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Alzheimer's disease (AD) and vascular dementia (VaD) are the two most common forms of dementia. However, their neuropsychological and pathological features often overlap, making it difficult to distinguish between AD and VaD. In addition to clinical consultation and laboratory examinations, clinical dementia diagnosis in Taiwan will also include Tc-99m-ECD SPECT imaging examination. Through machine learning and deep learning technology, we explored the feasibility of using the above clinical practice data to distinguish AD and VaD. We used the physiological data (33 features) and Tc-99m-ECD SPECT images of 112 AD patients and 85 VaD patients in the Taiwanese Nuclear Medicine Brain Image Database to train the classification model. The results, after filtering by the number of SVM RFE 5-fold features, show that the average accuracy of physiological data in distinguishing AD/VaD is 81.22% and the AUC is 0.836; the average accuracy of training images using the Inception V3 model is 85% and the AUC is 0.95. Finally, Grad-CAM heatmap was used to visualize the areas of concern of the model and compared with the SPM analysis method to further understand the differences. This research method can quickly use machine learning and deep learning models to automatically extract image features based on a small amount of general clinical data to objectively distinguish AD and VaD. [ABSTRACT FROM AUTHOR]

Background/Aims: Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is one of the best policies to control COVID-19 pandemic. The serological response to COVID-19 vaccination in Taiwanese patients with different comorbidities is elusive. Methods: Uninfected subjects who received 3 doses of mRNA vaccines (BNT162b2 [Pfizer-BioNTech, BNT] and mRNA-1273 [Moderna]), viral vector-based vaccines (ChAdOx1-S (AZD1222, AZ) or protein subunit vaccines (Medigen COVID-19 vaccine) were prospectively enrolled. The SARS-CoV-2-IgG spike antibody level was determined within three months after the 3rd dose of vaccination. The Charlson Comorbidity Index (CCI) was applied to determine the association between vaccine titers and underlying comorbidities. Results: A total of 824 subjects were enrolled in the current study. The proportions of CCI scores of 0–1, 2–3 and > 4 were 52.8% (n = 435), 31.3% (n = 258) and 15.9% (n = 131), respectively. The most commonly used vaccination combination was AZ–AZ–Moderna (39.2%), followed by Moderna–Moderna–Moderna (27.8%). The mean vaccination titer was 3.11 log BAU/mL after a median of 48 days after the 3rd dose. Factors associated with potentially effective neutralization capacity (IgG level ≥ 4160 AU/mL) included age ≥ 60 years (odds ratio [OR]/95% confidence interval [CI]: 0.50/0.34–0.72, P < 0.001), female sex (OR/CI: 1.85/1.30–2.63, P = 0.001), Moderna–Moderna-based vaccination (compared to AZ–AZ-based vaccination, OR/CI: 6.49/3.90–10.83, P < 0.001), BNT–BNT-based vaccination (compared to AZ–AZ-based vaccination, OR/CI: 7.91/1.82–34.3, P = 0.006) and a CCI score ≥ 4 (OR/CI: 0.53/0.34–0.82, P = 0.004). There was a decreasing trend in antibody titers with increasing CCI scores (trend P < 0.001). Linear regression analysis revealed that higher CCI scores (β: − 0.083; 95% CI: − 0.094–0.011, P = 0.014) independently correlated with low IgG spike antibody levels. Conclusions: Subjects with more comorbidities had a poor serological response to 3 doses of COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Background: Engaging in physical activity and reducing sedentary time in daily life may enable older individuals to maintain muscle mass. This study aimed to investigate the effects of replacing sedentary behavior with light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on the muscle function of older adults at a medical center in Taiwan. Methods: We recruited 141 older adults (51.1% men; 81.1 ± 6.9 years old) and asked them to wear a triaxial accelerometer on the waist to measure their sedentary behavior and physical activity. Functional performance was assessed based on handgrip strength, Timed Up and Go (TUG) test, gait speed, and five-times-sit-to-stand test (5XSST). Isotemporal substitution analysis was performed to examine the effect of substituting 60 min of sedentary time with 60 min of LPA, MVPA, and combined LPA and MVPA in different proportions. Results: Reallocating 60 min of sedentary behavior per day to LPA was associated with better handgrip strength (Beta [B] = 1.587, 95% confidence interval [CI] = 0.706, 2.468), TUG test findings (B = -1.415, 95% CI = -2.186, -0.643), and gait speed (B = 0.042, 95% CI = 0.007, 0.078). Reallocating 60 min of sedentary behavior per day to MVPA was associated with better gait speed (B = 0.105, 95% CI = 0.018, 0.193) and 5XSST findings (B = -0.060, 95% CI = -0.117, -0.003). In addition, each 5-min increment in MVPA in the total physical activity replacing 60 min of sedentary behavior per day resulted in greater gait speed. Replacing 60 min of sedentary behavior with 30-min of LPA and 30-min of MVPA per day significantly decreased the 5XSST test time. Conclusion: Our study indicates that introducing LPA and a combination of LPA and MVPA to specifically replace sedentary behavior may help maintain muscle function in older adults. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess the latest prevalence and secular trend of Helicobacter pylori infection and its association with the incidence and mortality of gastric cancer in Taiwan. Materials and Methods: Adults naive to H. pylori eradication received 13C‐urea breath test (13C‐UBT), H. pylori stool antigen test, and serology test during 2019–2020 in this prospective screening program. Children and adolescent aged between 7 and 19 years received 13C‐UBT for H. pylori screening. We also conducted a systematic review and meta‐analysis to assess the secular trend of prevalence of H. pylori from 1990 to 2020 in Taiwan. The secular trends of age‐standardized incidence and mortality of gastric cancer were obtained from the Taiwan Cancer Registry. Results: A total of 1494 participants were enrolled, including 294 children or adolescents and 1200 adults. The overall prevalence of active H. pylori infection by 13C‐UBT was 26.6% (397/1494), which was 30.8% in adults and 9.5% in adolescents/children. The age‐standardized prevalence of active H. pylori infection was 32.3% in adults after adjustment of the population structure in Taiwan. Of the 29 studies including 38,597 subjects eligible for the meta‐analysis, the pooled prevalence of H. pylori infection decreased from 63.8% (95% CI: 55.9%–71%) in 1990–2000 to 28.2% (95% CI:21.8%–35.6%) in 2016–2020. The age‐standardized incidence and mortality of gastric cancer have also declined from 15.2 to 10.75 per 100,000, respectively, in 1999 to 9.29 and 5.4 per 100,000, respectively, in 2019. Conclusions: The prevalence of H. pylori infection has declined in Taiwan, which correlates with the declining trends of age‐standardized incidence and mortality of gastric cancer in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori infection is known to decrease the incidences of autoimmune diseases and inflammatory bowel disease(IBD). Our aim was investigating the effect of H. pylori treatment in diabetes mellitus(DM) patients. Methods: Adults with newly-diagnosed H. pylori infection or peptic ulcer disease(PUD) within the general population and DM population were identified from the National Health Insurance Research Database of Taiwan from 2000–2010. 79,181 patients were assigned to the 3 groups: general population with PUD without H. pylori treatment(PUD-HPRx in general population), DM patients with PUD without H. pylori treatment(PUD-HPRx in DM), and DM patients with PUD who received H. pylori treatment(PUD+HPRx in DM). Results: Higher incidences of autoimmune diseases and IBD were observed in the PUD+HPRx in DM group than in the PUD-HPRx in general population and PUD-HPRx in DM groups (autoimmune diseases = 5.14% vs 3.47% and 3.65%; IBD = 5.60% vs 3.17% and 3.25%; P<0.0001). A lower all-cause mortality was noted in the PUD+HPRx in DM group (HR: 0.937, P<0.001) than in the PUD-HPRx in DM group. Trends of a higher incidence of IBD and a lower mortality in younger patients in the PUD+HPRx in DM group compared with the PUD-HPRx in DM group were noted. Conclusions: The results revealed that H. pylori treatment increased the incidences of autoimmune diseases and IBD and decreased the all-cause mortality in the DM group with PUD. The effect was more significant in younger patients. This finding assists in realizing the influence of H. pylori treatment in the DM population. [ABSTRACT FROM AUTHOR]

