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While the philosophy of deterrence has long been rooted in the criminal justice system and has informed policy and programming, the results of such strategies have been mixed. A handful of research efforts have focused on the relationship between various deterrence perspectives and cyberbullying; however, few address this issue in a non-Western context. To develop a more comprehensive assessment of cyberbullying deterrence and perceptions of punishment among adolescents, this study utilizes a large-scale data set collected from Taiwan. Results indicate a negative association between cyberbullying and a sense of the certainty of punishment from authorities. Moreover, perceptions of the severity of punishment decrease the propensity for cyberbullying behavior.

Background: Nurse engagement and retention are critical issues affecting the quality of healthcare. Although the work environment is known to affect nursing performance and patient outcomes, little is known regarding the impact of this environment on nurse burnout and future work intention, especially in non-Western settings. Purpose: This study explored the extent to which Taiwanese nurses' perceptions of their practice environment mediates burnout levels and intention-to-stay. Methods: This descriptive, correlational study, conducted between September and December 2020, recruited nurses employed at a regional teaching hospital located in a relatively rural region in Taiwan. The participants completed standardized questionnaires, including a demographic information form, the 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI), the 22-item Maslach Burnout Inventory (MBI-HSS), and the 6-item Intention-to-stay (ITS) scale. The mediating effect among the variables related to intention-to-stay was examined using Model 4 of the PROCESS macro and tested using the bootstrapping method (repeated 5,000 times) with a p value < .05. Results: The mean age of the 376 participants was 34.3 years (SD = 8.1). Nearly one-third (30.3%) scored > 27 on the emotional exhaustion subscale of the MBI-HSS, indicating they were "highly burned-out". Also, nearly one-third (30.6%) were uncertain about their intention to stay with their current employer. Burnout was associated with intention-to-stay (β = -.088, p < .001), and holding a positive perception toward their practice environment was shown to mediate the relationship between burnout and intention-to-stay (β = -.015; p < .001). Conclusions/Implications for Practice: Targeted interventions and technical support that promote a collaborative climate and psychological empowerment in clinical practice may alleviate burnout and intention-to-leave in nurses and improve workplace quality. [ABSTRACT FROM AUTHOR]

This study aims to discuss how the government and society of Taiwan have appropriated the heritage from Japanese colonial rule into the discourse of Taiwanese culture to bolster the national identity of Taiwan. The interconnected theoretical concepts of 'imagined communities' and 'nationalising the past' ground the analytical framework of this study. With a focus on the 'selective' presentations of the colonial heritage in historic Tainan City, this study explores how the official and social discourses have trivialised, reorganised, simplified, and recontextualised the historical intricacies of legacies of the Japanese colonial era through the process of heritagisation. The research results suggest that the meaning of colonial legacies has been shaped and reshaped from being a mark of the dark past and deprivation to constitute a glorious contribution fulfilling the discourse of multi-faceted Taiwanese culture. This case also suggests the possibility for a post-colonial society to extricate itself from a mimicking mentality and to redevelop their culture discourse as a buttress of the national identity. [ABSTRACT FROM AUTHOR]

Purpose: Transurethral procedures, including transurethral resection of the prostate (TURP) and laser prostatectomy, are often linked to emergency room (ER) visits for postoperative bleeding. Although some studies have been conducted, the risk factors associated with these ER visits are not completely understood. This retrospective cohort study identified potential risk factors associated with ER visits for postoperative bleeding. Patients and Methods: Preoperative assessment data and operational and postoperational parameters recorded at Chang Gung Memorial Hospital, Taiwan between December 2015 and January 2017 for patients who underwent elective transurethral procedures were analyzed to identify potential risk factors. The primary endpoint was ER visits for gross hematuria within three months following operation, and the secondary endpoint was ER visits for blood clot-induced urinary retention (clot retention) within three months following operation. Results: A total of 665 patients who underwent elective transurethral procedures were enrolled. The transurethral procedures included monopolar transurethral resection of the prostate (M-TURP), bipolar TURP (B-TURP), greenlight photoselective vaporization of the prostate (PVP), thulium laser enucleation of the prostate (ThuLEP) and thulium laser transurethral vaporesection of the prostate (ThuVARP). Regarding ER visits for clot retention within three months, multivariable logistic regression revealed significantly lower rates of clot retention in patients who received B-TURP than in those who underwent ThuVARP (AOR, 0.18; 95% confidence interval [CI], 0.04– 0.82, p = 0.027). Moreover, significantly higher clot retention was observed in patients who underwent two or more rounds of manual irrigation (AOR, 9.51; 95% CI, 1.66– 54.43, p = 0.011). Conclusion: Multiple manual irrigations shortly after operation can be considered a novel predictor of postoperative clot retention-related ER visits. Among the transurethral procedures, ThuVARP was associated with a higher risk of clot retention-related ER visits than was B-TURP. [ABSTRACT FROM AUTHOR]

