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Hot springs are important centers for recreation and tourism. However, the pollution that may potentially be caused by hot spring wastewater has rarely been discussed. More than half of Taiwan's hot springs are located in areas where the water quality of water bodies is to be protected, and untreated wastewater could pollute the receiving water bodies. In this study, we investigate hot spring wastewater in the Wulai area, one of Taiwan's famous hot spring resorts. Used water from five hot spring hotels was sampled and ten sampling events were carried out to evaluate the changes in the quality of used water in different seasons, at different periods of the week, and from different types of hotels. The concentrations of different pollutants in hot spring wastewater were found to exhibit wide variations, as follows: COD, 10-250 mg/L; SS, N.D. 293 mg/L; NH3-N, 0.01-1.93 mg/L; TP, 0.01-0.45 mg/L; and E. coli, 10-27,500 CFU/100 mL. The quality of hot spring wastewater depends on the operation of public pools, because this affects the frequency of supplementary fresh water and the outflow volume. Two management strategies, namely, onsite treatment systems and individually packaged treatment equipment, are considered, and a multi-objective optimization model is used to determine the optimal strategy. [ABSTRACT FROM AUTHOR]

AimsAcute haemorrhagic conjunctivitis (AHC) is a highly contagious conjunctivitis associated with enteroviruses. Coxsackie A-24 variant (CA-24v) and enterovirus-70 (EV-70) are the two major causative agents. During October 2007, an epidemic of AHC occurred in Taiwan, affecting more than 11 000 people. The aim of this study was to determine the aetiological agent associated with the outbreak in patients diagnosed with AHC and treated at the Cathay General Hospital, Taipei (CGHT) and Cathay General Hospital Sijhih (CGHS), Taiwan during October 2007.MethodsVirus isolates were obtained from six patients (four from CGHS and two from CGH), and a total of seven specimens (one throat and one rectal, and five eye swabs) were collected. The specimens were inoculated onto the MRC-5 cell lines. The viral isolation was confirmed by performing real-time reverse transcription-polymerase chain reaction (RT-PCR) and indirect immunofluorescence assay (IFA).ResultsThe conjunctival, throat, and rectal swabs collected in this study were all tested positive for a variant of CA-24. All seven viral isolates were characterized as a variant of CA-24 and confirmed by IFA and real-time RT-PCR.ConclusionsThe findings suggest that the outbreak of AHC that occurred during October 2007 in the northern area of Taiwan was caused by a variant of coxsackie A-24. Further phylogenic analysis is underway to further classify this CA-24v strain. [ABSTRACT FROM AUTHOR]

Aims:To study the efficacy of verteporfin photodynamic therapy (VPDT) retrospectively in the treatment of idiopathic subfoveal choroidal neovascularization (ICNV) in an Asian population in correlation with number of treatments and age at treatment. This is the first report to compare the efficacy between single and multiple treatments.Methods:VPDT was administered according to protocol to 45 eyes in 45 patients aged 18–55 years diagnosed with active subfoveal ICNV between September 2003 and December 2005. In total 28 patients received a single VPDT treatment and the remaining 17 received multiple treatments. Collected measurements of visual acuity (VA) were plotted on a time-course model, and later dichotomized by age (18–45 vs46–55 years).Results:The 28 patients receiving a single VPDT treatment showed significant improvement in VA at 3-month follow-up. The 17 patients, who did not show improvement after the first treatment, received multiple VPDT treatments. Those patients showed an even clearer trend in VA improvement although significance was detected only at the 24th month. All patients showed a significant improvement in mean VA of 0.46 logMAR (P<0.01 compared to baseline) by the end of the 24-month observation period, although VPDT treatment for subfoveal ICNV appears to stabilize vision more rapidly in younger patients.Conclusions:ICNV patients who did not benefit from single VPDT treatments could receive multiple treatments, and showed a more significant improvement in visual acuity. These results are the first of their kind in ICNV treatment.Eye (2009) 23, 314–319; doi:10.1038/sj.eye.6703073; published online 18 January 2008 [ABSTRACT FROM AUTHOR]

Background: Pap smear screening was the first nation-wide population-based organized screening since 1999 in Taiwan. After that, nationwide screening programs for breast cancer, colorectal cancer, and oral cancer have been launched since 2004. The national online information system was built for the infrastructure, monitoring, delivery, evaluation, and management of health care services in our nationwide screening program. Aim: To develop a comprehensive health information system for cancer screening to assist health professionals in processing screening with quality assurance and evaluation. Methods: A Web-based solution combining data gathering and processing capabilities was developed. Application design in a server was based on the ASP, HTML, DHTML, Java Script, Java Applet technology and SQL-SERVER relational database. Web-based software programs were developed to facilitate the structure, process, and outcome for screening. Individual screening data were transferred to centralized databases via the Internet. The client-users now include 25 health bureaus, 369 health centers and over 6500 clinics or hospitals. Results: The Taiwanese cancer screening system incorporates nationwide breast cancer screening with mammography, colorectal cancer with fecal immunochemical test, oral cancer with visual inspection. The key performance index for screening including screening rate, positive rate, referral rate, positive predictive rate, detection rate, and interval cancer rate were provided in the system. The system allows for the flow of information among different health services and country areas to monitor participants in the whole process screening. It has an alert system to prevent delayed referral for cases in need of diagnosis and treatment. A total of 2.27 million women aged 45-69 years have attended biennial mammography screening program at least once between 2004 and 2014. More than 4.6 million subjects with the exposure of betel quid and/or cigarette have attended the biennial oral cancer screening. Around 3.8 million subjects aged 50-74 years have attended the biennial FIT screening. Information on organized features appertaining to screening, diagnosis, and outcomes after long-term follow up were collected for the systematic evaluation. The proposed health information system for cancer screening is centered on modules that would allow for the computerization, process, update of screen data, and link with other registry data (e.g., population registry, cancer registry, and mortality). Conclusion: A nation-wide information system for breast cancer, colorectal cancer, and oral cancer screening was successfully developed to support health professionals and health decision makers for planning, delivery, management, and evaluation in population-based cancer screening program. [ABSTRACT FROM AUTHOR]