Diabetic kidney disease (DKD) is a critical microvascular complication of diabetes. With the continuous increase in the prevalence of diabetes since 2000, the prevalence of DKD has also been increasing in past years. The prevalence of DKD among individuals with type 2 diabetes in Taiwan increased from 13.32% in 2000 to 17.92% in 2014. The cumulative incidence of DKD among individuals with type 1 diabetes in Taiwan was higher than 30% during 1999–2012. DKD is the leading cause of end‐stage renal disease (ESRD), with a prevalence of approximately 45% in a population on chronic dialysis in Taiwan. Among individuals with type 2 diabetes, the prevalence of ESRD in the receipt of dialysis also increased from 1.32% in 2005 to 1.47% in 2014. Risk factors for DKD development are age, race, family history, hyperglycemia, hypertension, dyslipidemia, dietary patterns, and lifestyles. Prognostic factors that aggravate DKD progression include age, family history, sex, glycemic control, blood pressure (BP), microvascular complications, and atherosclerosis. This review summarizes updated information on the onset and progression of DKD, particularly in the Taiwanese population. Translating these epidemiological features is essential to optimizing the kidney care and improving the prognosis of DKD in Asian populations. [ABSTRACT FROM AUTHOR]

Congenital cytomegalovirus (CMV) infection is the leading cause of neurologic disabilities and sensorineural hearing loss in children. However, in Taiwan, there is limited information on the genotypic diversity and prevalence of perinatal CMV infection in both mothers and neonates. The aim of this study was to screen samples from both mothers and umbilical cord blood for CMV at the time of delivery and to determine the CMV genotypic distribution. Between June 2012 and July 2015, residual maternal and umbilical cord blood samples were collected from consenting participants admitted to the Chang Bing Show Chwan Memorial Hospital in central Taiwan. The blood samples were screened for CMV DNA using real-time PCR assay, and the genotypic classification of the CMV UL55, UL144, and US28 genes was determined by sequencing and phylogenetic analysis. A total of 1282 mother-neonate paired samples were enrolled in the study, 95.3% of whom were Taiwanese. CMV DNA was detectable in 6.2% of the maternal blood samples, with a significantly higher rate noted in non-Taiwanese mothers (11.7%, p = 0.027). For the 1,282 umbilical cord blood samples, CMV DNA was detectable in 5.3% of the samples. The presence of CMV DNA in maternal blood was positively associated with the presence of CMV DNA in umbilical cord blood (p = 0.01). In addition, the UL55, UL144, and US28 genotypic distribution was similar between mothers and neonates. The prevalence of CMV DNAemia in childbearing mothers and neonates is similar and their genotypic distribution implies potential CMV infection during pregnancy. [ABSTRACT FROM AUTHOR]

Background/purpose: Patients with diabetes have a higher risk of developing chronic complications and cause a huge burden to the public health care system as well as on patients and their families. We studied these diabetic complications about kidney, eye and peripheral vascular diseases to understand their prevalence and distributions in a national survey.Methods: We analyzed diabetic complications using National-Health-Insurance claims filed from 2005 to 2014. We used this database to evaluate their developments of kidney, eye, and peripheral vascular diseases according to the International-Classification-of-Diseases, Ninth Revision using clinical modification diagnosis codes.Results: The prevalence of diabetic kidney disease (DKD) significantly increased from 10.49% to 17.92% from 2005 to 2014. The prevalence rate of diabetic foot significantly decreased from 1.34% to 1.05% from 2005 to 2014, and the rate of severe infection also significantly decreased from 50.69% to 45.85%. The amputation rate significantly decreased from 24.91% to 17.47% among all patients with diabetic foot.Conclusion: In this study, the trends in DKD and dialysis prevalence were similar to those of the 2012 report. The rate of increase in dialysis prevalence is lower in this study than in the 2012 report. The prevalence of diabetic foot, severe infection, and amputation in this report exhibited significantly decreasing trends. This improvement may be attributable to care from multidisciplinary teams. We should dedicate more resources to our prevention program of DKD and retinopathy to further improve outcomes in the future. [ABSTRACT FROM AUTHOR]

Background: Unplanned readmission is an important healthcare quality issue. We studied the effect of a comprehensive geriatric screen (CGS) in the early admission course followed by a comprehensive geriatric assessment on readmission rates in elderly patients.Methods: This quasi-experimental study with a historical comparison group was conducted in the geriatric ward of a referral centre in northern Taiwan. Older adults (aged > = 65 y/o) admitted from June 2013 to December 2013 were recruited for the geriatric screen group (N = 377). Patients admitted to the same ward from July 2011 to June 2012 were selected for the historical group (N = 380). The CGS was administered within the first 48 h after admission and was followed by a comprehensive geriatric assessment (CGA). Confounding risk factors included age, gender, Charlson comorbidity index, Barthel index score and medical utilization (length of stay and number of admissions), which were controlled using logistic regression models. We also developed a scoring system to identify the group that would potentially benefit the most from the early CGS.Results: The 30-day readmission rate was significantly lower in the early CGS group than in the historical comparison group (11.4% vs 16.9%, p = 0.03). After adjusting for confounding variables, the hazard ratio of the early CGS group was 0.64 (95% CI 0.43-0.95). After scoring the potential benefit to the patients in the early CGS group, the log rank test showed a significant difference (p = 0.001 in the high-potential group and p = 0.98 in the low-potential group).Conclusion: An early CGS followed by a CGA may significantly reduce the 30-day readmission rate of elderly patients. [ABSTRACT FROM AUTHOR]

The White-breasted Waterhen (Amaurornis phoenicurus) is the only bird species known to breed on Pratas Island, Taiwan, for the past few decades. Since they are secretive and very difficult to observe, responses to different call playbacks were tested experimentally in the field to determine if call type affects response of birds to improve future surveys. Playbacks of two different call types (advertising call and aggressive call) were carried out at 26 stations in the east region of the island in April, June, July, and August 2016. The frequency of response and behavioral reaction of waterhens to playbacks were recorded within a 6-min test period at each station. Playbacks of the advertising call elicited more responses at stations than did aggressive calls. Two-way Repeated Measures ANOVA revealed a significant difference in response frequencies for the main effect of call type, but no difference was found for monthly effect and an interaction term for call type and month. This study provides evidence that playback experiments of the advertising call during the courtship period can be an effective way to monitor the population size of a secretive species such as the White-breasted Waterhen. [ABSTRACT FROM AUTHOR]

Background: The amyloid AV-45 (florbetapir) positron emission tomography (PET) has been used in the study of the familial Alzheimer's disease (FAD) with the D678H amyloid precursor protein (APP) mutation. In addition, the progress of the disease remains unknown.Objective: We aim to investigate the progression rate of amyloid accumulation in FAD patients with this mutation by neuroimages analysis.Methods: The clinical course, changes in cognitive function, brain magnetic resonance imaging (MRI) and 18F-AV-45 PET scan were investigated in FAD patients and sporadic AD (sAD) patients. We compared the amyloid deposition pattern in serial brain 18F-AV-45 PET scan among the FAD, familial mild cognitive impairment (FMCI), and sMCI and sAD patients.Results: Seven familial patients received a follow-up survey. The follow up duration for brain AV-45 PET was from 1.54 to 3.61 years. In 4 FMCI patients, an increased regional SUVR was noted, and the annual change rates were increased from 1.03% to 18.82%. However, a decreased regional SUVR was noted in 3 FAD patients and the annual change rates were from -2.62% to -16.03%. As compared with the sAD and sMCI patients, the annual change rate is statistically significant in FAD and FMCI patients respectively.Conclusions: The data indicate a biphasic course with an initial increase and then a decrease of SUVR in brain amyloid PET scan in familial APP mutation patients. The data also reveal that the novel Taiwan APP (D678H) mutation has a more amyloid burden than the sAD patients, particularly in an MCI stage. [ABSTRACT FROM AUTHOR]

