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The evolution of the Taiwan orogen, an active arc–continent collision zone between the North Luzon Arc (NLA) and the Eurasian continent, is recorded in arc volcanic and sedimentary rocks from the Taiyuan retro‐foredeep basin of the Coastal Range, eastern Taiwan. Arc volcanism in the northern NLA experienced a magmatic culmination at 9–7 Ma and a cessation at 5.3–4.3 Ma, based on new U‐Pb zircon ages. Young zircon U‐Pb ages (1.74, 1.58, and <1.2 Ma) and low Hf isotope signatures also indicate that three biotite‐bearing lapilli tuff layers deposited in the retro‐foredeep basin are associated with eruptions of the Lutao volcano in the southern NLA. NLA volcanism terminated progressively from ∼5.3 to <1.2 Ma in response to a southward‐propagating collision zone that followed the uplift of the orogenic wedge by <3 myr. The detrital zircon U‐Pb age spectra suggest no significant shift in provenance during the Plio‐Pleistocene period and indicate that the synorogenic sediments in the Taiyuan Basin were mainly derived from the Yuli Belt, a Miocene accretionary complex in the eastern Taiwan orogen. The accumulation rate of synorogenic deposits varies from 0.53 to 5.14 km/myr, with an abrupt increase at ∼2 Ma. This new rate is higher than the previously proposed rates and that of the pro‐foreland basin to the west, suggesting asymmetric and rapid uplift of the Taiwan orogen. Plain Language Summary: Taiwan was formed by the northwestward convergence of the North Luzon Arc (NLA) with the Eurasian continental margin. Most of the uppermost parts of the arc volcanoes and orogens have been intensely eroded; nevertheless, their detritus is well preserved in the Taiyuan Basin in the southern Coastal Range, eastern Taiwan. In this study, zircons separated from remnant arc volcanic and sedimentary sequences are dated by an in situ U‐Pb method to offer temporal constraints and provide insight into the arc‐continental collision evolution in Taiwan. The latest ages from the NLA volcanoes reveal a southward cessation of magmatism from ∼5.3 to <1.2 Ma, which is consistent with an oblique collision. Detritus from the Yuli Belt, a Miocene accretionary prism in the eastern Taiwan orogen, started to fill the Taiyuan Basin beginning at <4.3 Ma. Meanwhile, three embedded tuff layers dated at 1.74, 1.58, and <1.2 Ma indicate eruptions associated with Lutao, an offshore NLA volcanic islet, and suggest an abrupt increase in the deposition rate at ∼2 Ma, corresponding to rapid and extensive exhumation of the Taiwan orogen. Key Points: New zircon U‐Pb ages confirm the history of the volcanic arc and retro‐foredeep sediments and their linkages to the nearby Taiwan orogenThe previously proposed shift in clastic composition of the retro‐foredeep sediments is interpreted as an unroofing record of the Yuli BeltOur zircon ages confirm the abrupt increase in the deposition rate of retro‐foredeep basin infilling from 0.53 to 5.14 km/myr at ∼2 Ma [ABSTRACT FROM AUTHOR]

Background: The volume-outcome relationship has been validated previously for surgical procedures and cancer treatments. However, no studies have longitudinally compared the relationships between volume and outcome, and none have systematically compared laparoscopic cholecystectomy (LC) surgery outcomes in Taiwan. This study purposed to explore the relationship between volume and hospital treatment cost after LC. Methods: This cohort study retrospectively analyzed 247,751 LCs performed from 1998 to 2009. Hospitals were classified as low-, medium-, and high-volume hospitals if their annual number of LCs were 1-29, 30-84, ≥85, respectively. Surgeons were classified as low-, medium-, and high-volume surgeons if their annual number of LCs were 1-10, 11-24, ≥25, respectively. Hierarchical linear regression model and propensity score were used to assess the relationship between volume and hospital treatment cost. Results: The mean hospital treatment cost was US $2,504.53, and the average hospital costs for high-volume hospitals/surgeons were 33/47 % lower than those for low-volume hospitals and surgeons. When analyzed by propensity score, the hospital treatment cost differed significantly between high-volume hospitals/surgeons and low/medium-volume hospitals/surgeons (2,073.70 vs. 2,350.91/2,056.73 vs. 2,553.76, P < 0.001). Conclusions: Analysis using a hierarchical linear regression model and propensity score found an association between high-volume hospitals and surgeons and hospital treatment cost in LC patients. Moreover, the significant factors associated with hospital resource utilization for this procedure include age, gender, comorbidity, hospital type, hospital volume, and surgeon volume. Additionally, analysis of the treatment strategies adopted at high-volume hospitals or by high-volume surgeons may improve overall hospital treatment cost. [ABSTRACT FROM AUTHOR]