Background. We aimed to identify prognostic biomarkers of upper tract urothelial carcinomas (UTUCs), including microRNAs (miRNAs) and genes which account for only 5% to 10% of all urothelial carcinomas (UCs). In Taiwan, this figure is markedly higher, where it can reach up to 30% of UC cases. Materials and Methods. Using next-generation sequencing (NGS), we analyzed two pairs of renal pelvis tumors and adjacent normal urothelial tissues to screen miRNAs and messenger RNAs. By combining bioinformatics analysis from miRmap, Gene ExpressionOmnibus (GEO), andOncomine and Ingenuity R Pathway Analysis databases, we identified candidate genes. To search for upstream miRNAs with exact target binding sites, we used miRmap, TargetScan, and miRDB to enforce evidence. Then, we clarified gene and protein expression through an in vitro study using western blot analysis and quantitative real-time reverse transcriptase-PCR. Results. Interactions between selected target genes obtained using the NGS and miRmap methods were assessed through a Venn diagram analysis. Six potential genes, namely, PDE5A, RECK, ZEB2, NCALD, PLCXD3 and CYBRD1 showed significant differences. Further analysis of gene expression from the GEO dataset indicated lower expression of PDE5A, RECK, ZEB2, and CYBRD1 in bladder cancer tissue than in normal bladder mucosa, which indicated that PDE5A, RECK, ZEB2, and CYBRD1 may act as tumor suppressors in UTUC. In addition, we compared the expression of these genes in various UC cell lines (RT4, BFTC905, J82, T24, UMUC3, 5637, BFTC 909, UMUC14) and found decreased expression of PDE5A in muscle-invasive UC cells compared with the RT4 cell line. Furthermore, by using paired UTUC and normal tissues from 20 patients, lower PDE5A expression was also demonstrated in tumor specimens. Conclusions. Our findings suggest these candidate genes may play some roles in UTUC progression. We propose that these markers may be potential targets clarified by in vitro and in vivo experiments. PDE5A also potentially presents tumor suppressor genes, as identified by comparing the expression between normal and tumor specimens. [ABSTRACT FROM AUTHOR]

An increasing number of cybercrimes has presented new global challenges to law enforcement agencies that traditionally operate within designated geographical jurisdictions and patrol territories. The borderless nature of cyberspace has brought substantial opportunities-both legal and illegal-to its users, and many local law enforcement agencies have encountered motivated offenders taking advantage of the globally connected Internet and causing damage locally and transnationally. This study examines a high-profile case of European criminals who hacked into a Taiwanese financial institution-First Commercial Bank (FCB)-and programmed its ATMs to "spit out" cash netting the thieves $2.6 million US dollars in 2016 summer. Before the incident of FCB, this European criminal group committed more than a hundred similar ATMs hackings, victimizing dozens of financial institutions across several European countries, and profiting over one billion Euros. FCB is the only case revealing specific details about the modus operandi of ATM hacking thus far, in addition to disclosing reactions from law enforcement. By analyzing qualitative data collected from different branches of law enforcement involved in the investigations, this unique case study underscores the importance of national-local law enforcement collaboration in fighting transnational cybercrime. Empirical implications are particularly valuable in the law enforcement context of "turf jealousies" when defending homeland security. [ABSTRACT FROM AUTHOR]

