical illness (AOR = 1.17, 95% CI 1.06-1.30), and social workers participating in ACP meetings (AOR = 1.74, 95% CI 1.24-2.45)., Conclusion: The majority of inpatients with chronic life-limiting illness had ACP communication as part of this ACP program and over 80% completed an AD. Our study demonstrates the feasibility of implementing ACP discussion in East Asia and suggests that social workers may be an important component of ACP communication with patients., Competing Interests: The authors have declared that no competing interests exist.

Three-dimensional (3D) printing technology can generate objects in almost any shape and geometry. This technique also has clinical applications, such as the fabrication of specific devices based on a patient's anatomy. A demonstration study is presented of a 54-year-old man who needed a thermoplastic splint to limit arm movement while a dehisced left shoulder wound healed. The patient's upper extremity was scanned using the appropriate noncontact scanner and 3D technology software, and the polylactic acid splint was printed over the course of 66 hours. This patient-specific splint was worn during the day, and after 2 weeks the wound was healed sufficiently to permit hospital discharge. Creation of an individualized splint is one of many potential medical uses of 3D technology. Although the lengthy printing time imposes limitations, the implications for practice are positive.

Background: Thyroid cancer is the most common endocrine gland malignancy and fine-needle aspiration biopsy is widely used for thyroid nodule evaluation. Repeated aspiration biopsies are needed due to plausible false-negative results. This study aimed to investigate the overall relationship between aspiration biopsy and thyroid cancer diagnosis, and to explore factors related to shorter diagnostic time., Methods: This nationwide retrospective cohort study retrieved data from the Longitudinal Health Insurance Database in Taiwan. Subjects without known thyroid malignancies and who received the first thyroid aspiration biopsy after 2004 were followed-up from 2004 to 2009 (n = 7700). Chi-square test, Kaplan-Meier survival analysis, and Cox proportional hazards model were used for data analysis., Results: Of 7700 newly-aspirated patients, 276 eventually developed thyroid cancer (malignancy rate 3.6%). Among the 276 patients with thyroid cancer, 61.6% underwent only one aspiration biopsy and 81.2% were found within the first year after the initial aspiration. Cox proportional hazards model revealed that aspiration frequency (HR 1.07, 95% CI 1.06-1.08), ultrasound frequency (HR 1.02, 95% CI 1.01-1.03), older age, male sex, and aspiration biopsies arranged by surgery, endocrinology or otolaryngology subspecialties were all associated with shorter time to thyroid cancer diagnosis., Conclusions: About 17.4% of thyroid cancer cases received more than two aspiration biopsies and 18.8% were diagnosed one year after the first biopsy. Regular follow-up with repeated aspiration or ultrasound may be required for patients with clinically significant thyroid nodules.

Background: Inflammatory responses from chronic infection might affect the brain and increase the risk of depressive disorder. However, the temporal association between chronic infection (eg, tuberculosis [TB]) and incident depressive disorder has not been prospectively evaluated., Objective: To determine the association of pulmonary tuberculosis (PTB) and anti-TB drugs with incident depressive disorder (ICD-9-CM codes 296.2x-296.3x, 300.4, and 311.x)., Method: From January 1, 2000, we identified adult patients with PTB from the Taiwan National Health Insurance Research Database. A control cohort without PTB, matched for age (± 5 years), sex, comorbidities, and income level, was selected for comparison. The 2 cohorts were followed until December 31, 2011, and observed for occurrence of depressive disorder., Results: Of the 23,145 patients (4,629 study patients and 18,516 matched controls), 302 (1.3%) had depressive disorder during a mean follow-up period of 6.53 years, including 79 study patients (1.71%) and 223 controls (1.20%). After adjusting for age, sex, comorbidities, and income level in the Cox proportional hazards model, PTB was found to be an independent risk factor of incident depressive disorder (adjusted hazard ratio [HR], 1.74; 95% CI, 1.35-2.25). The risk of incident depressive disorder was significantly higher (adjusted HR, 2.54; 95% CI, 1.19-5.45) in patients with TB who received more than 60 defined daily doses (DDDs) of ethambutol, and the effect was dose-dependent., Conclusions: PTB patients had a higher risk of incident depressive disorder, particular in those with an ethambutol dose of more than 60 DDDs. Depressive disorder should be sought in patients following tuberculosis., (© Copyright 2015 Physicians Postgraduate Press, Inc.)

