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Q fever (QF) is a worldwide zoonosis associated with outbreaks. Only a few nationwide studies regarding the surveillance and epidemiology of human QF have been reported. Although QF is endemic in Taiwan, a nationwide database investigation of the epidemiology and characteristics of QF and its associations with scrub typhus (ST), murine typhus (MT) and leptospirosis (LS) has never been reported. We analysed nationwide databases of suspected QF, ST, MT and LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan. A total of 468 (4.2%) QF cases were identified among 11 109 suspected QF cases. QF cases were mainly distributed in the southern and Kaohsiung-Pingtung regions but rarely in the eastern region. Compared to non-QF cases, QF cases had significantly higher percentages of males (88.7 versus 66.2%) and high-risk occupations (farming, animal husbandry or veterinary medicine) (16.2 versus 10.5%). But the percentages of specific animal contact, including cattle (0.6 versus 0.8%) and goats (0.9 versus 1.0%), were low in both. The majority of suspected QF cases (89.4%) were simultaneously suspected with ST, MT or LS, and the combinations of suspected diseases differed between regions. The number of suspected QF cases from the eastern region decreased since 2009, which was not observed in other regions. A total of 1420 (12.8%) cases had confirmed diseases, including QF (453, 4.1%), QF+ST (7, 0.06%), QF+MT (4, 0.04%), QF+LS (4, 0.04%), MT (186, 1.7%), ST (545, 4.9%), ST+LS (11, 0.1%) and LS (210, 1.9%). Compared to cases of unknown disease, QF cases had larger percentages of high-risk occupations (16.2 versus 9.6%) but similar histories of animal contact (29.8 versus 25.1%). QF is an endemic disease in southern Taiwan. It is difficult to differentiate QF from ST, MT or LS only by high-risk occupations and history of animal contact, and co-infection of QF with these diseases should be considered. [ABSTRACT FROM AUTHOR]

AimThis study aimed to ascertain the prevalence of and the risk factors associated with early and late age-related macular degeneration (AMD) among Chinese individuals aged ≥65 years residing in Puzih, Taiwan.MethodsThis population-based cross-sectional study graded digital colour photographs of the ocular fundus of 673 individuals using the Wisconsin Age-Related Maculopathy Grading System. We compared the characteristics of individuals with early and late AMD using χ2-analyses and described risk factors for early and late AMD using odds ratios and 95% confidence intervals.ResultsIndividuals with late AMD were significantly older and more likely to have hypertension. Further, their sunlight exposure time was longer than that of those with early AMD, only drusen, or no AMD lesions (P<0.01). A history of hyperlipidaemia for >10 years was a significant risk factor for early AMD, while old age, hypertension for >10 years, and exposure to sunlight for >8 h per day were associated with late AMD.ConclusionsThe prevalence rate of early AMD in the present study was 15.0%, which is similar to that reported for Caucasians and Japanese included in the European Eye Study and the Hisayama Study, respectively. The late AMD prevalence rate of 7.3% found among our study participants was comparable to that reported by the Greenland Inuit Eye Study and Reykjavik Study, but considerably lower than that reported for Caucasians, indicating that late AMD might be less prevalent among Asians than Caucasians. [ABSTRACT FROM AUTHOR]

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

Summary: We evaluated bilateral femoral neck bone mineral densities (FNBMDs) in 32 men with poliomyelitis and their matched controls. Men with poliomyelitis had significantly lower FNBMD in both legs, and FNBMD was lowest in their shorter legs. Knee extensor strength and regular exercise were important predictive factors associated with decreased FNBMD. Introduction: People with poliomyelitis (polio) are prone to leg fractures after mild trauma. The flaccid paralysis, asymmetric involvement, and underdeveloped growth of afflicted legs may lead to osteoporosis of either leg, characterized by different patterns. This study aimed to measure their femoral FNBMD and to explore the factors associated with changes in FNBMD in either leg. Methods: We did a prospective study to evaluate bilateral FNBMD with dual-energy X-ray absorptiometry in 32 men with polio (age range, 41-57 years; mean, 47 years) and 32 age- and body mass index-matched controls. Measuring the difference in leg length, we classified the legs of each polio subject as 'longer' or 'shorter.' In addition, we chose the right leg of each control as a reference leg. We then used the Mann-Whitney U test to compare FNBMD of these three groups of legs and searched for the factors associated with FNBMD using stepwise multiple regression analyses. Results: Compared to the reference leg, men with polio had significantly lower FNBMD in both their longer and shorter legs, by 13% and 23%, respectively. The difference in FNBMD between the two legs of polio subjects was significant. Knee extensor strength and regular exercise were two important factors associated with bilateral FNBMD in men with polio. Conclusions: Men with polio had lower bilateral FNBMD. FNBMD of the shorter leg should be the choice for predicting the risk of hip fracture in men with polio because on average, the shorter leg has lower BMD. [ABSTRACT FROM AUTHOR]