Background: This study investigated the correlation between a history of human papillomavirus (HPV) infection and skin cancer risk. Materials and Methods: The study cohort comprised 26,919 patients with newly diagnosed HPV infection between 2000 and 2012; with the use of computer‐generated numbers, patients without previous HPV infection were randomly selected as the comparison cohort. The patients in the HPV infection cohort were matched to comparison individuals at a 1:4 ratio by demographic characteristics and comorbidities. All study individuals were followed up until they developed skin cancer, withdrew from the National Health Insurance program, were lost to follow‐up, or until the end of 2013. The primary outcome was subsequent skin cancer development. Cox proportional hazards regression analysis was used to analyze the risk of skin cancer with hazard ratios (HRs) and 95% confidence intervals (CIs) between the HPV and control cohort. Results: The adjusted HR of skin cancer for patients with HPV relative to controls was 2.45 after adjusting sex, age and comorbidities. (95% CI, 1.44–4.18, p <.01). The subgroup analysis indicated that a patient with HPV infection had a significantly greater risk of skin cancer if they were aged >40 years. Notably, a risk of skin cancer was found in the group diagnosed with HPV within the first 5 years after the index date (adjusted HR, 3.12; with 95% CI, 1.58–5.54). Sensitivity analysis by propensity score, matching with balanced sex, age, and comorbidities, showed consistent results. Conclusion: A history of HPV infection is associated with the development of subsequent skin cancer in Taiwanese subjects, and the risk wanes 5 years later. Implications for Practice: In this Taiwan nationwide cohort study, there was a 2.45‐fold increased risk of developing new‐onset skin cancers for patients with incident human papillomavirus (HPV) infection, compared with the matched controls. Furthermore, the risk was noticeably significant among patients aged >40 years. A prominent risk of skin cancers was found in the group diagnosed with HPV within the first 5 years after the index date in this study. The results of this analysis may raise consensus on the effect of HPV infection on the risk of skin cancers. Clinicians are encouraged to implement prudently on the differential diagnosis of skin cancers and HPV prevention and treatment, especially in older patients. Melanoma and nonmelanoma skin cancer (NMSC) remain common worldwide. This 12‐year retrospective cohort study explored whether people diagnosed with human papillomavirus infection have an increased risk of skin cancers, focusing on melanoma and NMSC. [ABSTRACT FROM AUTHOR]

Background: This study investigated whether patients with a history of human papillomavirus (HPV) infection are at increased risk of developing psoriasis.Methods: We enrolled 66 274 patients with HPV infection between 1997 and 2013 from the Taiwan National Health Insurance Research Database, and compared them with control individuals who had never been diagnosed with HPV infection (at a 1:4 ratio matched by age, sex and index year) in relation to the risk of developing psoriasis. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with the control group as reference.Results: The adjusted hazard ratio (aHR) was 1.177 (95% CI, 1.010-1.373) after adjusting for demographic characteristics, comorbidities, dermatology-related outpatient visits and medications. The HPV group had an increased risk of psoriasis compared with the control group in all of the different age groups. The P-value for interaction between age and exposure of HPV is 0.009 in our sub-group analysis.Conclusions: A higher risk of psoriasis was found after HPV infection, and age acted as an effect modifier between the HPV infection and risk of psoriasis. [ABSTRACT FROM AUTHOR]

Of all the Proteus spp., Proteus mirabilis is the most common species identified in clinical specimens and is a leading agent of complicated urinary tract infection. This study was undertaken to understand the antimicrobial susceptibility, prevalence of antibiotic resistance genes, and molecular typing of P. mirabilis isolates collected from three hospitals in northern Taiwan. The results showed that the collected isolates of P. mirabilis were susceptible to most antibiotics except cefazolin and tigecycline. Many resistance genes were detected in the collected isolates, of which TEM genes were the most common. Resistance to third- or fourth-generation cephalosporins was related to the presence of at least one of the tested extended-spectrum β-lactamase (ESBL) or AmpC genes. The presence of the VEB-1 gene seemed to be a good predictor for both cefepime and ceftazidime resistance, which was further supported by quantitative polymerase chain reaction results. Of the four imipenem-resistant P. mirabilis isolates, three isolates could hydrolyze imipenem by mass spectrometry analysis. Molecular typing by pulsed-field gel electrophoresis showed that the pulsotyping of the selected P. mirabilis isolates was heterogeneous. By analyzing the relationship of antimicrobial resistance and the presence of resistance genes, revision of the Clinical and Laboratory Standards Institute cefepime and ceftazidime MIC breakpoints for Enterobacteriaceae to predict ESBL producers might possibly be needed. [ABSTRACT FROM AUTHOR]

This study applies the multiple-regime panel smooth transition regression (MR-PSTR) estimation to investigate the non-linear dynamic relationship between a firm's corporate social responsibility (CSR) and firm growth in the food industry under the size threshold, using a panel of 30 Taiwanese food firms during 2007-2017. Our empirical results reveal that firm growth and firm size present a non-linear relationship, and that firm growth is different under the size threshold value and the control variables of firm age, CSR, R&D innovation, and finance policy. Corporate social responsibility helps reduce business risk. Regardless of the type and size, for many food industries, CSR is no longer an arbitrary choice, but an essential requirement. [ABSTRACT FROM AUTHOR]