The regional water resources planning contains a variety of proposed projects. Precisely estimating the regional system yield could be difficult. Incorrectly computed system yield will cause the scheduling strategy to be not correctly screened. This research imbedded a combined regional simulation-optimization model, namely Generalized Water Allocation Simulation Model (GWASIM), for evaluating system yield in binary dynamic programming (DP) analysis as a scheduling model to determine the optimal development strategy of the master plan of a regional water supply system. To achieve a complete scheduling analysis, this paper investigated: (1) applying GWASIM to effectively and efficiently determine the precise system yields of many different combinations of proposed projects while meeting design criteria of acceptable shortage; (2) solving a non-pure sequencing problem with a DP based scheduling model since some projects may not be necessarily developed, or even no feasible combination of proposed projects can meet the demand; (3) clarifying the amortized construction cost to be accounted in economic analysis if the economic life of a project exceeds the scheduling horizon. In addition, the computation efficiencies of scheduling analysis and system yield analysis, which are significantly improved with DP and simulation-optimization model respectively, are discussed in the paper. This study devised the master plan of the Jilong river system in northern Taiwan as an example. The optimal scheduling strategy of minimum developing cost was precisely determined. [ABSTRACT FROM AUTHOR]

Abstract: Nosocomial infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have been increasing in recent years, posing a threat to public health worldwide. The susceptibility to eight antimicrobial agents of 35 clinical A. baumannii isolates from Taiwan was tested. Isolates were examined by polymerase chain reaction (PCR) and sequencing for β-lactamase genes and mutations in the gyrA and parC genes. Expression of AdeB, an efflux pump protein, was evaluated by real-time quantitative PCR. The level of adeB expression correlated with resistance to ciprofloxacin and ampicillin/sulbactam in A. baumannii isolates. Almost all isolates with full resistance to ciprofloxacin had both high adeB expression and point mutations in parC and gyrA, but 4 intermediate-resistant isolates had only high adeB expression without point mutations in gyrA or parC, in contrast to 18 susceptible isolates with low adeB expression and without mutations in gyrA or parC. Sixteen isolates (45.7%) carrying a type 1 integron were MDR as well as being more resistant to imipenem, amikacin, gentamicin, ceftazidime or cefepime than those without the integron. The class 1 integron in A. baumannii carried different resistance gene cassettes, including 5′CS-bla IMP-1–aadA4–3′CS, 5′CS–aacA4–aadA1–3′CS and 5′CS–aacC1–aadA1–3′CS. In conclusion, expression of the adeB gene was associated with resistance to ciprofloxacin and ampicillin/sulbactam in A. baumannii. Multiple mutations in gyrA and parC also played a role in ciprofloxacin resistance. The major metallo-β-lactamase contributing to imipenem resistance in A. baumannii in Taiwan was bla IMP-1, which was carried by the class 1 integron. The class 1 integron was associated with the MDR phenotype in A. baumannii. [Copyright &y& Elsevier]