The purpose of the study was to investigate the epidemiology and medical costs of systemic lupus erythematosus (SLE) in Taiwan. Cases of SLE were identified from the National Health Insurance Research Database with corresponding International Classification of Diseases, Ninth Revision (ICD-9) code 710.0 from January 2000 to December 2007. Age and sexspecific incidences were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior. During the study period, 22,182 cases were identified. The average annual incidence rate was 8.1 per 100,000. The incidence was especially high in women of 20-54 years. The female:male incidence ratio increased with age to a peak in the age group of 40-44, and then declined. The prevalence increased steadily during the study period from 42.2/100,000 in 2000 to 67.4/100,000 in 2007, while the incidence decreased steadily from 9.9/100,000/year in 2001 to 6.8/100,000/year in 2007. The average cost was US$71.5 for each outpatient service and US$1922.3 for each hospitalization. This is the first epidemiologic study of both pediatric and adult SLE in Taiwan. The incidence and prevalence were higher than in most reports on Whites. The sex ratio was similar to that of Whites, with a marked female predominance, especially during reproductive age. There was a probable lower survival rate for male patients. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study is to investigate the epidemiology and medical expenses of Wilson’s disease in Taiwan. Methods: Cases of Wilson’s disease were identified from the National Health Insurance Research Database with corresponding International Classification of Diseases, Ninth Revision (ICD-9) code 275.1 from January 2000 to December 2005. Age and sex-specific incidences were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior. Results: During the study period, 495 cases of Wilson’s disease were identified. The male to female ratio was 1.28. The average annual incidence rate was 0.27 per 100 000, and the incidence rate peaked in the age group of 15–19 years. Most cases were juvenile and young adults. The prevalence increased steadily during the study period. Cirrhosis of the liver was the most common co-existing condition. Conclusions: This is the first population-based epidemiologic study of Wilson’s disease in Taiwan. Because of the effective and affordable treatment, the prevalence of Wilson’s disease in Taiwan is expected to increase continuously. [ABSTRACT FROM AUTHOR]

The air layer between the nocturnal boundary layer and the top of the daily mixing layer in an ozonepolluted area is known to serve as an ozone reservoir since the ozone that is produced in the mixing layer on the preceding day is effectively preserved throughout the night in the air layer. Ozone reservoir layers existing at night can enhance the accumulation of surface ozone on the following day. However, our knowledge of the characteristics of ozone reservoir layers and their effects on the daily ozone accumulations is limited. In this work, ozone reservoir layers were experimentally investigated at a coastal, near-mountain site in southern Taiwan, 30 km away from the coastline. Tethered ozone soundings were performed to obtain vertical profiles of ozone and meteorological variables during a four-day ozone episode in November 2006. Observation-based methods are adopted to evaluate the effects of the ozone reservoir layers on the surface ozone accumulation during the fourday ozone episode. Ozone reservoir layers were found to develop every evening with a depth of 1200-1400 m. Ozone concentrations within the reservoir layers reached over 140 parts per billion (ppb). From each evening to midnight, the size of the ozone reservoir layer and the ozone concentration inside dramatically changed. As a result, a concentrated, elevated ozone reservoir layer formed with a depth of 400m at 800-1200m every midnight. For the rest of each night, the elevated ozone reservoir layer gradually descended until it reached 500-900m in the next morning. The observed ozone reservoir layer is formed by the invasion of a cool, marine air mass into a relatively warm, ozone-rich mixing layer in the evening. The descending is related to nocturnal coastal subsidence as well. The ozone concentration at the study site was maximal at 15:00-17:00 LT daily because of the addition of the daily produced ozone on the preceding day. The rate of increase of surface ozone concentration due to the downward mixing of the ozone in the ozone reservoir layers can be as high as 12-24 ppb/h in the late morning. The contribution of the ozone carried over from the preceding day can be 60-85 ppb, which contributes over 50% to the daily ozone pollution as compared with ozone produced on the study day. [ABSTRACT FROM AUTHOR]

XRCC1 plays a central role in mammalian DNA repair processes. Two polymorphisms of XRCC1, rs1799782 (Arg>Trp at codon 194) and rs25487 (Arg>Gln at codon 399), are common in the Han Chinese population. Our objective was to analyze the relationship between these two functional single-nucleotide polymorphisms (SNPs) and systemic lupus erythematosus (SLE) in the Taiwanese Han Chinese population. Genotyping was performed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) on 172 SLE patients and 160 normal controls. Our data indicate that the frequency of A/G at codon 399 differed between patients and controls (p=0.01; odds ratio: 1.80; 95% confidence interval: 1.17-2.75), but the allelic frequency analysis did not reveal significant differences. For the SNP at codon 194, there were no differences in either allelic or genotype frequencies between SLE patients and normal subjects. Clinical association studies of SLE symptoms revealed the involvement of the A/G polymorphism at codon 399 in SLE pathogenesis. Our results indicate that a functional SNP at codon 399 of XRCC1 is associated with the development of SLE. [ABSTRACT FROM AUTHOR]