Two long-standing explanations of converging violence gender gap trends in the United States are net-widening enforcement and offender-behavioral changes. We examine these explanations in an Asian context, democratic Taiwan. We use sex-specific arrests, conviction, and imprisonment statistics for violent offenses, 1989 to 2012, to identify whether Taiwanese gender gaps are converging across the criminal justice system. This study did not identify a female violent crime “wave” but mainly stability, failing to support the offender-behavioral change hypothesis. There is limited evidence of net-widening enforcement of felony assault and domestic violence, where disparate impacts on female arrest trends are identified solely for domestic violence. [ABSTRACT FROM AUTHOR]

Background: Stigma affects patients with schizophrenia and may influence perceptions of the illness, whic hmay affect how family members interact with and care for these patients. Purpose: The aims of this study were to (a) explore the relationship between perceptions of schizophrenia and the negative emotions of family members within the context of an affiliate stigma model, and (b) validate the proposed affiliate stigma model. Methods: A cross-sectional design was used. Eligibility for participation was limited to the relatives of patients with schizophrenia. The participants were recruited from two regional psychiatric hospitals in central Taiwan. The study was approved by an Institutional Review Board, and all potential participants signed informed consent before enrollment. Sixty-two participants completed the set of self-administered questionnaires, including (a) a demographic questionnaire, (b) Affiliate Stigma Scale, and (c) the Illness Perception Questionnaire for Schizophrenia-Relatives version. Canonical correlations and structural equation modeling in STATISTICA 6.0 were used to validate the model of illness perceptions and negative emotions. Results: (a) There were three domains of perception regarding schizophrenia for the relatives of patients: disease chronicity, disease in control, and disease treatability. The correlation between these dimensions and negative emotion was r = .42. (b) The adjusted goodness of fit for the proposed affiliate stigma model was .79. Conclusions: The results of this study suggest that the affiliate stigma model is an appropriate resource for developing practical disease management strategies for the relatives of patientswith schizophrenia. [ABSTRACT FROM AUTHOR]

The prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) was up to 30% between 2014 and 2016 in the study hospital. Of these 77 CRKP isolates, 22 isolates with sequence type ST11 carried the new p KPC_P16 plasmid, a p KPC_LK30 variant, and were widely disseminated between 2014 and 2015 in northern Taiwan. [ABSTRACT FROM AUTHOR]

For more than 50 years, research has been accumulating on how regime differences impact Mainland China and Taiwan in terms of socioeconomic transformation, the development of politics and constitutions, and diverse issues of foreign policy. Much less is known, however, about differences in public confidence in the criminal justice system. To address the obvious gap, this study utilized second-wave data collected by the Asian Barometer cross-national survey. Findings demonstrated that Chinese citizens reflect higher levels of trust in criminal justice institutions than their Taiwanese counterparts and public perceptions of the degree of democracy had a positive effect on public attitudes. Citizens who acknowledge more satisfaction with institutional performance also tend to have more trust in the criminal justice system. [ABSTRACT FROM AUTHOR]

Since the late 1990s, Taiwan has seen an increasing number of special interdisciplinary programs on college campuses. The so-called special English-Chinese translation and interpretation programs, which are open to non-English majors at both the undergraduate and postgraduate levels, are a particularly pertinent example. So far, few researchers have looked into the positioning and content of such special programs which, unlike their predecessors that were offered to only English/T&I majors, now see students of different backgrounds sitting together in the same classroom. As a result, little is known about what may motivate students to enroll in these special T&I programs or about how they perceive their own translation skills after taking the courses. A survey based on the adaptation of existing models of translation competence and the iceberg model for competences is used to explore students' perception of translation competence and their learning experience in these special programs. This is followed by a semi-structured interview of selected respondents, including both English majors and non-English majors, to help the researcher get beyond the survey results to a deeper level. The research findings show that the two groups of respondents exhibit significant differences on only a few items, and that their attitudes toward translation can be influenced by the acquisition of more visible components such as new translation skills and knowledge. It is hoped that these findings and the relevant discussions may contribute to a further refinement of these special programs. [ABSTRACT FROM AUTHOR]