Background/purpose: To determine whether dual-phase 18F-florbetapir positron emission tomography imaging with perfusion-like and amyloid deposition information can distinguish among primary progressive aphasia (PPA), Alzheimer's disease (AD), and healthy controls (HCs).Methods: Patients diagnosed with PPA, including four semantic dementia (SD) and two progressive nonfluent aphasia (PNFA), as well as one logopenic variant (LV) of PPA, were studied. All PPA patients, and age-/sex-matched patients with probable AD (n=8) and HCs (n=8) were subjected to dual-phase 18F-florbetapir imaging. Atlas-based quantitative volumes of interest (VOIs) analysis for six cortical areas and whole cerebellum was performed. The standardized uptake value ratios were calculated by normalizing the dual-phase-integrated activities of the six VOIs to whole cerebellum counts.Results: Early phase 18F-florbetapir image showed significantly lower global perfusion index in six PPA patients as compared with HCs. According to VOI analysis, the hypoperfusion lesions were identified in the frontal, anterior cingulate, parietal, precuneus, and temporal regions. Similar findings were confirmed by voxel-base image comparison. 18F-florbetapir late-phase image showed significantly increased amyloid burden in the global cortex index and all six brain regions of eight AD and LV patients when compared with the other six PPA patients and eight HCs. There was no apparent uptake of amyloid tracer in both six PPA patients and eight HCs.Conclusion: Dual-phase 18F-florbetapir images of six PPA (SD and PNFA) patients showed hypoperfusion in the frontotemporal cortex, and little global amyloid uptake, which may be a distinct image pattern for differentiation among HC, AD, and PPA patients. [ABSTRACT FROM AUTHOR]

Background/purpose: The Taiwanese FRAX® calculator was launched in 2010. However, cost-effectiveness thresholds for the prescription of antiosteoporosis medications were not established. This study aims to establish and evaluate FRAX®-based probability thresholds in Taiwan.Methods: Using previous data from Taiwan and literature, we determined cost-effectiveness thresholds for prevention of osteoporotic fractures by alendronate with a Markov model, as well as using two other translational approaches. Sensitivity analysis was applied using different alendronate prices. A clinical sample was used to test these Taiwan-specific thresholds by determining the percentages of high-risk patients who would be qualified for current National Health Insurance reimbursement.Results: With the Markov model, the intervention threshold for hip fracture was 7% for women and 6% for men; for major osteoporotic fracture, it was 15% for women and 12.5% for men. Both translational approach models were cost effective only for certain age groups. However, if branded alendronate was reimbursed at 60% of the current price, they became cost effective in almost all age groups. This clinical screening study showed that the National Health Insurance Administration model identified the highest proportion (44%) of patients qualified for National Health Insurance reimbursements, followed by the Markov model (30%), and the United States model (22%).Conclusion: Three FRAX®-based models of alendronate use were established in Taiwan to help optimize treatment strategies. The government is encouraged to incorporate FRAX®-based approaches into the reimbursement policy for antiosteoporosis medicines. [ABSTRACT FROM AUTHOR]

Introduction: Concerns have been raised regarding the potential association between proton pump inhibitor (PPI) use and dementia. Objective: This study aimed to examine this association in an Asian population. Methods: Patients initiating PPI therapy between January 1, 2000 and December 31, 2003 without a prior history of dementia were identified from Taiwan’s National Health Insurance Research Database. The outcome of interest was all-cause dementia. Cox regression models were applied to estimate the hazard ratio (HR) of dementia. The cumulative PPI dosage stratified by quartiles of defined daily doses and adjusted for baseline disease risk score served as the primary variables compared against no PPI use. Results: We analyzed the data of 15726 participants aged 40 years or older and free of dementia at baseline. PPI users (n = 7863; average follow-up 8.44 years) had a significantly increased risk of dementia over non—PPI users (n = 7863; average follow-up 9.55 years) (adjusted HR [aHR] 1.22; 95% confidence interval: 1.05–1.42). A significant association was observed between cumulative PPI use and risk of dementia (P for trend = .013). Subgroup analysis showed excess frequency of dementia in PPI users diagnosed with depression (aHR 2.73 [1.91–3.89]), hyperlipidemia (aHR 1.81 [1.38–2.38]), ischemic heart disease (aHR 1.55 [1.12–2.14]), and hypertension (aHR 1.54 [1.21–1.95]). Conclusions: An increased risk for dementia was identified among the Asian PPI users. Cumulative PPI use was significantly associated with dementia. Further investigation into the possible biological mechanisms underlying the relationship between dementia and PPI use is warranted. [ABSTRACT FROM AUTHOR]

This study employs the data of twenty-seven banks listed on the Taiwan Stock Exchange from 2000–11 to examine the determinants of board structure, e.g., board size and the independent directors ratio. The evidence shows that bank size, the degree of revenue diversification, and the CEO’s shareholding are positively associated with the independent directors ratio. A higher outside block shareholding is correlated with a larger board size and a higher independent directors ratio. As the creditors’ stake decreases, a larger board and greater board independence are required to maintain internal corporate governance. Finally, banks with M&A activity tend to downsize their board sizes and reduce board independence in the subsequent period. [ABSTRACT FROM PUBLISHER]

Introduction Religious affiliations vary across ethnic groups because of different cultural backgrounds. Some studies have explored the association between religious affiliation and cognitive decline. Only a small portion of patients with cognitive decline progress to dementia. However, the association between religious affiliation and dementia risk remains unclear. Methods In this case–control study, we recruited 280 patients with Alzheimer's disease (AD) and 138 with vascular dementia (VaD) (both aged ≥60 years) from three teaching hospitals in northern Taiwan between 2007 and 2010. Age-matched healthy controls ( n = 466) were recruited from an elderly health checkup program and from volunteers visiting the hospital during the same period. Three religious affiliations—Taoism, Buddhism, and Christianity—were evaluated. The study also assessed the effect of important factors such as gender or leisure activities on the association of religious affiliation with dementia risk. Results Participants with Christianity affiliation showed decreased AD risk (adjusted odds ratio [AOR] = 0.46, 95% confidence interval [CI] = 0.25–0.87) compared with those without any religious affiliation. Moreover, this effect was stronger in women (AOR = 0.38, 95% CI = 0.15–0.92) and in participants who exercised regularly (>3 times/week; AOR = 0.33, 95% CI = 0.14–0.77). No significant association was observed among participants with Taoism and Buddhism affiliations. Affiliation to none of the religions was associated with VaD risk. Conclusions Thus, Chinese participants having Christianity affiliation showed decreased AD risk. Moreover, the protective effect was more evident in women and in participants who exercised regularly. [ABSTRACT FROM AUTHOR]

The benefits of aquaculture for humans worldwide have become increasingly important, especially in Asia. Although Taiwan does not have a high aquaculture output, the superior aquaculture techniques employed allow Taiwan to maintain competitiveness in the Asian region. The objective of this study was to evaluate the trend of sustainable aquaculture fishery development in Taiwan, and the potential problems that exist. This study used a sustainable development indicator framework with 4 dimensions to analyze the sustainable development of Taiwan's aquaculture fisheries. The results showed that between 2004 and 2009, economic indicators declined, posing substantial concerns for the sustainable management of Taiwan's aquaculture. The results for the ecological, social, and institutional dimensions demonstrated stability or slight increases. Although the indicators partially reflect the effects of government aquaculture policies, problems such as illegal aquaculture fish ponds, inaccurate sales data, and sales channels controlled by a limited number of fishmongers and middlemen remain. In summation, current aquaculture fisheries cannot achieve sustainability through production alone; instead, integrating the aquaculture fisheries with social humanities, environment and ecology, and resource management is required. [ABSTRACT FROM AUTHOR]

With the growth of population and rapid development of economy in Taiwan, problems including the reduced number of marine habitats and increased sea pollution have continued to harm marine bio-resources and diversity. Although the Taiwanese government has established several kind of marine protected areas (MPAs) but the management performance is dissatisfactory. Therefore, the management arrangements of MPAs in Taiwan are discussed in this study, based on 3 institutional arrangement elements: governmental organization, legal basis, and non-governmental organizations (NGOs). A questionnaire survey was administered to 4 groups (industrial, governmental, scholar, and NGO) to understand how these groups perceive the institutional arrangements of the management of MPAs in Taiwan. Finally, the institutional arrangements of the management of the MPAs discussed. The research findings showed that most survey participants believed that governmental organizations most required improvement, particularly in "monitoring standard" and "financial budget allotment." Other than "stability," the participants disapproved of the legal basis in the institutional arrangements of the management of MPAs. Among the 4 participating groups, only NGOs agreed that NGOs should be involved in the institutional arrangements of the management for MPAs in Taiwan. All 4 groups approved the institutional arrangements regarding "participation and cooperation," and none of the 4 groups approved the institutional arrangements regarding "more responsible behavior." [ABSTRACT FROM AUTHOR]