Tumour necrosis factor-α (TNF-α), an important proinflammatory cytokine, exerts a variety of physiological and pathogenic effects that lead to tissue destruction. Studies on the association of TNF-α genetic polymorphisms with systemic lupus erythematosus (SLE) have yielded inconclusive results. We investigated the association of TNF-α genetic polymorphisms (-1031T/C, -863C/A, -857T/C, -308A/G and +489A/G) with SLE in Taiwanese patients and controls. Our results indicate that 1) the frequency of the A-allele at -863 position was significantly higher in SLE patients (odds ratio = 1.46; 95% CI = 1.02-2.08); 2) the frequency of the A-allele at +489 position was significantly higher in SLE patients (odds ratio = 1.79; 95% CI = 1.21-2.65); 3) the AA or GA genotype frequencies at +489 position were significantly increased in SLE patients (AA genotype: odds ratio = 11.20; 95% CI = 1.36-92.55; GA genotype: odds ratio = 1.63; 95% CI = 1.03-2.58); 4) no significant association of TNF-α haplotypic distributions was observed, except for the haplotypes TCCGA, CACGA and CCCGG; and 5) the genotype frequency of the polymorphisms at -1031 was significantly different in patients with antinuclear antibodies (P = 0.022). The allele and genotype frequencies of the polymorphisms at -863 were not significantly different. The genotype frequency of the polymorphisms at -857 was significantly different in patients with haematological disorder (P = 0.025). The frequency of A allele of the polymorphisms at -308 was significantly increased in patients with malar rash (P = 0.033), discoid rash (P = 0.023), photosensitivity (P = 0.037), oral ulcers (P = 0.002) and serositis (P = 0.029). The genotype frequency of the polymorphisms at +489 was significantly different in patients with discoid rash and photosensitivity (data not shown; discoid rash, P = 0.031; photosensitivity, P = 0.044). These results suggest that TNF-α genetic polymorphisms contribute to SLE susceptibility in the Taiwanese population. [ABSTRACT FROM AUTHOR]

Melioidosis is a disease prevalent in the tropics, especially in Southeast Asia. The most common clinical presentations are bacteremic pneumonia and abscess formation in various organs. Although a wide variety of disease presentations are reported for melioidosis, acute cholangitis has not been previously reported. Herein, we report a 54-year-old woman who had fever, right upper abdominal pain and jaundice 1 week after a flood caused by a typhoon in southern Taiwan. Acute cholangitis and pneumonia with septic shock caused by Burkholderia pseudomallei were subsequently diagnosed. [ABSTRACT FROM AUTHOR]

This retrospective study investigated the clinical significance and impact of Stenotrophomonas maltophilia bacteraemia in 49 haematology and oncology patients at a tertiary referral medical centre in Taipei between July 1999 and December 2003. Sixteen patients had 24 episodes of central venous catheter (CVC)-related bacteraemia, with the main clinical characteristics being a nosocomial bacteraemia (100%), preceding antibiotic therapy (94%), bacteraemia developed in a general ward (87%), immunosuppressive therapy (75%), in-situ CVC-related bacteraemia (75%), and neutropenia (63%). Only four (25%) patients had inflammatory signs at the CVC site following diagnosis of bacteraemia. Five patients had recurrent bacteraemia, with risk-factors being long-lasting (>10 days) neutropenia (p 0.036) and an initial failure to remove the CVC (p 0.001). These cases did not involve re-infection, as the same S. maltophilia strain was identified following random amplified polymorphic DNA (RAPD) analysis of the initial and subsequent isolates. However, relapses could occur after long latency periods (maximum, 200 days). Most patients were cured after removal of the CVC, even without appropriate antibiotic treatment. Physicians should have a high index of suspicion for CVC-related bacteraemia with haematology and oncology patients with CVCs and S. maltophilia bacteraemia. In addition to appropriate antibiotic therapy, removal of the CVC is crucial for successful treatment of CVC-related S. maltophilia bacteraemia and prevention of relapses. [ABSTRACT FROM AUTHOR]

The present study was designed to examine whether different p53 haplotypes of exon 4-intron 3-intron 6 affect the frequency of mutations and loss of heterozygosity (LOH) of the p53 gene in male oral squamous cell carcinomas (OSCCs) in Taiwan. We found that individuals without two Pro-W-G alleles had significantly higher frequency of p53 mutations than those with two Pro-W-G alleles (odds ratio (OR)=1.98; 95%confidence interval (CI), 1.10-3.56). Out of the 172 p53 gene exon 4 informative male OSCCs, 72 (41.9%) showed LOH. Among these 72 OSCCs with LOH, the frequency of Pro allele loss was 73.6%(53/72). It is notable that alcohol drinking increased the frequency of Arg allele loss (OR=10.56; 95%CI, 1.23-234.94) in OSCCs from patients who both smoked cigarettes and chewed areca quid (AQ). The frequency of LOH of p53 was not different between p53-mutated OSCCs and p53-normal OSCCs. Thus, the present study revealed that (a) the Arg allele is associated with p53 mutations, (b) the Pro allele is preferentially lost in OSCCs associated with cigarette smoking and AQ chewing, while the frequency of Arg allele loss is increased with alcohol drinking, and (c) haploinsufficiency of p53 is in itself likely to contribute to tumour progression in Taiwanese OSCCs.British Journal of Cancer (2005) 92, 30-35. doi:10.1038/sj.bjc.6602271 www.bjcancer.com Published online 7 December 2004 [ABSTRACT FROM AUTHOR]