Background: Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are widely recommended to hinder the progression of renal disease among patients with DM. However, little is known about adherence to these guidelines or the predictors of such use., Methods: Data from the Taiwan National Health Insurance was used to investigate 7,186 DN patients, nested within 2960 randomly assigned primary care physicians in Taiwan over the course of 1 year of treatment. Patient-level variables included gender, age, and co-morbidity (i.e., coronary arterial disease, congestive heart failure, cerebrovascular disease, peripheral arterial disease, DM complications, albuminuria, anemia, hyperlipidemia, asthma, gout, and depression). Physician-level variables included work experience, the area of specialization, and the level of the physicians working in the hospital., Results: We determined that 63.69% of the variation in the use of ACEIs or ARBs was at the within-physician level and 36.31% was at the between-physician level. Approximately 35.10 % of the total variation was explained by predictors related to patient characteristics. The likelihood of taking ACEIs or ARBs is significantly higher (12.92%) among male patients than females. Cardiologists and family doctors are more likely to prescribe ACEIs or ARBs in of doctors working in medical centers., Conclusions: Management of DN patients is less than optimal due to unfamiliarity on the part of physicians regarding treatment guidelines and a lack of awareness among the general population with regard to DN. Educational initiatives are required to ensure adherence to clinical practice guidelines in the evaluation and care of DN patients.

Objectives: National guidelines recommend angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) therapy for diabetic patients with hypertension and/or proteinuria to hinder renal disease progression. However, little is known about the adequacy of adherence to these guidelines in diabetic patients and about the predictors of such appropriate ACEIs or ARBs use. We sought to define the rates of ACEIs and ARBs use in a large population of patients with diabetic nephropathy (DN)., Methods: Using linked medical claims from the National Health Insurance Research Database, we studied a cohort of patients with DN. We used multivariate logistic regression to measure the predictors of usage of the agents studied., Results: Of the 7159 DN patients studied, 5564 patients (77.7%) had hypertension. Of these, only 50.6% were administered ACEIs or ARBs during the quarter studied. In multivariate analyses, greater rates for usage of ACEIs or ARBs were found in patients with coronary artery disease or congestive heart failure., Conclusions: Only 50% of the patients with DN received the recommended treatment with ACEIs or ARBs. This shortfall provides an opportunity for quality-improvement interventions that could provide beneficial clinical outcomes for these high-risk patients., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Five novel yeast species belonging to the Kodamaea clade are proposed in this paper based on nine strains isolated from mushrooms and soil in Taiwan between 2007 and 2008. These nine yeast strains were found to represent five novel yeast species based on their D1/D2 domain sequences of the large subunit (LSU) rRNA gene and physiological characteristics. Sequence analysis of the D1/D2 domain of the LSU rRNA gene revealed that the five species are phylogenetically related to Kodamaea and Candida sp. clustered into the Kodamaea clade in the phylogenetic tree. All the species reproduced asexually, and no ascospores could be found. Therefore, the scientific names of Candida alishanica sp. nov., Candida hsintzibuensis sp. nov., Candida kaohsiungensis sp. nov., Candida lidongshanica sp. nov., and Candida smagusa sp. nov. were proposed to accommodate these strains. Strains of the first species were discovered from soil; two strains of the second species were isolated from soil and the fruiting body of a mushroom, respectively; and strains of the latter three species were recovered from fruiting bodies of mushrooms. The type strains are listed as follows: C. alishanica GY43S11(T) (=CBS 11429(T) =BCRC 23188(T) ); C. hsintzibuensis EJ7S06(T) (=CBS 11427(T) =BCRC 23183(T) ); C. kaohsiungensis GJ10M01(T) (=CBS 11435(T) =BCRC 23197(T) ); C. lidongshanica SD5S01(T) (=CBS 11426(T) =BCRC 23191(T) ); and C. smagusa EN4M03(T) (=CBS 11430(T) =BCRC 23186(T) ).