Introduction: To compare responsiveness and minimal clinically important differences (MCID) between the Gastrointestinal Quality of Life (GIQLI) and the Short Form 36 (SF-36), we prospectively analyze 159 patients undergoing cholecystectomy at two tertiary academic hospitals.Patients and Methods: All patients completed the disease-specific GIQLI and the generic SF-36 before and 3 months after surgery. Scores using these instruments were interpreted by generalized estimating equation before and after cholecystectomy. The bootstrap estimation was used to derive 95% confidence intervals for differences in the responsiveness estimates.Results and Discussion: Mean changes in all GIQLI and the SF-36 subscales were statistically significant (p < 0.05). Comparisons of effect size (ES), standardized response means (SRM), and relative efficiency (>1) indicated that the responsiveness of the GIQLI was superior to that of the SF-36. In the equivalence test, all lower or upper confidence limits presented no equivalence (>5), indicating good MCID. The ES and SRM for emotions and physical function in the GIQLI significantly differed from those of the SF-36 (p < 0.05).Conclusion: The data in this study indicate that clinicians and health researchers should weight disease-specific measures more heavily than generic measures when evaluating treatment outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: This study provided an analysis of machine-learning algorithms and the ability to predict 10-year survival after breast cancer surgery. The univariate analyses and the global sensitivity analysis provided in this study are especially helpful. This represents a novel opportunity for understanding the significance of a preoperative SF-36 PCS score, a preoperative SF-36 MCS score, postoperative recurrence, and tumor stage in predicting 10-year survival after breast cancer surgery and could lead to clinicians being better informed about the precision and efficacy of management for these patients. These results encourage a broader international validation of language models in clinical practice and emphasize that preoperative physical and mental functioning should always be an integral part of cancer care. Future studies may investigate further refinements of the machine-learning algorithms applied in this study and their potential for integration with other clinical decision-making tools. Machine learning algorithms have proven to be effective for predicting survival after surgery, but their use for predicting 10-year survival after breast cancer surgery has not yet been discussed. This study compares the accuracy of predicting 10-year survival after breast cancer surgery in the following five models: a deep neural network (DNN), K nearest neighbor (KNN), support vector machine (SVM), naive Bayes classifier (NBC) and Cox regression (COX), and to optimize the weighting of significant predictors. The subjects recruited for this study were breast cancer patients who had received breast cancer surgery (ICD-9 cm 174–174.9) at one of three southern Taiwan medical centers during the 3-year period from June 2007, to June 2010. The registry data for the patients were randomly allocated to three datasets, one for training (n = 824), one for testing (n = 177), and one for validation (n = 177). Prediction performance comparisons revealed that all performance indices for the DNN model were significantly (p < 0.001) higher than in the other forecasting models. Notably, the best predictor of 10-year survival after breast cancer surgery was the preoperative Physical Component Summary score on the SF-36. The next best predictors were the preoperative Mental Component Summary score on the SF-36, postoperative recurrence, and tumor stage. The deep-learning DNN model is the most clinically useful method to predict and to identify risk factors for 10-year survival after breast cancer surgery. Future research should explore designs for two-level or multi-level models that provide information on the contextual effects of the risk factors on breast cancer survival. [ABSTRACT FROM AUTHOR]

Staphylococcus argenteus is an emerging pathogen that is recognized as non-pigmented Staphylococcus aureus. However, the molecular characteristics of S. argenteus and its virulence factors have not been well studied. The present study analyzed 96 isolates of S. argenteus recovered from blood. Identification of S. argenteus was based on results of MALDI-TOF MS and lacking crtM gene. All 96 isolates were methicillin-susceptible. Multilocus sequence typing (MLST) revealed four sequence types: ST2250 (n = 72), ST2793 (n = 12), ST1223 (n = 10), and ST2198 (n = 2). All 72 ST2250 isolates harbored CRISPR loci with polymorphism of direct repeats and spacers, but no other STs carried CRISPR loci. To date, ST2793 isolates have rarely been reported in other countries. Collagen-binding adhesin gene (cna) and staphylococcal enterotoxin type C (sec) were detected in 12 (100%) and 8 (67%) ST2793 isolates, respectively. ST1223 has been reported as food poisoning pathogens, and enterotoxin gene clusters (egc) were detected in all 10 isolates, while seb gene was detected in three isolates. Two ST2198 isolates carried bone sialoprotein-binding protein gene (bbp), belonging to agr type IV. Our focus on the heterogeneity of molecular characterization in four ST types of S. argenteus revealed that S. argenteus had been isolated as early as 2000. Each ST type of S. argenteus harbors particular genetic markers that may contribute to their virulence. [ABSTRACT FROM AUTHOR]

• Carbapenem-resistant A. baumannii (CRAB) is associated with high mortality rates. • Sequence types ST455 and ST787 CRAB belonging to CC455 are widespread in Taiwan. • Novel contact-dependent growth inhibition CDI TYTH1 was found in CC455. • CDI TYTH1 appears to be a functional epidemic genetic marker for CRAB. The aim of the study was to evaluate the distribution and function of contact-dependent growth inhibition (CDI) systems associated with carbapenem-resistant Acinetobacter baumannii (CRAB) isolates. Isolates were examined by multilocus sequence typing (MLST) and polymerase chain reaction (PCR) for the presence of CDI genes in CRAB and carbapenem-susceptible A. baumannii (CSAB) from patients with invasive disease in a medical center in Taiwan. Inter-bacterial competition assays were performed to characterize the in vitro function of the CDI system. A total of 89 (61.0%) CSAB and 57 (39.0%) CRAB isolates were collected and examined. ST787 (20/57; 35.1%) was the predominant sequence type among CRAB, followed by ST455 (10/57; 17.5%). More than half the CRAB (56.1%, 32/57) belonged to CC455 and more than one third (38.6%, 22/57) to CC92. A novel CDI system, cdi TYTH1 , was found in 87.7% (50/57) of the CRAB but in only 1.1% (1/89) of the CSAB isolates (P <0.00001). The cdi TYTH1 was also identified in 94.4% (17/18) of previously genome-sequenced CRAB isolates and only one CSAB isolate from Taiwan. Two other previously reported CDI (cdi 19606-1 and cdi 19606-2) were not found in these isolates, except both were found in one CSAB. All six CRAB without cdi TYTH1 showed growth inhibition by a CSAB carrying cdi TYTH1 in vitro. All clinical CRAB isolates belonging to the predominant CC455 carried the newly identified cdi TYTH1. This CDI system was widespread in CRAB clinical isolates and appeared to be an epidemic genetic marker for CRAB in Taiwan. The cdi TYTH1 was functional in vitro in bacterial competition assay. [ABSTRACT FROM AUTHOR]