SummaryFrom October 1997 to September 1998, 3085 Culex quinquefasciatus (Say) (Diptera: Culicidae), 584 Cx. tritaeniorhynchus (Giles) (Diptera: Culicidae), 392 Cx. annulus (Theobald) (Diptera: Culicidae), 374 Aedes albopictus (Skuse) (Diptera: Culicidae) and 102 Armigeres subalbatus (Coquillet) (Diptera: Culicidae) were collected and examined for Dirofilaria immitis (Leidy) (Spirurida: Filariidae) infection. However, only Cx. quinquefasciatus and Ae. albopictus were infected, with a prevalence of 4.28% and 3.74%, respectively. The intensity of D. immitis found in Ae. albopictus (3.43 larvae/mosquito) was higher than that found in Cx. quinquefasciatus (2.89 larvae/mosquito). After being fed with canine blood containing 7500 microfilariae (mf) per mL, Cx. quinquefasciatus ingested approximately two times as many mf as Ae. albopictus (mean of 31.73 in comparison to 16.47). However, almost three times as many third-stage infective larvae developed in Ae. albopictus as in Cx. quinquefasciatus (mean of 3.25 as compared with 1.10), with a vector efficiency index (VEI) of 19.73 and 3.47, respectively. The results showed that Cx. quinquefasciatus and Ae. albopictus served as natural vectors of D. immitis in central Taiwan. Although Ae. albopictus was more efficient for heartworm transmission, Cx. quinquefasciatus may play a more prominent role on the transmission of dirofilariasis in central Taiwan. [ABSTRACT FROM AUTHOR]

Focuses on measurement of twenty-five volatile organic compounds up to C10 using Carbotrap multibed thermal adsorption tubes during the morning and afternoon rush hours on four different days in all three traffic tunnels in Kaohsiung, Taiwan. Equipment used for analyzing volatile organic compounds; Factors influencing the pattern of emissions in each tunnel; Assessment of the ozone formation potential in each tunnel.

This work analyzes the variations in daily maximum 1-hr ozone (O[sub3]) concentrations and the long-term trends in annual means of hourly ambient concentrations of O[sub3], nitrogen oxides (nitrous oxide + nitrogen dioxide), and nonmethane hydrocarbons in the three administrative regions of Kao-Ping airshed in southern Taiwan over a recent 8-yr period. The annual or monthly means of all maxima, most 95th percentiles, and some 90th percentiles of the daily maximum 1-hr O[sub3] concentrations exceed the daily limit of 120 parts per billion by volume in all three regions, namely, Kao-hsiung City, Kso-hsiung County, and P'ing-tung County. The monthly means of daily maximum 1-hr O[sub3] concentrations exhibit distinct seasonal variations, with a bimodal form with the maxima in autumn and late winter to the middle of spring and a minimum in summer. The long-term variations in the annual means of hourly O[sub3] concentrations in the three regions exhibit increasing trends. These increases in O[sub3] are associated with the decline in ambient concentrations of nitrogen oxides and nonmethane hydrocarbons. High O[sub3] episodes occur most often in autumn and most rarely in summer. The seasonal mean mixing heights in descending order follow the order of spring, summer, autumn, and winter. Meteorological parameters in autumn and winter indicate that the ground-level O[sub3] tends to accumulate and trigger a high O[sub3] episode on a warm day with sufficient sunlight and low wind in a high-pressure system, consistent with the low mixing heights in these two seasons. [ABSTRACT FROM AUTHOR]