Human psittacosis caused by Chlamydophila psittaci is one of the most common zoonotic atypical pneumonias featuring pulmonary as well as extrapulmonary infections. Most of the cases involve avian contact history especially with psittacine birds. Herein we report a 44-year-old male patient displaying atypical pneumonia symptoms of intermittent fever, dry cough, chest pain, dyspnea, headache, hepatitis, and hyponatremia. He had two sick cockatiels, one of which had died a month previously. A microimmunofluorescence test was performed to check the serum antibody levels against Chlamydophila psittaci. The serum IgM titer showed positive titer of 1:256, 1:256, and 1:128 on Days 11, 23, and 43 after disease onset, respectively. His fever subsided soon and clinical symptoms improved after minocycline was administrated on Day 12. The psittacosis case was confirmed by history of psittacine bird contact, clinical symptoms, treatment response, and positive IgM titer. To our knowledge, this is the first report of a psittacosis case in Taiwan. [ABSTRACT FROM AUTHOR]

This study examines the Taiwanese institutional arrangements for ocean and coastal management to explore the development of ocean and coastal management in Taiwan 20 years after the “Rio Declaration on Environment and Development.” First, we employed purposive sampling to distribute questionnaires among industry personnel, government officials and personnel, scholars, and personnel of nongovernment organizations (NGOs) involved in institutional arrangements for ocean and coastal management. We recovered 159 effective copies of the 323 distributed questionnaires, for an effective recovery rate of 49.2%. Subsequently, we used descriptive statistics, analysis of variance (ANOVA), and Scheffé's method for post hoc tests to analyze whether the four groups of participants had differing perspectives or cognition levels of the three dimensions and multiple criteria of the institutional arrangements. The results show that (1) for state organizational arrangements, the four groups all disagreed with the Taiwanese government's institutional arrangements for finance and budget allocation, and the government officials and personnel and scholars disagreed with the Taiwanese institutional arrangements for the planning, implementation, and promotion of ocean and coastal management; (2) for legal basis arrangements, the government officials and personnel, scholars, and NGO personnel believed that the existing Taiwanese laws and regulations lacked clear roles, authorization, and responsibilities, as well as coordination and stability; and (3) for non-state organizational arrangements, the scholars considered the non-state organizational arrangements for Taiwan's ocean and coastal management insufficient, which differed significantly from the opinions of the other three groups. [ABSTRACT FROM AUTHOR]

Background/Purpose: Diabetes is one of the leading causes of dialysis, blindness, and amputation worldwide. However, the prevalence of diabetes-related kidney, eye, and foot diseases has not been investigated in national surveys. Methods: In this study, we reviewed data sets of the National Health Insurance claims for the years 2000–2009. In 2009, the total population of Taiwan was 23 million. We de-identified the data and then analyzed them on inpatients and outpatients with diabetes mellitus, kidney diseases, eye diseases, peripheral vascular diseases (PVDs), and diabetic foot according to the International Classification of Diseases, 9th Revision with Clinical Modification diagnosis codes. Results: The prevalence of diabetic nephropathy increased from 13.32% in 2000 to 15.42% in 2009. The corresponding diabetes dialysis rate increased from 1.5% to 2.46% during the same period (p < 0.001). The prevalence rates of retinopathy and PVD also increased (from 6.17% to 8.91%; p = 0.002 and from 1.87 to 2.47; p < 0.001, respectively). More than 94% of the patients treated for diabetic foot in the hospital had an associated foot infection. The prevalence of in-hospital diabetic foot decreased from 1.68% to 1.02% during the years 2000–2009 (p < 0.001), while the rates of lower extremity amputation as the treatment outcome did not show improvement (mean amputation rate: 28.35%). Conclusion: During the years 2000–2009, patients with diabetes in Taiwan had an increased risk for kidney, eye, and PVDs. Multidisciplinary teams need to be set up for the treatment of complications related to diabetic foot, and preventions programs that are specifically designed to target these complications should now be made mandatory. [Copyright &y& Elsevier]

Abstract: Enterprises evaluate customers’ preferences of high-tech products to appropriately adjust product lines when the technologies are ready for commercialization. Conjoint analysis (CA) is usually applied to measure customers’ preferences while the product line design model (PLDM) is used to simulate customers’ purchase decisions based on these preferences. The optimal product line extension scheme (PLES) can then be found. For customers unfamiliar with a new technology, it is difficult to precisely appraise preferences for new products. This paper proposes fuzzy PLDM that combines fuzzy theory with CA to take preference uncertainty into consideration. To precisely apply fuzzy preferences, fuzzy rating is used to simulate customers’ purchase decisions. This paper focuses on the notebook industry in Taiwan. Optimal PLES are obtained under Fuzzy and Crisp scenarios. The results show that customers with high preference uncertainty have different purchase decisions under above scenarios, which leads to a great inconsistency between the optimal PLES obtained from Fuzzy and Crisp scenarios. The Fuzzy scenario takes preference uncertainty into consideration and uses stricter standards to judge whether customers buy products with new technology. [ABSTRACT FROM AUTHOR]

Background: The three geriatric conditions, depression, dementia and delirium (3D's), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization.Methods: A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients who aged over 65 years and admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients' functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation (GEE) was used to calculate the associations between 3 D's and BI.Results: One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. The study demonstrated that all the geriatric patients with functional decline presented gradual improvements of physical function up to 180 days after discharge. Whether depression exists did not substantially affect functional recovery after discharge, whilst either dementia or delirium could impede elder people functional status. The recovery of functional improvement in delirium or dementia was relatively irreversible when comparing with depression. Once delirium or dementia was diagnosed, poorer functional restore was expected. In brief, intensive work and strategies on modifying delirium or dementia should be put more effort as early as possible.Conclusions: Old hospitalized patients with depression can recover well after adequate intervention. We emphasize that early detection of dementia and delirium is imperative in subsequent functional outcome, even if at or before admission. Comprehensive plan must be implemented timely. [ABSTRACT FROM AUTHOR]

Title: Analysis of the financing difficulties of Taiwan's small-and medium-sized Energy Services CompanyAbstract:International Energy Agency indicates that enhance energy efficiency is the most important and concrete part to meet the Sustainable Development Scenario achieve limiting global temperature rise to 1.5 °C in these decades. Taiwan government follows up the global trend and mentions the importance of high energy efficiency on energy policy. In recent years, Taiwan has actively achieved its goal of reducing electricity demand through energy conservation strategies or the replacement of electrical equipment.Energy Services Company(ESCO) provides energy-saving consulting, energy system design and improvement projects to improve energy efficiency and ease the urgency of Taiwan's peak electricity use from the energy demand side.ESCO, which emphasizes energy-saving performance, its production value has a stable rise in the existing business model in Taiwan, and it is expected to explore the abundant potential in the future. For ESCO, although the profit is a long-term stable benefit, the cost of initial investment in energy-saving is a big problem for small-and medium-sized company. The performance guarantee contract between the operator and the customer is based on "shared saving contract", the operator needs to implement energy saving projects with their own funds or the bank loan. For small-and medium-sized ESCOs, the scale of the ESCO project must be expanded through financing, but the number of applications is low because of high-interest rate costs and the banks have low willingness to give the loan.This study will use the factors for loan theory of financing and use Analytic Hierarchy Process as a research method to understand the prioritization of these factors by experts in various fields (ESCO, energy users, banks). The results of the analysis can be used as a reference for small-and medium-sized ESCOs breakthrough financing dilemma.Keywords: Energy Services Company (ESCO), energy efficiency, energy demand side, energy policy, Taiwan [ABSTRACT FROM AUTHOR]