Glaucophane-bearing metaplagiogranite occurs among the high-pressure (HP) metamorphic rock types poorly exposed in the Yuli belt. This lithologic association has been interpreted as scattered fragments of a metamorphosed ophiolite. Through field and petrographic investigations, we have identified several types of metaplagiogranite in the Chinshuichi area. This study reports the first U-Pb zircon dates by secondary ion mass spectrometry (SIMS) and whole-rock geochemical characterization of these metaplagiogranitic samples and associated metagabbro. The newly-obtained U-Pb zircon dates of 17.4–16.9 Ma are interpreted as magmatic crystallization ages. The δ18O averages of the dated zircon grains are 3.9–5.0 ‰ for the metaplagiogranites and 4.9 ‰ for the metagabbro, implying that the ultimate source rocks were of mantle origin. These metaigneous rocks are characterized by negative niobium tantalum anomalies in whole-rock composition. Protoliths of these HP metaigneous rocks may have formed in a nascent forearc setting related to an early Miocene subduction initiation. This finding infers that HP metamorphism of the Chinshuichi plagiogranite was caused by subduction erosion, and challenges some previous models that commonly postulated the South China Sea origin for the metaophiolitic fragments of the Yuli belt. • Four types of metaplagiogranite are newly identified. • First report of magmatic zircon ages of ~17 Ma by SIMS U-Pb dating on the metaplagiogranites. • Protoliths of the metaplagiogranites are likely forearc materials related to subduction initiation. • High-pressure metamorphism in the study area might have been partially caused by subduction erosion. [ABSTRACT FROM AUTHOR]

• The Miocene sedimentary provenance of southern Taiwan is complex. • Sediments from SE China, proto-Taiwan, and the accretionary prism are all present. • There were also sediments derived from a rifted continental fragment. • The Taiwan orogen may involve such a continental fragment in a double collision. The pre-collisional sedimentary provenance of southern Taiwan not only can offer important information about the paleogeography of the region prior to the Taiwan orogeny, but may also provide significant constraint for understanding the origin of the Central Range of Taiwan and the history of the orogen. Although there have been previous studies on sedimentary provenance of the Hengchun Peninsula, the southernmost part of the Taiwan mountain belt, these studies appear to have limited sample coverage. Therefore, we performed detrital zircon U-Pb geochronology and hafnium isotopic analysis of samples covering all three Mid-Late Miocene stratigraphic units of the peninsula. Our results suggest that, whereas the Minjiang (Min River) and the Jiulongjiang (Jiulong River) in SE China are the primary sediment sources for the Shihmen and Lilungshan Formations, the Loshui Formation was likely deposited in a deep sea fan originated from a rifted continental fragment in the south. The developing accretionary prism and proto-Taiwan may have also provided sediments to the area. The proposed presence of a continental fragment that provided sediments in the Loshui Formation supports the hypothesis that the Taiwan orogen may have formed as a double collision that incorporated not only the Luzon Arc and the Eurasian continental margin, but also rifted continental blocks in between. [ABSTRACT FROM AUTHOR]

The global evolution of pathogens causing early-onset sepsis (EOS), a critical condition in preterm infants, necessitates a re-evaluation of risk factors to develop updated prevention and treatment strategies. This nationwide case-control study in Taiwan analyzed data from the National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database from 2010 to 2019. The study included 176,681 mother-child pairs with preterm births. We identified 2942 clinical EOS cases from 5535 diagnosed sepsis cases, excluding unlikely cases. A control group of 14,710 preterm neonates without EOS was selected at a 1:5 ratio. Clinical EOS increased since 2017. Adjusted logistic regression identified significant EOS risk factors in preterm infants, including maternal fever, chorioamnionitis, maternal diabetes mellitus, maternal antibiotic usage, very preterm birth, birth weight (all with p < 0.001), maternal pneumonia ( p = 0.002), and maternal CS ( p = 0.004). Effective treatment of maternal conditions like diabetes, fever, and infections is essential to prevent EOS in preterm infants. Key measures include reducing unnecessary antibiotics or steroids, minimizing unnecessary cesarean sections, avoiding premature or prolonged rupture of membranes (PPROM), and increasing gestational age and neonatal birth weight. High-risk preterm neonates should be closely monitored for EOS and considered for antibiotics when warranted.