Introduction: Metabolic syndrome (MS) is strongly associated with cardiovascular diseases and diabetes but can be prevented with regular physical activity. This study aimed to assess the impact of a physical fitness training programme on MS among military personnel., Methods: This retrospective observational study included volunteer army soldiers who underwent annual health examinations between 2011 and 2014. In 2011, the reformed physical fitness training programme and physical fitness test were introduced to the participants. MS evaluation and physical fitness performances were evaluated before and after implementing the training programme using a mixed-effects model and generalised estimating equation, adjusted for sex, age and smoking., Results: From 2011 to 2014, 1720 soldiers underwent the annual health examination. In 2011, before the fitness programme, 246 soldiers (14.3%) had MS. After implementation, decreases in blood pressure and fasting glucose levels were observed and maintained for 3 years. Running performance was negatively correlated to triglycerides (ß=-11.37; p<0.001) and waist circumference (ß=-0.42; p<0.001) and positively correlated to high-density lipoprotein cholesterol levels (ß=2.14; p<0.001). The severity of MS was reduced following introduction of the physical fitness programme., Conclusions: MS and its components improved after introducing the reformed fitness programme, with running performance proving to be most relevant to MS. Clinicians should encourage increased physical activity to prevent MS among military personnel., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Epidemiological studies of rheumatoid arthritis in Asia are rare. The aim of this research was to study the epidemiology and associated medical expenses of rheumatoid arthritis in Taiwan., Methods: Cases of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria, were retrieved from the National Health Insurance Research Database with corresponding International Classification of Diseases, Ninth Revision code (ICD-9) 714.0 from January 2000 to December 2007, and limited to those 16 years and older. Age- and sex-specific incidences were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior., Results: There were a total of 40,995 cases. The average age-adjusted annual incidence rate was 15.8 per 100,000. The adjusted incidence rates were very stable at 20.9-25.2/100,000/year and 7.0-8.2/100,000/year for females and males, respectively, during the study period. The adjusted average incidence ratio of females/males was 3.1. The age-specific incidence peaked in the 60-64 and 70-74 year age groups for females and males, respectively. The adjusted prevalence rate increased steadily during the study period from 57.7/100,000 in 2000 to 99.6/100,000 in 2007. The average total yearly expense per patient increased from 1,155 United States Dollars (USD) in 2000 to 1,821 USD in 2007. Sicca syndrome (ICD-9 code 710.2) was the most common co-existing ICD-9 code., Conclusions: This is the first incidence study based on the 1987 American College of Rheumatology criteria in Asia. The prevalence rate based on these criteria was lower than in previous Asia studies. The medical expenses increased continuously.

Kawasaki disease (KD) is the most common form of pediatric vasculitis. Though its etiology is unknown, researchers have suggested that it is related to genetics. The inositol 1,4,5-triphosphate receptor type 3 (ITPR3) gene has a strong association with the development of type 1 diabetes and, plays a critical role in the development of autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, and Graves' disease. The aim of study is to examine the association of ITPR3 polymorphisms with KD risk in Taiwanese children. This study evaluates the single nucleotide polymorphisms (SNP) rs2229634 in the ITPR3 gene with KD in a case-control study involving 93 KD patients and 680 healthy, gender- and age-matched controls. The frequency of the rs2229634 T/T genotype was significantly higher in KD patients with coronary artery aneurysm (CAA) than in patients without CAA [odds ratio (OR) = 2.56, 95% confidence interval (95% CI) = 1.35-4.88, P = 0.004]. In addition, KD patients with the T/T genotype elevated mean serum levels of C-reactive protein compared with patients with the C/C or C/T genotype (12.2 mg dL(-1) vs. 8.5 mg dL(-1) , P = 0.036). In conclusion, the results of this study suggest that the rs2229634 SNP in the ITPR3 gene is associated with the risk of CAA formation in Taiwanese KD patients., (© 2010 Blackwell Publishing Ltd.)

The concentrations of eighteen atmospheric carbonyls species were measured by the LpDNPH-Cartridge and the microcomputer air sampling device at Nan-Chie (northern part) and Hsiung-Kong (southern part) sites in Kaohsiung city, southern Taiwan. These samples were then analyzed using a high performance liquid chromatography (HPLC). Measurements showed that the highest concentrations of carbonyls were formaldehyde (18.33 and 18.74 microg m(-3)) at the Nan-Chie and Hsiung-Kong site, followed by acetaldehyde (14.90 and 15.71 microg m(-3)). The concentrations of total carbonyls were higher at Hsiung-Kong site (66.96 microg m(-3)) than at Nan-Chie site (60.41 microg m(-3)). The concentrations of total carbonyls at Nan-Chie site (or Hsiung-Kong site) were 74.06 microg m(-3) (89.99 microg m(-3)) in summer and 37.14 microg m(-3) (46.50 microg m(-3)) in winter, due to the fact that photochemical activities are stronger in summer than in winter. The results of principal component analysis (PCA)/absolute principal component scores (APCS) suggest that the primary pollution sources at Nan-Chie were vehicle exhausts (gasoline and diesel engines), stationary emissions (petrochemical and food industry) and restaurant emissions, and the primary pollution sources at Hsiung-Kong were vehicle exhausts (gasoline and diesel engines), stationary emissions (metal assembly and petrochemical industry) and restaurant emissions., (2010 Elsevier B.V. All rights reserved.)