Purpose: This study was designed to illustrate the effects of C-reactive protein (CRP) and interleukin polymorphisms on serum CRP levels., Methods: A total of 390 patients with coronary heart disease (CHD) were recruited and high-sensitivity CRP levels were measured. Six polymorphic alleles on the genes of CRP, IL-1, and the IL-1 receptor antagonist were identified. A classification tree was applied to determine their effects and interactions on serum CRP levels., Results: In the hypertensive CHD patients, the presence of CRP + 1059 GC heterozygotes was associated with a lower risk for elevated CRP levels (OR = 0.318, P = 0.001). The coexistence of CRP + 1059 GC and IL-1beta-511 (CT or TT) might result in reduction in the CRP levels compared to IL-1beta-511 CC (OR = 0.222, P = 0.088 and OR = 0.148, P = 0.060, respectively)., Conclusion: The results demonstrated the distribution of CRP-related polymorphisms and the interactions in Taiwanese patients with CHD.

Background/purpose: Elevation of C-reactive protein (CRP) level is associated with increased risk of cardiovascular events. The 1059 G>C polymorphism in exon 2 of the CRP gene has been shown to affect plasma concentration of CRP. We want to elucidate the effect of this polymorphism on the development of coronary artery disease (CAD) among the Chinese population in Taiwan., Methods: We scrutinized 536 patients undergoing coronary angiography (365 patients with CAD and 171 controls with patent coronaries) and evaluated the association of CRP gene 1059 G>C polymorphism with CAD. Genotyping of the polymorphism was performed by polymerase chain reaction and MaeIII restriction enzyme digestion., Results: The CC genotype was associated with lower plasma CRP concentration (GG, 6.5+/-5.8; GC, 3.3+/-4.4; CC, 2.3+/-3.1 mg/L; p=0.02). Subjects with CAD or myocardial infarction (MI) had significantly higher plasma CRP concentration than that in controls (CAD vs. controls, 8.9+/-18.9 vs. 3.3+/-7.2 mg/L; p<0.001), while patients with MI showed higher CRP when compared to those with chronic stable angina (13.5+/-22.9 vs. 5.2+/-14.1 mg/L; p<0.001). However, this polymorphism was not associated with CAD in our population., Conclusion: Our data suggest that human CRP gene 1059 G>C polymorphism is associated with plasma CRP concentration among Chinese in Taiwan receiving coronary angiography.

Background: To evaluate the efficacy and feasibility of tension-free vaginal tape (TVT) surgery combined with gynecologic surgery using general anesthesia., Methods: One hundred and six women with genuine stress incontinence (GSI) diagnosed with a traditional urodynamic examination were prospectively enrolled into this study. All of the 106 women underwent TVT surgery for the treatment of GSI, along with a concomitant hysterectomy procedure, under general anesthesia. We estimated the severity of incontinence symptoms on a visual analog scale (VAS), and used a questionnaire for subjective assessment before and after TVT surgery. The objective assessment of urinary incontinence was carried out with a 1-h pad test and traditional urodynamic examination. Of the 106 patients, 50 had uterine prolapse and underwent transvaginal hysterectomy and anteroposterior colporrhaphy (APC), and another 50 had uterine myoma and underwent laparoscopic-assisted vaginal hysterectomy (LAVH)., Results: The follow-up mean interval was 18 months (range 12-36 months). The 50 women undergoing LAVH and TVT surgery had a mean hospitalization of 3.5 days. The subjective success rate was 90.5% and the objective success rate was 86.8%. The other group of 50 women undergoing vaginal total hysterectomy (VTH), APC and TVT surgery had a mean hospitalization of 4.8 days. The subjective success rate was 88.6% and the objective success rate was 84.9%. There were six patients lost to follow-up for several reasons. The rates of complications of bladder perforation, postoperative voiding difficulty and postoperative urinary urgency were 2%, 11% and 10%, respectively; neither pelvic hematoma requiring blood transfusion nor conversion to laparotomy occurred., Conclusion: The results of this study prove that the TVT procedure, performed under general anesthesia without the need for the intraoperative cough provocation test to treat GSI, and carried out concomitantly with other gynecologic surgeries, is safe and effective.