Abstract: The Convention for ballast water management is approaching the threshold of enforcement. Many countries around the world formulate national laws and regulations to mitigate the hazards of non-indigenous aquatic species (NIAS) brought about by the discharge of ballast water from ships. Taiwan’s critical location as an important transportation hub in the Western Pacific Ocean makes it a hot spot for the invasion of NIAS. Therefore, devising strategies for the management of ballast water is urgently needed. This study explores the global trend in ballast water management, and discusses the possible strategies which Taiwan may adopt in response to the Ballast Water Convention, from the perspective of Taiwan’s stakeholders in relation to the ballast water issue. Some of the proper actions that Taiwan should take in the future regarding the management of ballast water include: delineating the area for ballast water exchange, establishing the ballast water declaration system for incoming vessels, assisting shipping companies in installing ballast water treatment systems, determining risk priority for incoming vessels, and inspecting ballast water-related parameters by means of port state control (PSC). In this way, the invasion of NIAS may then be prevented in compliance with the global standards. [Copyright &y& Elsevier]

Background/purpose: Isolation of teeth with rubber dams is an important procedure for infection control in dentistry, especially in endodontic treatment. This study surveyed the prevalence of rubber dam usage in nonsurgical root canal treatment (RCT) by dentists under the National Health Insurance system in Taiwan.Methods: A total of 1,332 completed RCT cases were randomly selected from a large database from the Bureau of National Health Insurance in Taiwan in 2004. The radiographs and dental charts of the selected cases were evaluated for the prevalence of rubber dam usage in RCT. The frequencies of rubber dam usage for RCT by dentists were compared between hospitals and private dental clinics and among six different regions in Taiwan.Results: The overall prevalence of rubber dam usage for RCT by dentists under the National Health Insurance system in Taiwan was 16.5%. The frequency of rubber dam usage for RCT by dentists in hospitals (32.8%) was significantly higher than that (10.3%) in private dental clinics (p < 0.0001). However, there was no significant difference in the frequency of rubber dam usage for RCT by dentists among six different geographic regions in Taiwan.Conclusion: The prevalence of rubber dam usage for RCT by dentists in Taiwan is relatively low. Because rubber dam isolation of an endodontically-treated tooth can provide better infection control, increase patient protection, and improve treatment efficiency, there is an urgent need to advise dentists in Taiwan to use rubber dams for every RCT case. [ABSTRACT FROM AUTHOR]

Reminiscence therapy has been utilized for many years in the treatment of dementia in older people. Purposes of the research included examining different methods of promoting interactivity, social participation, cognitive function improvement in those with dementia, and the effectiveness in reducing symptoms of depression following group treatment. This study used pretest and posttest electroencephalography (EEG) measurements to test reminiscence therapy efficacy on participants. This research organized a social group work with 12 elderly clients with dementia (mild to moderate stage) selected from among 90 residents of an older persons care facility in Pingtung. Eleven agreed to join the study, and 10 completed successfully all treatment sessions. Eight sessions of reminiscence cooking lessons were conducted. The effectiveness of interventions was evaluated by comparing presession and postsession EEG, mental health status, depression scale, and feeling of participation scale scores. Significant differences in values, particularly for EEG, were found between the two sets of scores. The average value of participants' fast waves rose from 43.88 to 55.12, whereas average slow-wave values fell from 56.12 to 44.13. After analysis using the Wilcoxon matched paired signed rank test, significant differences were noted. Findings and suggestions include the following: (a) The rise in Mini-Mental State Examination and reduction in depression scale scores, although noted, were not significant, and (b) the self-achievement, emotional stability, family atmosphere, and physical needs of participants were met. The authors recommend that reminiscence group work be promoted in the home for older persons and that childhood cooking sessions twice each week may be the ideal format for reminiscence group work. [ABSTRACT FROM AUTHOR]

The DEA model is applied to analyze the operational efficiency of Taiwan's publicly-listed banks to reveal the influence of the rising non-performing loan ratio (NPLR) on Taiwan's banking industry. After taking into account the NPLR and the different classifications of banks, the respective performances of different types of banks exhibit the following variations and characteristics: the originally more-efficient new private banks significantly fell behind the old public banks in terms of efficiency scores after the NPLR was included. The old private banks' operational efficiency fell behind that of the other banks at all times. The productivity of all new private banks exceeded that of the other banks. [ABSTRACT FROM AUTHOR]