Rheumatoid arthritis (RA) is a chronic autoimmune disease and can lead to deformities and severe disabilities, due to irreversible damage of tendons, joints, and bones. A previous study indicated that a DNA repair system was involved in the development of RA. In this study, we investigated the association of four N-methylpurine-DNA glycosylase (MPG) gene polymorphisms (rs3176364, rs710079, rs2858056, and rs2541632) with susceptibility to RA in 384 Taiwanese individuals (192 RA patients and 192 control subjects). Our data show a statistically significant difference in genotype frequency distributions at rs710079 and rs2858056 SNPs between RA patients and control groups (P = 0.040 and 0.029, respectively). Our data also indicated that individuals with the GG genotype at rs2858056 SNP may have a higher risk of developing RA. In addition, compared with the haplotype frequencies between case and control groups, individuals with the GCGC haplotype appeared to be at a greater risk of RA progression (P = 0.003, OR = 1.75; 95&percnt; CI = 1.20-1.55). Our results suggest that rs710079 and rs2858056 polymorphisms and the GCGC haplotype in the MPG gene are associated with the risk of RA progression, and thus may be used as molecular markers of RA if they are confirmed by further research.

Tumour necrosis factor-alpha (TNF-alpha), an important proinflammatory cytokine, exerts a variety of physiological and pathogenic effects that lead to tissue destruction. Studies on the association of TNF-alpha genetic polymorphisms with systemic lupus erythematosus (SLE) have yielded inconclusive results. We investigated the association of TNF-alpha genetic polymorphisms (-1031T/C, -863C/A, -857T/C, -308A/G and +489A/G) with SLE in Taiwanese patients and controls. Our results indicate that 1) the frequency of the A-allele at -863 position was significantly higher in SLE patients (odds ratio = 1.46; 95% CI = 1.02-2.08); 2) the frequency of the A-allele at +489 position was significantly higher in SLE patients (odds ratio = 1.79; 95% CI = 1.21-2.65); 3) the AA or GA genotype frequencies at +489 position were significantly increased in SLE patients (AA genotype: odds ratio = 11.20; 95% CI = 1.36-92.55; GA genotype: odds ratio = 1.63; 95% CI = 1.03-2.58); 4) no significant association of TNF-alpha haplotypic distributions was observed, except for the haplotypes TCCGA, CACGA and CCCGG; and 5) the genotype frequency of the polymorphisms at -1031 was significantly different in patients with antinuclear antibodies (P = 0.022). The allele and genotype frequencies of the polymorphisms at -863 were not significantly different. The genotype frequency of the polymorphisms at -857 was significantly different in patients with haematological disorder (P = 0.025). The frequency of A allele of the polymorphisms at -308 was significantly increased in patients with malar rash (P = 0.033), discoid rash (P = 0.023), photosensitivity (P = 0.037), oral ulcers (P = 0.002) and serositis (P = 0.029). The genotype frequency of the polymorphisms at +489 was significantly different in patients with discoid rash and photosensitivity (data not shown; discoid rash, P = 0.031; photosensitivity, P = 0.044). These results suggest that TNF-alpha genetic polymorphisms contribute to SLE susceptibility in the Taiwanese population.

Aims: Protamine, when administered to neutralize heparin in cardiovascular surgery, is associated with occasionally severe antigen-antibody reactions associated with substantial morbidity and mortality. The objective of this study is to investigate whether patients on hemodialysis are more susceptible to the protamine adverse effects., Method: First, a retrospective analysis of a protamine-associated hypotension episode (PAHE) in 239 patients undergoing coronary artery bypass grafting surgery was performed for the incidence study in the period of 1999 to 2005. Second, an ELISA determination of serum anti-protamine IgG antibody in 255 serum samples from individuals without previous surgical histories was conducted for prevalence survey. In both studies, patients on HD were matched for age with non HD patients., Results: The highest incidence (57%) of PAHE occurred in patients on hemodialysis using of M-insulin (a mixed type of insulin aspart 30%, insulin aspart protamine 70%) formulation, and this group also exhibited a high anti-protamine IgG antibody titer in serum (odds ratio: 18.31)., Conclusions: A substantial proportion of patients on hemodialysis are at high risk of acquiring protamine adverse effects, but definite conclusion about the association between uremia and PAHE, however, still needs to be made with caution.

Background: Tuberculosis (TB) continues to be a major global health problem. Extra-pulmonary TB (EPTB) manifests with protean symptoms, and establishing a diagnosis is more difficult than pulmonary TB (PTB)., Setting: A university-affiliated hospital in southern Taiwan., Objective: To analyse the risk factors for EPTB compared with PTB., Design: This retrospective study compared patients with EPTB and PTB in southern Taiwan by analysing their demographic data and clinical underlying diseases. Risk factors for EPTB were further analysed., Results: A total of 766 TB patients were enrolled in this study, with 102 (13.3%) EPTB and 664 (86.7%) PTB cases. Of the 766 patients, 3% of PTB patients had EPTB, while 19.6% of EPTB patients also had PTB. The most frequently involved EPTB site was the bone and joints (24.5%). The incidence of EPTB vs. PTB decreased significantly for each decade increase in patient age. Multivariate logistic regression analysis showed that being female, not being diabetic, having end-stage renal disease and not smoking were independent risk factors for EPTB., Conclusion: This study defines the risk factors for EPTB compared with PTB. Awareness of these factors is essential for physicians to have a high index of suspicion for accurate and timely diagnosis.