Abstract Introduction The novel D678H amyloid precursor protein (APP) gene mutation has been called the "Taiwan mutation". The study aims to identify amyloid deposition patterns and clinical features associated with this mutation. Methods we analyzed the clinical manifestations, brain neuroimages and 18F-AV-45 positron emission tomography (PET) findings in symptomatic patients and asymptomatic subjects with the autosomal-dominant Alzheimer's disease (AD). We compared the amyloid deposition pattern among 10 patients with genetically-positive familial cognitive decline (CD), 18 patients with sporadic CD, and 19 healthy controls. Results The clinical features were the early onset of memory impairment in all 10 patients and cerebral amyloid angiopathy in 3 patients. The characteristic results of brain 18F-AV-45 PET included the highest standard uptake value ratio (SUVR) in the occipital and cerebellar cortical areas in the genetically-positive CD patients. In subgroup analysis, the familial AD patients had a decreased amyloid SUVR trend in most areas except for cerebellar cortex compared to those with familial mild cognitive impairment. Conclusion Our data indicate that the familial D678H gene mutation have resulted in a more potent amyloid burden than in the patients with sporadic AD patients. The high amyloid uptake in the occipital area is characteristic of the specific Taiwan APP gene. Highlights • The study evaluated the amyloid patterns and clinical features in the Taiwan familial AD with D678H APP mutation. • Early onset of memory impairment and cerebral amyloid angiopathy in 2 patients. • The highest stardand uptake value ratio in the occipital and cerebellar cortical areas in the gCD patients. • The familial D678H gene mutation patients have a more potent amyloid burden than the sporadic AD patients [ABSTRACT FROM AUTHOR]

Highlights • Homogeneous or heterogeneous T and S estimates from HT analysis can lead to the unbiased prediction of flow fields in different years. • Self-validation and cross-validation demonstrate that the estimated heterogeneous T and S fields using conditional HT are reproducible. • Generally, groundwater flow models can be validated. Abstract Over the past decades, a new aquifer test technology (sequential pumping tests or hydraulic tomography, HT) has been developed and successfully applied to many field sites to delineate the spatial distributions of hydraulic properties (e.g., transmissivity (T) and storage coefficient (S)). Yet, the reproducibility of its estimated T and S fields and the predictive capabilities of the estimates for different flow scenarios at different time periods remain unexplored. That is to say, if the estimated fields based on sequential pumping tests conducted during different years are the same since the geologic formation and processes may have undergone changes. In order to answer this important question, this study first compares the drawdown-time behaviors from the sequential pumping tests (SPTs) conducted in 2010 with those conducted in 2012 at a field site and then finds they are similar but different in detail. It then uses these data to estimate the T and S fields and checks the reproducibility of the estimates. The estimated heterogeneity patterns are found to be generally reproducible in spite of uncertainties. In addition, the estimates from each year are capable of predicting the observed drawdowns, induced by independent pumping tests during the corresponding year (i.e., self-validation). Moreover, the estimated fields are cross-validated. That is, this study uses the estimates obtained from the 2010 pumping tests to predict the observed drawdowns of the independent pumping tests conducted in 2012. Likewise, it uses the estimates from 2012 pumping tests to forecast the drawdowns of the independent pumping tests of 2010. The results of both self-validation and cross-validation indicate that the estimated T and S fields based on the test in one year can be used to predict bulk flow behavior in the other year. Differences in detailed behaviors may be attributed to changes in the processes, omitted in the depth-averaged flow model. [ABSTRACT FROM AUTHOR]

Objective: To examine association of interactions between patient empowerment (PE) and health literacy with 1-year-later self-management behaviors in patients with type 2 diabetes (T2DM).Methods: A prospective design was employed in this study. Overall, 395 patients with T2DM completed self-reported questionnaires at baseline and 1year later. A hierarchical multiple regression was used to identify the association of interactions between PE and health literacy at baseline with the 1-year-later self-management behaviors.Results: Interactions between PE and communicative and critical health literacy (CCHL) at baseline significantly associated with the 1-year-later global self-management behaviors in patients with T2DM. Among the participants who exhibited high PE at baseline, the scores of 1-year-later global self-management behaviors of the participants with a high CCHL at baseline were significantly higher than those with a low CCHL at baseline. Nevertheless, among the participants who exhibited low PE at baseline, no significant differences were identified in the 1-year-later global self-management behaviors between the participants with high vs. low CCHL at baseline.Conclusions: PE may improve self-management behaviors in patients with high CCHL, but may prove useless in patients with low CCHL.Practice Implications: Healthcare providers should ensure that patients with T2DM have adequate CCHL prior to empowering them. [ABSTRACT FROM AUTHOR]

Objective: To validate a hypothesized model exploring the influencing pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycosylated hemoglobin (HbA1c) levels in patients with type 2 diabetes (T2DM).Methods: Overall, 295 patients with T2DM were recruited from five endocrine clinics in Taiwan through convenience sampling. Data regarding personal characteristics, empowerment perceptions, health literacy, self-efficacy, self-care behaviors, and HbA1c levels were collected. A structural equation modeling was used to validate the hypothesized model.Results: Significant direct pathways were determined from empowerment perceptions to health literacy, from health literacy to self-efficacy, from self-efficacy to self-care behaviors, and from self-care behaviors to HbA1c levels.Conclusions: The empowerment perceptions and health literacy relatively influenced self-efficacy and self-care behaviors. Self-efficacy and self-care behaviors relatively influenced glycemic control in patients with T2DM.Practice Implications: Modifying self-care behaviors have been demonstrated to be the most essential for improving glycemic control. To improve self-care behaviors, healthcare providers should target improving self-efficacy, and enhancing health literacy can be considered to be a potential strategy for improving self-efficacy. To enhance health literacy, healthcare providers could use an empowerment approach rather than an authoritative approach that emphasizes patient compliance in managing patients with T2DM. [ABSTRACT FROM AUTHOR]

Abstract: 8-hydroxydeoxyguanosine, the key lesion of oxidative DNA damage, contributes to the development of coronary artery disease (CAD). In humans, 8-hydroxydeoxyguanosine is repaired by the enzyme 8-oxoguanine glycosylase I (hOGG1). We investigated the association between the hOGG1 Ser 326 Cys polymorphism and the presence and the severity of CAD in a Taiwan population. Genotypes of the hOGG1 Ser 326 Cys polymorphism were determined from 1397 participants enrolled in this study (378 CAD patients and 1019 controls). CAD severity was indicated both by number of vessels affected (single-vessel disease, SVD vs. multi-vessel disease, MVD), and by individual diffuse score. Real-time polymerase chain reaction was used to determine genotype, using allele-specific TaqMan probes. We found that presence of the hOGG1 Ser 326 Cys polymorphism was associated with a significantly increased risk of CAD and multi-vessel disease when assuming a dominant model of inheritance (OR: 1.52 [95%:1.082~2.133], p = 0.015; OR: 2.26 [95%:1.232~4.156], p = 0.007). This result was confirmed by multivariate analysis, after adjustment for age, gender, body-mass index, diabetes hypertension, hypercholesterolemia and smoking (OR: 1.78 [95%:1.127~2.806], p < 0.005; OR: 2.44 [95%:1.276~4.651], p < 0.001). In the present study, hOGG1 Ser 326 Cys polymorphism is a novel genetic marker to be independently associated with the development and severity of CAD in Taiwanese population. [ABSTRACT FROM AUTHOR]