In recent years, the formation of strategic alliances has become an increasingly common trend among developing countries around the world. In spite of this, the numerous attempts to comprehensively review the research on the correlation between these strategic alliances and stock prices over the years have, by and large, limited their discussion to how the stock price of a corporation responds to its announcement that it is forming a strategic alliance. Only a few studies have, however, discussed the announcement's indirect impact on the stock prices of investing companies that have entered into such strategic alliances. It is for this reason that we conduct an event study and develop an empirical model to measure that indirect impact on the stock prices of investing companies engaging in strategic alliances with Taiwan's high-tech industry from 1998 to 2002, while also discussing the market's different responses in their stock prices according to various industrial types that have been used to classify these investing companies. [ABSTRACT FROM AUTHOR]

This article discusses various issues related to the avant-garde movements, its relevance for people, and its populism in Taiwan. Examining the social origin of the avant-garde artists, one finds that most of them, especially their leaders, are sons and daughters of intellectuals, professionals, middle to high ranking military and civil bureaucrats; almost none of them comes from families of the working class or the peasantry. Most of the artists themselves come from prestigious colleges; many of them had even studied abroad. There is a significant difference between the artists' lifestyle and the life of those they proclaim to side with. The ambiguous relationship between the avant-garde movements and their populism is not a phenomenon specific to Taiwan's theatre movement. It has been shown in a study that populism has entangled the historical avant-garde movement since its very beginning. Even though it led to radically different positions, to Fascism or to Communism, to social democracy or to conservatism and the cult of excellence, avant-garde politics had at least one general property in common: all were anti-bourgeois revolts. This was also the basis upon which the artists could join or support a wider movement aspiring to overthrow bourgeois society.

The article discusses ways on how to improve the shortage of nurses in Taiwan and strengthen the social image of professional nursing. The author states that setting a standard is an essential element in improving the overall health care system. He mentions that reducing unnecessary and tedious paperwork and procedures can improve the workflow efficiency of nurses.

Both polycystic ovary syndrome (PCOS) and psoriasis are associated with insulin resistance and metabolic syndrome. Nonetheless, the incidence of psoriasis in patients with PCOS is unclear. We used the Longitudinal Health Insurance Research Database (LHID) in Taiwan from 2000 to 2012 to perform a retrospective population-based cohort study to elucidate the occurrence of psoriasis in PCOS patients. Patients with PCOS without psoriasis in the index year (the year of PCOS diagnosis) were recruited as the PCOS group. Those without PCOS nor psoriasis (control group) were selected using propensity score matching at a ratio of 4:1. Hazard ratios (HRs) were obtained using the Cox proportional hazards regression model. In total, 4707 and 18,828 patients were included in the PCOS and control groups, respectively. The incidence rates of psoriasis in the control and PCOS groups were 0.34 and 0.70 per 1000 person-years, respectively. The risk of psoriasis was higher in the PCOS group by an HR of 2.07 (95% confidence interval [CI] = 1.25–3.43) compared with the control group. In conclusion, the incidence of psoriasis in the PCOS group was higher than that in the control group. Further studies should be conducted to investigate the mechanism underlying the association, and to benefit the long-term management of patients with PCOS. [ABSTRACT FROM AUTHOR]

Background: Taiwan's population is aging rapidly. Taiwan has met the criteria for an “aged society" in 2018, with more than 14 percent of the population aged 65 years of age or older. The rapid growth of the elderly population results in a great need for long-term care services and a heavy burden on families and the whole society. Taiwan's government launched the new “10-year long-term care 2.0 plan" in 2016 to establish a comprehensive community care service system that promoted “aging in place". Home based, instead of institutional based long-term care services were encouraged. However, the difference of the health care utilization and mortality of the patients between the two services were not fully investigated. National Health Insurance program in Taiwan reimburses skilled nursing services for patients living in home or institutions who have limited activities of daily living, receive palliative care for terminal illness or are dependent on ventilators. The policy gives us a chance to compare the clinical impact on the patients living in home and institutions. Objects: The aim of the study was to investigate the difference of health care utilization and one- year mortality between patients receiving home care and nursing home care. Methods: This was a retrospective cohort study. 678 home care patients and 84 nursing home residents receiving skilled nursing services from 2015 to 2017 at National Taiwan UniversityHospital, Bei-Hu Branch were enrolled. We applied Cox regression and Poisson regression models for data analysis. Results: In comparison with nursing home residents, patients living at home significantly had higher educational level, were more in married status, with religion, higher ratio to sign do not resuscitation (DNR) directives, had more pressure ulcer and higher utilization of outpatient clinic, emergency room services, hospitalization with longer hospital length of stay (LOS). The ratio of nasogastric (NG) tube use is lower for home care cases. Patients who had higher Charlson Comorbidity Index (CCI), not used NG tube and signed DNR directives were independently associated with 1-year mortality. Conclusion: In comparison with nursing home residents, patients receiving our nursing care at home had higher utilization of outpatient clinic, emergency room services, hospitalization and longer hospital LOS. The place they lived was not related to patients' one-year mortality. [ABSTRACT FROM AUTHOR]