Objective: Kawasaki disease (KD) is a pediatric systemic vasculitis of unknown cause for which a genetic influence is supposed. The purpose of this study was to identify possible genetic variants in the major histocompatibility complex (MHC) region that are associated with KD and the development of coronary artery aneurysms (CAAs) in a Taiwanese population., Methods: The 168 genetic variants covering the MHC locus were analyzed in an association study of a Taiwanese cohort of 93 KD patients and 680 unrelated healthy children matched for sex and age with the study patients., Results: Eleven single-nucleotide polymorphisms (SNPs) were associated with the occurrence of KD. The SNP located at the 3'-untranslated region of HLA-E (rs2844724) was highly associated (P < 1 x 10(-7)). In addition, the frequency of the C allele was higher in KD patients without CAAs than in controls (P < 0.001) due to a significantly increased frequency of the CC and CT genotypes. Plasma levels of soluble HLA-E were significantly higher in KD patients than in controls regardless of the presence of CAAs. Furthermore, there was a trend toward higher plasma levels of soluble HLA-E in KD patients with the CT and TT genotypes of the HLA-E gene polymorphism., Conclusion: Our results suggest that the HLA-E gene polymorphism may play a role in the pathogenesis of KD.

Interleukin-18 (IL-18) is associated with chronic inflammation, autoimmune diseases and various cancers and infectious diseases. An IL-18 genetic A/C polymorphism at coding position 105 (rs549908) has been linked with asthma and rheumatoid arthritis. We tested a hypothesis that the IL-18 genetic polymorphism confers systemic lupus erythematosus (SLE) susceptibility. Study participants were Taiwanese SLE patients and a healthy control group. Our results indicate (1) a significantly higher A allele frequency in SLE patients (P = 0.003; OR = 1.97; 95% CI = 1.26-3.08) and (2) a significantly higher A allele frequency in SLE patients with a central nervous system disorder (P = 0.027; OR = 7.18; 95% CI = 0.95-54.28). Our results suggest that the A/C polymorphism contributes to SLE pathogenesis.

This work analyzes the variations in daily maximum 1-hr ozone (O3) concentrations and the long-term trends in annual means of hourly ambient concentrations of O3, nitrogen oxides (nitrous oxide + nitrogen dioxide), and nonmethane hydrocarbons in the three administrative regions of Kao-Ping airshed in southern Taiwan over a recent 8-yr period. The annual or monthly means of all maxima, most 95th percentiles, and some 90th percentiles of the daily maximum 1-hr O3 concentrations exceed the daily limit of 120 parts per billion by volume in all three regions, namely, Kao-hsiung City, Kso-hsiung County, and P'ing-tung County. The monthly means of daily maximum 1-hr O3 concentrations exhibit distinct seasonal variations, with a bimodal form with the maxima in autumn and late winter to the middle of spring and a minimum in summer. The long-term variations in the annual means of hourly O3 concentrations in the three regions exhibit increasing trends. These increases in O3 are associated with the decline in ambient concentrations of nitrogen oxides and nonmethane hydrocarbons. High O3 episodes occur most often in autumn and most rarely in summer. The seasonal mean mixing heights in descending order follow the order of spring, summer, autumn, and winter. Meteorological parameters in autumn and winter indicate that the ground-level O3 tends to accumulate and trigger a high O3 episode on a warm day with sufficient sunlight and low wind in a high-pressure system, consistent with the low mixing heights in these two seasons.

The purpose of this study was to investigate pretreatment variables related to prognosis and to evaluate long-term outcome in patients with bulky early-stage cervical carcinoma who were enrolled into a protocol treatment of neoadjuvant chemotherapy (NAC) followed by radical surgery. Between 1988 and 1999, 162 women with previously untreated bulky (>/=4 cm) stage IB or IIA carcinoma of the uterine cervix registered to receive cisplatin, vincristine, and bleomycin for three cycles followed by radical hysterectomy and pelvic lymphadenectomy, were enrolled into this study. The 5-year relapse-free (RFS) and overall survival (OS) rates of the whole series were 65% and 69%, respectively. In multivariate analyses, age (< 35 vs. >/= 35-year-old: relative risk [RR], 2.06; 95% confidence interval [CI], 1.02-4.14; P = 0.043) and histologic type (adeno-adenosquamous vs. squamous carcinoma: RR, 2.60; 95% CI, 1.26-5.39; P = 0.010) were independent variables associated with RFS, and age (< 35 vs. >/= 35-year-old: RR, 2.53; 95% CI, 1.24-5.14; P = 0.010) and pre-NAC tumor size (> 5 vs. = 5 cm: RR, 2.06; 95% CI, 1.09-3.90; P = 0.027) were significantly related to OS. Narrowing down patient selection to squamous carcinoma and age older than 35 years with stratification of tumor size (break point of 5 cm) is recommended in future trials involving cisplatin-based NAC plus radical surgery.