Background/purpose: Sarcopenia and decreased muscle strength (dynapenia) are emerging health issues. However, the study exploring muscle strength changes of both upper and lower limbs at the same time among all age groups is rare. This study aims to investigate the muscle strength and to establish a muscle strength norm of an ostensibly healthy non-diabetic Asian population., Methods: From 2018 June to 2020 March, subjects (aged from 20 to <80 years old) undergoing health checkup in Good Liver Medical Examination Center and National Taiwan University Hospital Geriatrics and Gerontology Department were enrolled. A battery of muscle power examinations including handgrip strength (HGS), five times sit-to-stand test (5TSTS), and one-leg standing test (OLST) were performed., Results: A total of 183 participants was enrolled, consisting of 92 females and 91 males. The finding shows the strongest HGS, best 5TSTS, and the longest OLST of both genders appeared in the 20-29-year-old group. Age, gender, and palm length are significantly related to HGS, whereas age is the only factor affecting 5TSTS and OLST. It revealed a progressive decline during ageing process, especially after age 60. Finally, Z-score and T-score norms of these were established., Conclusion: These data will be useful as normal controls for muscle strength of specific disease groups. The application of the cutoffs from these data and their comparisons with the recommended cutoffs from various guidelines worth further exploration., Competing Interests: Declaration of competing interest Wu NM, Chiang C, LinKP, ChenYM and YangWS have nothing to declare., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Recent genetic progress allows the molecular diagnosis of young-onset dementia, including Alzheimer's disease (AD) and frontotemporal dementia (FTD). We aimed to identify the mutational and clinical spectra of causal genes in a Taiwanese cohort of young-onset dementia. Ninety-one patients with young-onset dementia and 22 age/gender-matched controls were recruited. Genetic causes were identified by a targeted panel containing 90 causative genes for AD, FTD, and related neurodegenerative disorders. Plasma biomarkers, including total tau, Aβ42, and Aβ40, were assayed. Molecular amyloid and tau PET scans were performed in some patients carrying mutations. Nine of 52 patients (17.3%) with young-onset AD had mutations: 2 (22.2%), 4 (44.5%), 2 (22.2%), and 1 (11.1%) in APP, PSEN1, PSEN2, and TREM2, respectively. Two of 33 patients (6.1%) with young-onset FTD had mutations in MAPT and LRRK2. Three of the 6 patients (50.0%) with possible FTD combined with other neurodegenerative disorders had individual mutations in APP, PSEN2, or MAPT. Patients with PSEN1 mutations had earlier onset of disease than those without mutations (p = .02). Plasma level of total tau was increased and Aβ42 and Aβ40 levels decreased in all groups of dementia patients compared to controls. Our findings provide a genetic spectrum of young-onset dementia in our population., (© 2021 Wiley Periodicals LLC.)

Background: Post-cardiac arrest care is critically important in bringing cardiac arrest patients to functional recovery after the detrimental event. More high quality studies are published and evidence is accumulated for the post-cardiac arrest care in the recent years. It is still a challenge for the clinicians to integrate these scientific data into the real clinical practice for such a complicated intensive care involving many different disciplines., Methods: With the cooperation of the experienced experts from all disciplines relevant to post-cardiac arrest care, the consensus of the scientific statement was generated and supported by three major scientific groups for emergency and critical care in post-cardiac arrest care., Results: High quality post-cardiac arrest care, including targeted temperature management, early evaluation of possible acute coronary event and intensive care for hemodynamic and respiratory care are inevitably needed to get full recovery for cardiac arrest. Management of these critical issues were reviewed and proposed in the consensus CONCLUSION: The goal of the statement is to provide help for the clinical physician to achieve better quality and evidence-based care in post-cardiac arrest period., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2020 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

This study aimed to evaluate the therapeutic effects of Low intensity extracorporeal low energy shock wave therapy (LiESWT) on stress urinary incontinence (SUI). The investigation was a single-arm, open-label, multicentre study conducted in Taiwan. 50 female patients with SUI received LiESWT-treated with 0.25 mJ/mm 2 intensity, 3000 pulses, and 3 pulses/second, once weekly for 4-weeks (W4) and 8-weeks (W8). The pad test, uroflowmetry, life quality questionnaires, and 3-day urinary diary measurement were performed before and after LiESWT intervention. The results revealed that 8-week of LiESWT treatment meaningfully improved urine leakage (pad test), maximum flow rate, post-voided residual urine, average urine volume, functional bladder capacity, urinary frequency, urgency symptom, and nocturia, which also persisted to show significant improvements at 1-month follow up (F1). Moreover, bothersome questionnaires scores were significantly improved at W4, W8, and F1 as compared to the baseline (W0). These results indicated that 8 weeks of LiESWT attenuated SUI symptoms on physical activity, reduced bladder leaks and overactive bladder (OAB), implying that LiESWT brought significant improvement in the quality of life. (ClinicalTrials.gov number, NCT04059133).

Background & Aims: Helicobacter pylori induces immune tolerance and is associated with a lower risk for immune-mediated disorders, such as autoimmune and inflammatory bowel diseases (IBD). We aimed to determine the effects of treatment for H pylori infection on the incidence of autoimmune disease and IBD., Methods: We collected data from the National Health Insurance Research Database in Taiwan on patients younger than 18 years old without a prior diagnosis of autoimmune disease or IBD. Patients with peptic ulcer disease (PUD) with treatment of H pylori infection (PUD+HPRx), PUD without H pylori treatment (PUD-HPRx), a urinary tract infection (UTI) treated with cephalosporin, or without PUD (controls) were matched for age, sex, insurance, and Charlson's comorbidity index score., Results: Of the 1 million patients we collected data from in 2005, we included 79,181 patients in the study. We compared the effects of treatment for H pylori infection on the risk of autoimmunity or IBD and found that PUD+HPRx has the highest adjusted hazard risk (aHR) for autoimmunity or IBD (aHR, 2.36), compared to PUD-HPRx (aHR, 1.91) or UTI (aHRs, 1.71) (P < .001). The increased risk of autoimmune disease was not completely accounted for by antibiotic therapy alone, because PUD+HPRx had a higher aHR than UTI (P < .001). A small but significant increase in mortality was observed in the PUD+HPRx cohort (aHR, 1.11; P = .001)., Conclusion: In an analysis of data from the National Health Insurance Research Database in Taiwan, we found that treatment for H pylori infection is associated with a significant increase in the risk for autoimmune disease, including IBD., (Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background/purpose: Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) for use in guiding endobronchial dye marking of small pulmonary nodules prior to thoracoscopic surgery is still under development. We sought to evaluate the effect of the cumulative experience on procedural parameters of CBCT-AF-guided endobronchial dye marking for preoperative localization of small pulmonary nodules., Methods: Clinical variables and treatment outcomes of the 30 initial patients with small pulmonary nodules who were managed with CBCT-AF-guided endobronchial dye marking followed by thoracoscopic resection in our institution were analyzed. Two sequential groups of patients (group I and group II, n = 15 each) were compared with regard to localization time and radiation doses. The Mann-Whitney U test and chi-square test or Fisher exact test were used in the statistical analyses., Results: In the entire cohort, the median size of solitary pulmonary nodules on preoperative computed tomography (CT) images was 9.3 mm (interquartile range, 7.4-13.6 mm), and their median distance from the pleural surface was 15.2 mm (interquartile range, 10.3-27.1 mm). The median tumor depth-to-size ratio was 1.6 (interquartile range, 1.1-2.3). A significant reduction in single DynaCT radiation (3690.4 versus [vs.] 1132.3 μGym 2 ; P < 0.001) and total radiation exposure (median, 4878.8 vs. 1673.8 μGym 2 ; P < 0.001) was noted in group II (late patients) compared with group I., Conclusion: Our initial results of CBCT-AF-guided lung marking demonstrate that the cumulative experience with several technical modifications can achieve the same purpose of endobronchial localization with less procedure-related radiation exposure., (Copyright © 2019. Published by Elsevier B.V.)