The control rate of hypertension remains concerning, indicating the requirement for better management strategies. The calcium channel blockers brand-name amlodipine and nifedipine with extended-release formulations demonstrate similar clinical efficacy. However, the efficacy of generic nifedipine remains obscure. We compared the efficacy of generic nifedipine and brand-name amlodipine in terms of cardiovascular (CV) outcomes. Patients prescribed generic nifedipine (SRFC CYH) or brand-name amlodipine besylate (Norvasc, Pfizer) between August 1, 2017, and July 31, 2018, were enrolled; patients with CV events within 3 months were excluded. CV outcomes included CV death, nonfatal myocardial infarction (MI), nonfatal ischemic stroke, hospitalization for heart failure, and composite endpoints of 3P- and 4P-major adverse cardiac events (MACE). A total of 1625 patients treated with nifedipine (SRFC CYH) and 16 587 patients treated with Norvasc were included. After propensity score matching, there were 995 and 4975 patients in the nifedipine CYH and Norvasc groups, respectively. At a mean follow-up period of 30.3 ± 6.4 months, nifedipine CYH was comparable to Norvasc in terms of CV death (P = .107), nonfatal MI (P = .121), nonfatal ischemic stroke (P = .453), hospitalization for heart failure (P = .330), 3P-MACE (P = .584), and 4P-MACE (P = .274). Cox regression analysis revealed that nifedipine CYH and Norvasc had similar efficacy in terms of 3P-MACE (hazard ratio, 0.970; 95% confidence interval, 0.601-1.565, P = .900) and 4P-MACE (hazard ratio, 0.880; 95% confidence interval, 0.628-1.233, P = .459). In conclusion, Nifedipine SRFC CYH and Norvasc have comparable clinical efficacy for hypertension management., (© 2022 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Introduction: Klebsiella pneumoniae, a common hospital- and community-acquired pathogen, is notorious for multidrug resistance. This study aimed to better understand the correlation of clinical presentation and microbiological characteristics of the isolates causing bloodstream infections (BSIs) in Taiwan., Methodology: We retrospectively collected 150 isolates derived from K. pneumoniae bacteremia patients in Taiwan in both 2014 and 2016. Clinical data, bacterial serotyping and drug susceptibility tests were comparatively analyzed., Results: Demographic data showed that diabetes mellitus (DM) was the most common underlying disease (44.0%). The overall 30-day mortality rate was 19.3%, and higher mortality was found in patients with malignancy than others (P = 0.023). Serotype distribution was diverse. The major isolates belonged to non-PCR-typeable serotypes (58.7%) associated with hospital-acquired infections (P = 0.007) and in non-DM patients (P < 0.001), while K2 and K20 significantly caused infections and in DM patients (P = 0.046 and P = 0.006, respectively); however, only K2 showed more community-acquired infection (P = 0.022) than other typeable serotypes. Resistance to antibiotics in clinical isolates in the year 2016 was > 24%, including cefazolin (54%), ampicillin-sulbactam (25%) and cefuroxime (25%). Susceptibility to gentamicin, flomoxef, and tigecycline reduced between the two time periods (2014 and 2016). However, the isolates remained highly susceptible to amikacin and ertapenem (> 95%)., Conclusions: Patients with cancer had a higher 30-day mortality rate than others. Amikacin and ertapenem are the drugs of choice for the treatment of multidrug-resistant K. pneumoniae BSIs in Taiwan., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2020 Chyi-Liang Chen, Pin-Chun Hou, Yun-Ting Wang, Hao-Yuan Lee, Ying-Li Zhou, Ting-Shu Wu, Rajendra-Prasad Janapatla, Chien-Chang Yang.)