Aim: To evaluate Helicobacter pylori primary resistance and its clinical impact on the efficacy of two lansoprazole-based eradication triple therapies., Methods: H. pylori-positive patients (n=228) were randomized to receive one of the 1-week regimens: lansoprazole 30 mg, clarithromycin 500 mg and amoxicillin 1 g (LAC), or lansoprazole 30 mg, clarithromycin 500 mg and metronidazole 500 mg (LMC), each given twice daily. H. pylori status was assessed by 13C-urea breath test and culture at diagnosis and by 13C-urea breath test 6 weeks after therapy. Antibiotic susceptibility was determined by E-test (n=98)., Results: The eradication rates with per protocol/ intention-to-treat analyses were: LAC (n=95/114) 83%/69% and LMC (n=96/114) 85%/72%. Primary resistance was 11% for clarithromycin, 41% for metronidazole and 0% for amoxicillin. Eradication in metronidazole-susceptible/-resistant strains was 85%/82% in LAC and 83%/63% in LMC. Significantly lower cure rates were observed in clarithromycin-resistant patients treated with LAC (95% vs. 0%, P < 0.001) and LMC (86% vs. 0%, P < 0.001)., Conclusions: One-week LAC and LMC are similarly effective therapies. Clarithromycin resistance significantly affected H. pylori eradication in both regimens.

Background: There are high risks from general anesthesia and excessive bleeding associated with traditional liposuction using the dry or wet method. The blood loss has been estimated to be between 15% and 45%. The tumescent technique permits liposuction of more than 3,000 ml of fat totally by local anesthesia without sedation. The blood loss is reported to be less than 1% of aspirate., Objective: To examine the blood loss during liposuction using tumescent technique in Chinese patients compared with that of Caucasians as published in the literature., Methods: Hemoglobin values of patient's preoperative venous blood and infranatant of aspirate were measured in 45 consecutive cases of liposuction using the tumescent technique from May 1996 to June 1997., Results: A total of 30 patients completed the study. The average blood loss was estimated to be 1.08% of aspirate., Conclusion: From this study, we found the blood loss in Chinese patients is comparable with that in Caucasians. Tumescent liposuction is a safe dermatologic cosmetic surgical procedure without the need of blood transfusion and general anesthesia.

Cytotoxin-associated gene A (CagA), expressed in about 60% of H. pylori isolates in Western countries, may play a role in the pathogenesis of peptic ulcer. In this study, we determined the prevalence and significance of the H. pylori cagA gene and protein expression in Taiwan. Genomic DNA from antrum biopsies and H. pylori isolates were analyzed for cagA using polymerase chain reaction, Southern hybridization, or colony hybridization. CagA seropositivity was analyzed using Helico blots. In addition, Western blotting was performed to detect the CagA protein. About 94% of antrum tissues from both asymptomatic subjects and duodenal ulcer patients and all 76 H. pylori isolates (21 asymptomatic subjects, 39 with duodenal ulcers, 13 with gastric ulcers, 2 with gastric cancers, and 1 with mucosa-associated lymphoid tissue [MALT] lymphoma) were positive for the cagA gene. Moreover 77 out of 78 H. pylori-positive serum and all 27 H. pylori lysates had anti-CagA antibodies or CagA protein, respectively. H. pylori isolated from patients with various upper gastrointestinal diseases in Taiwan contained the cagA gene and expressed CagA protein at high frequencies.

Thirty-five patients with ovarian germ cell malignancies presenting from 1982 to 1992 were studied. The pathologic diagnoses were immature teratoma in 11 patients, endodermal sinus tumor in eight, dysgerminoma in 12, and mixed germ cell tumor in four. The median age at presentation was 20 years. Postoperative multiple-agent chemotherapy was given to 28 patients. Five out of 35 (14%) patients died of malignancy, three with endodermal sinus tumors with stage Ia, Ic, and IIIc, respectively, one with stage IIIc dysgerminoma, and one with stage IIIc mixed germ cell tumor. The other 30 patients were alive without evidence of disease from 14 to 124 months, with a median follow-up of 52 months. All eleven patients with immature teratoma were alive with no evidence of disease at 20 to 104 months of follow-up. Four patients with stage I, grade 1 immature teratoma were successfully treated with surgery alone. The other seven patients were treated with adjuvant chemotherapy and were disease-free. One patient with stage IIIc dysgerminoma was treated with surgery and radiotherapy but died of disease. The other eleven patients were safely treated with surgery and adjuvant chemotherapy with vincristine, actinomycin-D and cyclophosphamide (VAC) or platinum-based chemotherapy. For the more virulent tumors such as endodermal sinus tumor and mixed germ cell tumor, platinum-based chemotherapy should be used exclusively in view of the high failure rate of the VAC regimen. Preservation of fertility for young patients with malignant ovarian germ cell tumors is possible in the early stages of disease and in selected cases of advanced disease.