Background: Primary aldosteronism (PA) is a common cause of secondary hypertension. Among the many leading causes of PA, the two most frequent are, bilateral adrenal hyperplasia (BAH) and aldosterone-producing adenomas (APA). Since a solitary APA may be cured surgically, but BAH needs lifelong pharmacologic therapy, confirmation is mandatory before surgery. We herein sought to determine the diagnostic value of iodine-131 6-beta-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy to distinguish BAH from APA., Patients and Methods: Patients clinically suspected of PA from March 2000 to October 2016 were retrospectively analyzed. A total of 145 patients, including 74 postunilateral adrenalectomy and seven postradiofrequency ablation for adrenal mass, were reviewed. All patients received NP-59 adrenal scintigraphy prior to surgery. The accuracy of the NP-59 adrenal scintigraphy was confirmed by the pathologic findings and postoperative outcomes., Results: Among 81 patients receiving interventional procedures for adrenal mass, adenoma was eventually diagnosed in 72 patients according to their pathologic results, with 60 unilaterally and seven bilaterally localized lesions by NP-59 scintigraphy; nevertheless, there were five negative findings initially. The sensitivity, specificity, and positive predictive value of NP-59 scintigraphy for APA detection were therefore 83.3, 44.4, and 92.3%, respectively. Moreover, single-photon emission computed tomography/computed tomography scan increased the sensitivity and specificity, but not the positive predictive value (85.0, 60.0, and 89.5%) of NP-59 scintigraphy in this study., Conclusion: NP-59 adrenal scintigraphy is a useful imaging test to detect APA. Lateralization by this modality prior to surgical intervention may reduce the need for such invasive procedures as adrenal venous sampling.

Aims: This study investigated whether there is a link between severe hypoglycemia and progression into end-stage renal disease (ESRD) in patients with type 2 diabetes. Methods: Tapping into Taiwan's Health Insurance Research Database, we identified all type 2 diabetes patients between 1996 and 2013 and identified those diagnosed with a severe hypoglycemia episode during an emergency department visit and those who were not. Controls were then matched 1:1 for age, sex, index year, and medication. Results: We identified 468,421 type 2 diabetes patients diagnosed as having severe hypoglycemia in an emergency department visit. Compared with controls, these patients with SH had a higher risk of all-cause mortality (Hazard Ratio (HR), 1.76; 95% confidence interval, 1.61⁻1.94) and progressed into ESRD within a shorter period of time. Results were similar after controlling for competing risk. Conclusion: Severe hypoglycemia is significantly associated with worsening renal dysfunction in patients with type 2 diabetes and hastened progression into ESRD.

Context: Although α-glucosidase inhibitors (AGIs) have been shown to reduce the risk of myocardial infarction in patients with impaired glucose tolerance, the cardiovascular benefits of AGIs in those with type 2 diabetes (T2D) remains unclear., Objective: We compared the clinical outcomes of adding acarbose vs sulfonylureas to metformin therapy in patients with T2D., Design, Setting, and Participants: The study population was drawn from the database of the Diabetes Pay-for-Performance program in Taiwan. Sulfonylureas and acarbose were prescribed to 196,143 and 14,306 patients with T2D, respectively, from 2004 to 2015, who had been treated with metformin. A propensity score-matched cohort study was conducted. The patients were followed up for clinical adverse events of all-cause mortality and hospitalizations of major atherosclerotic events (i.e., myocardial infarction and ischemic stroke), heart failure, or hypoglycemia., Results: A total of 14,306 propensity score-matched pairs (age, 55.8 ± 13.1 years; 47.8% men) were enrolled in the present analysis. Compared with sulfonylureas as the add-on therapy to metformin, the use of acarbose was associated with significantly lower risks of hospitalizations for major atherosclerotic events [hazard ratio (HR), 0.69; 95% CI, 0.52 to 0.91], ischemic stroke (HR, 0.68; 95% CI, 0.49 to 0.94), and hypoglycemia (HR, 0.23; 95% CI, 0.08 to 0.71), after accounting for major confounding factors., Conclusions: In T2D treatment, the use of acarbose as an add-on remedy to metformin was associated with lower risks of major atherosclerotic events, ischemic stroke, and hypoglycemia compared with the use of sulfonylurea as an add-on remedy.

Few food frequency questionnaires (FFQs) have been developed to assess diet in diabetes patients. This cross-sectional study examined the validity of a 45-item FFQ assessing the intake of macronutrients against three 24-h dietary recalls (24-HDRs) in Taiwan, and compared vegetable and fruit intakes with carotenoid biomarkers. We recruited 126 adults with type 2 diabetes who completed the FFQ and three 24-HDRs administered by a registered dietitian. We measured plasma carotenoids (α-carotene, β-carotene and lutein) in 71 subjects. Partial Pearson correlation coefficients derived from the FFQs and three 24-HDRs and adjusted for energy were of 0.651, 0.587, 0.639 and 0.664 for protein, fat, carbohydrate and fiber, respectively. Cross-classification analysis revealed that 71.5⁻81% of the macronutrients and fiber were categorized into the same or adjacent quartiles by the FFQ and 24-HDRs. Bland⁻Altman plots revealed good agreement for energy/macronutrients/fiber across the range of intakes. Multiple linear regression of backward elimination revealed that tertile levels of dark- or light-colored vegetables obtained by the FFQ were significantly associated with plasma α-carotene and β-carotene, but not lutein. Fruit consumption did not correlate with carotenoid biomarkers. In conclusion, this short FFQ provided a valid assessment of macronutrients and fiber intake in type 2 diabetes patients. Vegetable consumption estimated by the FFQ corresponded to plasma α-carotene and β-carotene concentrations.

Recognizing potentially avoidable hospital readmission and admissions are important health care quality issues. We develop prediction models for inpatient readmission and outpatient admission to hospitals for older adults In the retrospective cohort study with 2 million sampling file of the National Health Insurance Research Database in Taiwan, older adults (aged ≥65 y/o) with a first admission in 2008 were enrolled in the inpatient cohort (N = 39,156). The outpatient cohort included subjects who had ≥1 outpatient visit in 2008 (N = 178,286). Each cohort was split into derivation (3/4) and validation (1/4) data set. Primary outcome of the inpatient cohort: 30-day readmission from the date of discharge. The outpatient cohort included hospital admissions within the 1-year follow-up period. Candidate risk factors include demographics, comorbidities, and previous health care utilizations. Series of logistic regression models were applied with area under the receiver operating curves (AUCs) to identify the best model. Roughly 1 of 7 (14.6%) of the inpatients was readmitted within 30 days, and 1 of 5 (19.1%) of the outpatient cohort was admitted within 1 year. Age, education, use of home health care, and selected comorbidities (e.g., cancer with metastasis) were included in the final model. The AUC of the inpatient readmission model was 0.655 (95% confidence interval [CI] 0.646-0.664) and outpatient admission model was 0.642 (95% CI 0.639-0.646). Predictive performance was maintained in both validation data sets. The goodness-to-fit model demonstrated good calibration in both groups. We developed and validated practical clinical prediction models for inpatient readmission and outpatient admissions for general older adults with indicators easily obtained from an administrative data set.

Although a possible association between hepatitis B and cardiovascular disease has been identified, the impact of viral hepatitis B on long-term prognosis after an acute myocardial infarction (AMI) is uncertain. Therefore, the aim of our study was to evaluate the specific impact of viral hepatitis B on survival after a first AMI through a retrospective analysis of data from the Taiwan National Health Insurance Research Database.This was a nationwide, propensity score-matched case-control study of patients admitted to hospitals between January 2000 and December 2012 with a primary diagnosis of a first AMI. Among the 7671 prospective patients, 244 patients with a confirmed diagnosis of viral hepatitis B infection were identified. A propensity score, one-to-one matching technique was used to match 244 controls to the AMI group for analysis. Controls were matched on the following variables: sex, age, hypertension, dyslipidemia, diabetes, peripheral vascular disease, heart failure, cerebrovascular accidents, end-stage renal disease, chronic obstructive pulmonary disease, and percutaneous coronary intervention (PCI).Overall, viral hepatitis B infection did not influence the 12-year survival rate (P = 0.98). However, survival was lower in female patients with viral hepatitis B infection compared to those without (P = 0.03; hazard ratio, 1.79; 95% confidence interval, 1.08-2.94). Inclusion of percutaneous coronary management improved survival, independent of sex, age, or hepatitis B status.Hepatitis B infection might increase the mortality risk of female patients after a first AMI. PCI may improve the long-term survival of patients after a first AMI, regardless of sex, age, and hepatitis B status.