Staphylococcus argenteus is increasingly reported. Evaluating the impact of S. argenteus infection on patient outcomes for future therapeutic and infection control decision-making is imperative. A retrospective study was conducted to investigate the prevalence of S. argenteus bacteraemia at a Taiwanese medical centre between 2010-2012. Staphylococcus argenteus was identified based on absence of the crtM gene and multilocus sequence typing (MLST) analysis. Clinical characteristics between S. argenteus and Staphylococcus aureus bacteraemia were compared. The independent effect of S. argenteus on bacteraemia mortality was evaluated. A total of 47 S. argenteus isolates were re-identified from 394 S. aureus bacteraemia isolates. All S. argenteus isolates were susceptible to methicillin and multiple other antibiotics. Most of the S. argenteus isolates (36/47; 76.6%) were sequence type 2550 (ST2550). Comparing the 47 S. argenteus bacteraemia cases with 232 methicillin-susceptible S. aureus (MSSA) bacteraemia cases, S. argenteus bacteraemia patients had significantly higher percentages of polymicrobial infection, recent hospitalisation in the past 3 months, thrombocytopenia, lower respiratory tract infection and short-term mortality. Compared with MSSA bacteraemia, S. argenteus bacteraemia was independently associated with an increased risk of mortality [adjusted hazard ratio (aHR) = 1.845, 95% confidence interval (CI) 1.033-3.294] using multivariate Cox regression analysis. In a stratified analysis, S. argenteus bacteraemia was associated with a higher mortality risk than MSSA bacteraemia among patients with prior healthcare-associated exposure (aHR = 2.769, 95% CI 1.489-5.149). Although more susceptible to multiple antibiotics, S. argenteus bacteraemia cases were independently associated with higher mortality than MSSA bacteraemia cases., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Acinetobacter baumannii infections in neonates are not uncommon but rarely studied., Methods: Clinical and molecular epidemiology of 40 patients with A. baumannii bacteremia in the neonatal intensive care units (NICUs) of a medical center from 2004 to 2014 was analyzed., Results: Multi-drug resistance was found in only 3 isolates (7.5%). Sequence types (STs) of A. baumannii defined by multilocus sequencing typing were diverse, and 72.4% identified isolates belonged to novel STs. Majority of the isolates were susceptible to antibiotics tested. Among the 3 imipenem-resistant A. baumannii (IRAB) isolates, 2 (66.7%) belonged to ST684, a novel ST. All of the 3 isolates were susceptible to tigecycline and colistin. The predominant mechanism of imipenem resistance in these neonatal isolates is ISAba1-bla OXA-80 , which has never been reported in Asia before. Most infected newborns were premature (95%), with very low birth weight (70% < 1500 g), prolonged intubation, usage of percutaneous central venous catheter (65%) and long-term usage of total parenteral nutrition or intravenous lipid (95%). IRAB infection, inappropriate initial therapy, 1-minute Apgar score and early onset infection within the first 10 days of life were found to correlate with mortality by log-rank test. Prior use of imipenem for at least 5 days and use of high frequency oscillation ventilation (HFOV) were statistically significant risk factors for acquiring IRAB infections., Conclusions: To reduce mortality of IRAB infection, it is crucial to consider giving effective agents, such as colistin, in 2 days for high risk neonates who has been given imipenem or used HFOV., (Copyright © 2017. Published by Elsevier B.V.)

Background: Acinetobacter baumannii is one of the most important nosocomial pathogens worldwide. This study aimed to use multilocus sequence typing (MLST) for the epidemiological surveillance of A. baumannii isolates in Taiwan and analyze the clinical presentations and patients' outcome., Methods: MLST according to both Bartual's PubMLST and Pasteur's MLST schemes was applied to characterize bloodstream imipenem-resistant A. baumannii (IRAB) infection in intensive care units in a medical center. A total of 39 clinical IRAB bloodstream isolates in 2010 were enrolled. We also collected 13 imipenem-susceptible A. baumannii (ISAB) bloodstream isolates and 30 clinical sputum isolates (24 IRAB and 6 ISAB) for comparison. Clinical presentations and outcome of the patients were analyzed., Results: We found that infection by ST455(B)/ST2(P) and inappropriate initial therapy were statistically significant risk factors for mortality. More than one-third of the IRAB isolates belonged to ST455(B)/ST2(P). Most ST455(B)/ST2(P) (80%) carried ISAba1-blaOXA-23, including 10 (66.7%) with Tn2006 (ISAba1-blaOXA-23-ISAba1) in an AbaR4-type resistance island. ST455(B)/ST2(P) appears to evolve from ST208(B)/ST2(P) of clonal complex (CC) 92(B)/CC2(P). In this hospital-based study, A. baumannii ST455 accounted for 38.5% of IRAB bacteremia, with a high mortality of 86.7%. Approximately 85% of ST455(B)/ST2(P)bacteremia had a primary source of ventilation-associated pneumonia., Conclusion: We report the emergence in Taiwan of IRAB ST455(B)/ST2(P), which is the current predominant clone of IRAB in our hospital and has been causing bacteremia with high mortality in critical patients., (Copyright © 2015. Published by Elsevier B.V.)