Background Cutaneous lupus erythematosus (CLE) includes a broad range of dermatologic manifestations. Periorbital involvement, however, is a relatively rare clinical presentation of CLE. Objectives This clinical study aimed to investigate the characteristics of this unique presentation of CLE in tertiary medical centers. Methods We enrolled patients with periorbital erythema and swelling as the presenting sign of lupus erythematosus, from January 2003 to November 2017, using the data of 553 pathologically proven CLE cases from the registration database of the Chang Gung Memorial Hospitals in Taiwan. Results We enrolled a total of 25 patients. The mean age was 46.7 years and 68% of the patients were female. Most of the patients (84.0%) presented with unilateral involvement, with the left orbit involved in 15 patients (60%); the upper eyelid was the most frequently involved (72%). Mean duration between the onset of clinical manifestations and the diagnosis of CLE was approximately 59 weeks. Nineteen patients had been previously misdiagnosed. All patients had features compatible with CLE on histopathological examination. In contrast, laboratory analysis of the autoimmune profile often revealed negative results, including those for antinuclear antibodies (25%). Notably, anti-SSA/SSB (45.5%) showed the highest positive rate. During follow-up, six patients developed systemic lupus erythematosus (SLE) and two patients developed Sjögren syndrome. Conclusions The diagnosis of CLE presenting as periorbital erythema and swelling is often delayed because of clinical mimicry and the high proportion of negative results on autoantibody tests. Increased clinical suspicion and prompt histopathological examination are crucial for early diagnosis. Moreover, one-fourth of the patients ultimately developed SLE, which highlights the importance of clinical awareness.

We investigated the genetic properties of imipenem-resistant Acinetobacter baumannii collected from a regional hospital in Taiwan. Pulsed-field gel electrophoresis demonstrated that the isolates were genetically diverse. Polymerase chain reaction, DNA sequencing, and DNA-DNA hybridisation showed that the bla(IMP-1) gene resided as a cassette in a plasmid-borne class 1 integron in two isolates. The majority of the resistant isolates were plasmid-less and carried no bla(IMP), bla(VIM) or bla(CFI) genes, indicating that other uncharacterised metallo-beta-lactamases or mechanisms other than enzyme production are involved in carbapenem resistance in this group of A. baumannii. We conclude that multidrug resistance of A. baumannii was a combined effect of lateral gene transfer and clonal spread of multiple resistant clones. Strict measures should be implemented to control the further spread of resistance.

An open reading frame (ORF) that encodes a 715-amino-acid polypeptide was found in an 8421-bp EcoRI fragment of the shrimp white spot syndrome virus (WSSV) genome. The polypeptide shows significant homology to eukaryotic serine/threonine protein kinase (PK) and contains the major conserved subdomains for eukaryotic protein kinases. Coupled in vitro transcription and translation generated a protein having an apparent molecular mass of about 87 kDa according to sodium dodecyl sulfate-polyacrylamide gel electrophoresis. For transcriptional analysis of the pk gene, total RNA was isolated from WSSV-infected shrimp at different times after infection. Northern blot analysis with pk-specific riboprobe found a major and a minor transcript of 2.7 and 5.7 kb, respectively. Rapid amplification of the 5' cDNA ends of the major 2.7-kb pk transcript showed that there were two transcriptional initiation sites located at nucleotide residues -38(G) and -39(G) relative to the ATG translational start codon. Temporal expression analysis by RT-PCR indicated that the transcription of the pk gene started 2 h after infection and continued for at least 60 h. Phylogenetic analysis showed that WSSV protein kinase does not have any close relatives and does not fall into any of the major protein kinase groups., (Copyright 2001 Academic Press.)

Palmar hyperhidrosis (PH) is a common disorder in Taiwan. It often causes social embarrassment and occupational handicaps. So far, there has been no satisfactory treatment for PH. In 1990, we first developed a minimally invasive technique: video endoscopic sympathectomy to treat PH. The procedure has subsequently proven to be a standard treatment for PH. In this study, a survey of 9988 cases of PH patients from 17 hospitals in Taiwan treated by this method during the past 5 years is presented. Although there were some variations in the model of anaesthesia, technique and extent of sympathectomy, the postoperative results were generally satisfactory. Both sides of sympathectomy were mostly accomplished within half an hour in one stage. The operative scars were tiny and concealed in the axillary region. The patients were discharged from the hospital after an overnight stay. Complications such as pneumothorax, haemothorax (0.3%) or Horner's syndrome (0.1%) were rare. There was no surgical mortality in this series. The most common complication was compensatory hyperhidrosis which was usually mild to moderate and tolerable after reassurance. The recurrence rate of PH was approximately 1% in the first year and less than 3% during the 3 years of follow up. Intraoperative monitoring of palmar skin temperature (PST) was advocated to confirm an adequate sympathectomy warranting a definite result. En bloc ablation of T2 segment invariably resulted in a rise of PST to about 2 degrees C and was considered as an adequate extent of sympathectomy for PH. The refined technique was extended to treat young children with PH and patients with craniofacial hyperhidrosis. The therapeutic results were generally excellent with minimal morbidity and rare recurrence. It is concluded that video endoscopic en bloc T2 sympathectomy is a simple, minimally invasive and effective treatment for both adults and children with PH and also for patients with craniofacial hyperhidrosis.