Background: Diabetes mellitus is known to exacerbate bacterial infection, but its effect on the severity of viral infection has not been well studied. The severity of thrombocytopenia is an indicator of the severity of dengue virus infection. We investigated whether diabetes is associated with thrombocytopenia in dengue-infected patients., Methods: We studied clinical characteristics of 644 patients with dengue infection at a university hospital during the epidemic on 1 June 2002 to 31 December 2002 in Taiwan. Platelet counts and biochemical data were compared between patients with and without diabetes. Potential risk factors associated with thrombocytopenia were explored using regression analyses., Results: Dengue-infected patients with diabetes had lower platelet counts than patients without diabetes during the first three days (54.54±51.69 vs. 86.58±63.4 (p≤0.001), 43.98±44.09 vs. 64.52±45.06 (p=0.002), 43.86±35.75 vs. 62.72±51.2 (p=0.012)). Diabetes mellitus, death, dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF) and increased glutamic-pyruvate transaminase (GPT) levels were significantly associated with lower platelet counts during the first day of hospitalization for dengue fever with regression β of -13.981 (95% confidence interval (CI) -27.587, -0.374), -26.847 (95% CI -37.562, -16.132), and 0.054 (95% CI 0.015, 0.094) respectively. Older age, hypoalbuminemia, and hypertriglyceridemia were independently correlated with thrombocytopenia in dengue patients with or without diabetes with regression β of -2.947 (p=0.004), 2.801 (p=0.005), and -3.568 (p≤0.001), respectively. Diabetic patients with dengue had a higher rate of dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) than non-diabetic patients. They also had lower blood albumin, were older, and higher triglyceride levels. Older age, hypoalbuminemia, and hypertriglyceridemia were independently correlated with thrombocytopenia in dengue patients., Conclusions: Dengue patients with diabetes tended to have more severe thrombocytopenia and were more likely to have DHF/DSS. Older age, hypoalbuminemia, and hypertriglyceridemia were independently associated with more severe thrombocytopenia in dengue patients.

Objective: Although studies have shown an association between pioglitazone and bladder cancer, the associated factors have not been identified. The aim of this study was to investigate the factors that may link pioglitazone to bladder cancer., Materials and Methods: In total, 34,970 study subjects were identified from the National Health Insurance Research Database in 2003 with follow-up from 2005 to 2009. The demographic characteristics of patients who had used and had never used pioglitazone, including age, sex, diabetes duration, urinary tract disease, nephropathy, bladder cancer, and cumulative dose and duration of pioglitazone therapy, were analyzed using the χ2 test. Cox proportional hazard regression models were used to determine the independent effects of pioglitazone on bladder cancer and newly developed chronic kidney disease., Results: Among 3,497 ever users and 31,473 never users of pioglitazone, the respective incident cases of bladder cancer were 12 (0.4%) and 72 (0.2%), and for newly developed chronic kidney disease 245 (8.1%) and 663 (2.3%), respectively. Ever use of pioglitazone [1.59(1.32-1.91)], cumulative dose of pioglitazone <10,500 mg [1.69 (1.37-2.01)] and >10,500 mg [1.34 (1.04-1.73)], and duration of therapy <12 months [1.68 (1.36-2.08)] and >12 months [1.39 (1.09-1.76)] were associated with the development of chronic kidney disease., Conclusions: There was no association of pioglitazone use with bladder cancer development, however, there was an association with an increased risk of newly developed chronic kidney disease.

Background and Objective: Therapeutic responses of lung adenocarcinoma patients to tyrosine kinase inhibitors (TKIs) of epidermal growth factor receptor (EGFR) are closely associated with activating mutations within the EGFR tyrosine kinase domain. Screening activating EGFR mutations prior to selection for therapeutic strategy has been considered extremely valuable for clinical management of lung adenocarcinoma patients in Asian countries including Taiwan, where the EGFR mutation rate is higher than in the rest of the world. Currently there is no consensus on the method of choice to assess EGFR mutations in tumour tissue., Methods: We enrolled 445 lung adenocarcinoma patients for analysis of tumour EGFR mutations using polymerase chain reaction (PCR)-direct sequencing, scorpion/amplified refractory mutation system (ARMS) technology and immunohistochemistry with mutation-specific antibodies., Results: Two hundred forty-five patients (245/445; 55%) were found to harbour activating EGFR mutations using PCR-direct sequencing method, with a majority of patients (233/245; 95%) carrying exon 19 deletion or p.L858R point mutations. One hundred three of 200 patients were negative for EGFR mutations from PCR-direct sequencing were further analysed using Scorpion/ARMS technology. Up to 30% of the PCR-direct sequencing negative patients turned out to be positive in the Scorpion/ARMS EGFR mutation tests. For immunohistochemistry analysis of EGFR mutations, the p.E746&#95;A750del specific antibody showed a sensitivity of 57% and a specificity of 100% for exon 19 deletions while the p.L858R point mutation specific antibody showed a sensitivity of 68% and a specificity of 95%., Conclusions: Based on this study, we proposed an algorithm for comprehensive and efficient testing of EGFR mutations on lung adenocarcinoma patients in Asia., (© 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.)

Studies have shown an association between diabetes and cancer in Western countries; but this, as well as the influence of associated metabolic factors, must be confirmed by a prospective study in other population groups. This study aimed to investigate whether the strong association of cancer and diabetes is independent from the influence of hypertension, dyslipidemia, and gout in the Taiwanese population. A total of 985,815 study subjects were identified from the National Health Insurance in 1997 and followed up from 1998 to 2009. The demographic characteristics between patients with diabetes and cancer, including age, sex, hypertension, dyslipidemia, and gout, were analyzed using the χ(2) test. Cox proportional hazard regression models were used to determine the independent effects of diabetes on the risks of cancer. A total of 104,343 diabetic patients were followed up from 1998 to 2009. After adjusting for sex, age, hypertension, dyslipidemia, and gout, the incidences of cancer at any site and in the liver, colon, lungs, and prostate in diabetic patients were independently higher, with risk ratios of 1.56 (95% confidence interval [CI], 1.43-1.71), 1.67 (95% CI, 1.39-2.01), 1.75 (95% CI, 1.49-2.06), 1.54 (95% CI, 1.26-1.88), and 1.56 (95% CI, 1.19-2.04), respectively. Only breast cancer did not show any clinical significance. There was an increased incidence of cancer at any site in the diabetic patients compared with nondiabetic subjects. The most common cancers were liver, colon, lung, breast, and prostate cancer; and except for breast cancer, their incidences increased independently of hypertension, dyslipidemia, and gout in patients with diabetes., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: Manipulation and plaster fixation is the primary management for diaphyseal fractures of the radius and/or ulna in children. This study was designed to evaluate risk factors of fracture redisplacement after closed reduction and cast immobilization., Design: Retrospective study., Setting: Tertiary hospital., Patients: Fifty-seven children with fractures of the radius were included., Intervention: The medical records of patients with/without ulna treated with closed reduction and casting were reviewed., Main Outcome Measures: Data analyzed were age, sex, dominant hand, fracture pattern, reduction quality, experience of the surgeon, and type of anesthesia. Logistic regression was used for multivariate analysis., Results: There were 41 (71.9%) males and 16 (28.1%) females with a mean age of 9.74 ± 3.07 years. There were 53 radius fractures and 54 ulna fractures, and 22 subjects experienced redisplacement. The redisplacement rate of radius fractures was 34% and of ulnar fractures was 27.8%. Multivariate analysis showed that the factors associated with redisplacement of radius fractures were fair reduction quality [odds ratio (OR), 8.45] and complete fracture (OR 9.62) and those for redisplacement of ulna fractures were fair reduction quality (OR 8.10) and complete fracture (OR 8.43)., Conclusions: Poorer reduction and complete fracture are more likely to result in redisplacement, and surgical management may be considered in these cases.

Among 254 Neisseria gonorrhoeae isolates from a sexually transmitted infection (STI) clinic in northern Taiwan, 69 isolates were found to contain the mosaic penA (MA) gene and were associated with elevated cefixime and ceftriaxone MICs. Most of these MA gene-harboring isolates were also resistant to penicillin (71.4%) and ciprofloxacin (100%) and were from men who have sex with men (MSM) or from bisexual men (81.2%). Three major sequence types (ST835, ST2180, and ST2253) constituted 55.7% of these isolates. The major sequence types harboring the mosaic penA gene may represent major sexual networks responsible for the emergence/introduction and the spread of the multidrug-resistant clones in Taiwan.