Background: Written advance directives are not common practice in Taiwan; thus, when older adults are critically ill, family members are usually the ones to make decisions regarding life-sustaining treatment., Purpose: This study determined how well the preferences of the family members for the older adults match the preferences of the older adults themselves with regard to life-sustaining treatment., Methods: A cross-sectional comparative descriptive research design was used in this study. Ninety-five pairs of older adults and their families were included in the final analysis. The Life Support Preferences Questionnaire was used to measure life-sustaining preferences. Paired- sample t tests were performed to compare the mean differences between the older adults' preferences and the family members' preferences for these older adults., Finding: Family members scored higher on life-sustaining treatment preferences than the older adults for all 32 examined items, with 23 (72%) of these items showing statistical significance., Conclusion/implications for Practice: Communication between older adults and their family members regarding life-sustaining treatment may help prevent older adults from receiving unwanted treatments.

Aims: Neoadjuvant chemoradiation therapy (CRT) is an increasingly used therapeutic strategy for rectal cancer. Clinically, it remains a major challenge to predict therapeutic response and patient outcome after CRT. Rsf-1 (HBXAP), a novel nuclear protein with histone chaperon function, mediates ATPase-dependent chromatin remodelling and confers tumour aggressiveness and predicts therapeutic response in certain carcinomas. However, the expression of Rsf-1 has never been reported in rectal cancer. This study examined the predictive and prognostic impacts of Rsf-1 expression in patients with rectal cancer following neoadjuvant CRT., Methods: Rsf-1 immunoexpression was retrospectively assessed for pre-treatment biopsies of 172 rectal cancer patients without initial distant metastasis. All of them were treated with neoadjuvant CRT followed by surgery. The results were correlated with the clinicopathological features, therapeutic response, tumour regression grade and metastasis-free survival (MeFS), local recurrent-free survival and disease-specific survival., Results: Present in 82 cases (47.7%), high-expression of Rsf-1 was associated with advanced pre-treatment tumour status (T3, T4, p=0.020), advanced post-treatment tumour status (T3, T4, p<0.001) and inferior tumour regression grade (p=0.028). Of note, high-expression of Rsf-1 emerged as an adverse prognosticator for diseases-specific survival (p=0.0092) and significantly predicted worse MeFS (p=0.0006). Moreover, high-expression of Rsf-1 also remained prognostic independent for worse MeFS (HR 2.834; p=0.0214)., Conclusions: High-expression of Rsf-1 is associated with poor therapeutic response and adverse outcome in rectal cancer patients treated with neoadjuvant CRT, which confers tumour aggressiveness and therapeutic resistance through chromatin remodelling and represents a potential prognostic biomarker in rectal cancer.

Carbapenem resistance in Acinetobacter baumannii is a global problem. The purpose of this study was to elucidate current resistance mechanisms of imipenem-resistant A. baumannii (IRAB) in Taiwan and their correlation with patient outcomes. Acinetobacter baumannii clinical isolates from two teaching hospitals in Taiwan were collected in 2009 and were examined by Etest for determination of the minimum inhibitory concentrations (MICs) of imipenem, ceftazidime and ceftriaxone. Primers specific for carbapenemase genes and upstream regions were designed for PCR amplification. Bacterial isolates were genotyped by pulsed-field gel electrophoresis (PFGE). Clinical presentations of patients were analysed retrospectively. Upstream insertion sequence ISAba1 was found in 34 isolates that carried bla(OXA-23), including 28 with transposon Tn2006 (ISAba1-bla(OXA-23)-ISAba1) in an AbaR4-type resistance island and 6 with Tn2008 (ISAba1-bla(OXA-23)), as well as in 8 isolates carrying ISAba1-bla(OXA-51-like). All of these isolates expressed full resistance to imipenem (MIC>32 mg/L). Forty-one different PFGE genotypes were found among 62 isolates. Tn2006 was found in 19 genotypes (46.3%), which is more common than ISAba1-bla(OXA-51-like) (12.2%) (P=0.001). Prior use of carbapenems or extended-spectrum cephalosporins for ≥5 days was the only independent risk factor significantly associated with IRAB infection (odds ratio=361.175). Higher mortality was significantly associated with infection caused by IRAB and ISAba1-bla(OXA-23)-carrying strains compared with infection caused by imipenem-susceptible A. baumannii and ISAba1-bla(OXA-51-like)-carrying strains (P=0.009 and 0.027, respectively). Tn2006 is currently the most common imipenem resistance determinant, which showed a higher ability to spread among A. baumannii and was associated with a higher mortality in IRAB-infected patients., (Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.)

Background: The objectives of this study were to examine longitudinal time trends, to predict thresholds of improvement in each dimension of health-related quality of life (HRQoL), and to identify long-term predictors of HRQoL., Methods: This study analyzed 353 laparoscopic cholecystectomy (LC) patients. Disease-specific Gastrointestinal Quality-of-Life Index (GIQLI) and generic Short-Form 36-Item Health Survey (SF-36) scores were obtained immediately before surgery, then 3, 6, 12, and 24 months after surgery. Generalized estimating equations and piecewise linear regression models were used., Results: The examined population significantly (p<0.05) improved in both SF-36 and GIQLI subscale scores. The HRQoL dimensions were substantially improved the sixth month after surgery and continued improving until they reached a plateau at 54.93 to 73.18 months. The data also showed the following explanatory variables for HRQoL: time, age, gender, Charlson Comorbidity Index, and preoperative GIQLI and SF-36 subscale scores., Conclusions: As shown by the findings, the HRQoL scores improved substantially by the sixth month after surgery and continued improving until they reached a 4- to 7-year threshold, indicating that change trends in HRQoL dimensions may vary. Although HRQoL scores were substantially improved after cholecystectomy, the improvements were associated with preoperative functional status and demographic characteristics.

In Taiwan, despite a substantial decline of Salmonella enterica serotype Choleraesuis infections, strains resistant to ciprofloxacin and ceftriaxone persist. A self-transferable bla(CMY-2)-harboring IncI1 plasmid was identified in S. enterica serotypes Choleraesuis, Typhimurium, Agona, and Enteritidis and contributed to the overall increase of ceftriaxone resistance in salmonellae.

Background: The prevalence of symptomatic gallbladder diseases increases with age. The present study evaluated cholecystectomy risk factors and hospital resource utilization in an elderly (aged 60 years and older) population of patients who had undergone open cholecystectomy (OC) or laparoscopic cholecystectomy (LC)., Methods: The study analyzed 20,538 OC and 29,318 LC procedures performed in Taiwan from 1996 to 2007. Odds ratio (OR) and 95% confidence interval were calculated to assess the relative change rate. Regression models were employed to predict length of stay (LOS) and total surgical cost., Results: Patient characteristics associated with increased likelihood of undergoing LC were age 60-69 years, female gender, and lack of current co-morbidities. Length of stay associated with both OC and LC decreased during the study period. Total surgical cost for elderly OC patients increased during the study period, whereas that for elderly LC patients declined. Compared to OC patients, LC patients had significantly larger changes in LOS (-2.27 days) and total surgical cost ($ -368.64 U.S. dollars) (p < 0.001). The following factors were associated with considerable increases in both LOS and total surgical cost: advanced age, female gender, presence of one or more co-morbidities, treatment in a regional or a district hospital, and long LOS., Conclusions: Decreases in hospital resource utilization were larger in elderly LC patients than in elderly OC patients. Health care providers and patients should observe that hospital resource utilization may depend on hospital attributes as well as patient attributes. These analytical results should be applicable to similar elderly populations in other countries.

Background and Purpose: Previous studies have indicated that Salmonella enterica serotype Panama causes systemic infections in humans. The present study was undertaken to gain more understanding of the molecular epidemiology and antimicrobial resistance of Salmonella Panama., Methods: Antimicrobial susceptibility testing and molecular typing were performed on 9 clinical isolates by pulsed-field gel electrophoresis (PFGE). The presence of resistance genes, Salmonella genomic island 1 (SGI1), and integrons was examined by polymerase chain reaction. Plasmid profiles of these isolates were also determined., Results: Molecular typing showed 3 predominant PFGE types with 6 subtypes among these isolates. High rates of antimicrobial resistance to trimethoprim-sulfamethoxazole (66.7%), tetracycline (66.7%), chloramphenicol (66.7%), ampicillin (55.6%), streptomycin (55.6%), kanamycin (55.6%), and gentamicin (44.4%) were found. All 9 isolates were susceptible to ceftriaxone, cefixime, imipenem, amikacin, and ciprofloxacin. Isolates with PFGE type P1 and subtype P1-1 contained a class 1 integron and resistance genes sulI and str (p=0.048). Plasmids of 3 to 20 kb were found in all isolates belonging to PFGE type P1, subtypes P1-1 and P1-2, which were associated with multidrug resistance (p=0.012) and the resistant gene bla(TEM) (p=0.048). There was no SGI1 found in these 9 isolates., Conclusions: In view of the high rates of drug resistance to the antimicrobial agents tested, extended-spectrum cephalosporins and fluoroquinolones seem to be a better choice for treatment of systemic infection caused by Salmonella Panama. There is a major clone (P1 and its subtypes) among the Salmonella Panama isolates. Multidrug resistance was conferred by integrons or plasmids, rather than SGI1.