Acinetobacter baumannii has emerged recently as a major cause of health care-associated infections due to the extent of its antimicrobial resistance and its propensity to cause large nosocomial outbreaks. Here we report the genome sequence of Acinetobacter baumannii TYTH-1 isolated in Taiwan during 2008. [ABSTRACT FROM AUTHOR]

Objectives: To determine the earliest noticeable manifestation and diagnosis in patients diagnosed with tuberculosis (TB) epididymitis/epididymo-orchitis incidentally and to analyze their responses to surgical and medical treatment.Methods: Patients who underwent surgery for the preliminary impression of chronic epididymitis/epididymo-orchitis or epididymal/testicular tumor from 2000 to 2019 were included in the study. The clinical presentations, laboratory data, radiological examinations, and operative findings were analyzed retrospectively. The outcomes were assessed by the responses to anti-TB chemotherapy and post treatment radiographic evaluations.Results: All of our 25 patients with a mean age of 60.6 years were diagnosed incidentally with TB epididymitis (48.0%) and TB epididymo-orchitis (52.0%) according to the histopathological findings from their surgeries. The presence of a palpable scrotal mass (76.0%), was the major presentation. Nineteen (76.0%) patients had undergone complete chemotherapy after the surgery and 15 (78.9%) patients showed complete recovery. Four (21.1%) patients had unfavorable outcomes, 3 had TB autonephrectomies and 1 required re-surgery years after complete chemotherapy. Of the 3 (12.0%) patients who did not receive chemotherapy after their surgeries, 1 had a TB relapse in the spine and lung and 1 developed bladder cancer years later.Conclusion: Tuberculosis epididymitis/epididymo-orchitis is difficult to diagnose. However, some clinical clues can assist including aged patients, extragenital TB histories, poor responses to antibiotic treatment and scrotal skin lesion. Complete anti-TB chemotherapy is mandatory even after the total removal of TB lesion. Supplemental surgical interventions can be considered when the symptoms are not relieved after chemotherapy. Lifespan follow-up is recommended due to high relapse rate. [ABSTRACT FROM AUTHOR]

Objectives: To report outcomes for localized prostate cancer patients treated with the combination of high-dose-rate (HDR) brachytherapy and external beam radiotherapy (EBRT). Methods: Eighty-five Stage T1c to T3b prostate cancer patients treated with HDR brachytherapy plus EBRT were included. An HDR dose of 16.5 Gy in 3 fractions over 24 hours was given 2 weeks before EBRT. An EBRT dose of 50.4 Gy was administered to the prostate and seminal vesicles. Younger patients (aged less than 75 years) with greater than 15% risk of nodal metastasis received whole-pelvis RT (45 Gy in 25 fractions) as part of EBRT. Results: Fifty percent of patients belonged to the high-risk (T3a or Gleason score 8–10 or prostate-specific antigen greater than 20 ng/mL) or very-high-risk (T3b) groups. After a median follow-up of 49 months (range, 24 to 70 months), 4-year biochemical control survival (less than nadir + 2) was 86% (100%, 91%, and 81% for patients in the low, intermediate, and high-risk groups, respectively. Three of four T3b patients experienced early biochemical failure. Four patients (5%) had grade 3 implant-related urinary retention. Chronic gastrointestinal toxicities were limited, but four grade 3 chronic genitourinary toxicities (5%) were noted in relation to urethral stricture and severe hematuria. Whole-pelvis EBRT was a major contributing factor to acute but not to chronic gastrointestinal toxicities. Among 60 patients with pretreatment sexual potency, 17 (26%) retained capability after 4 years. Six patients (10%) lost potency merely as a result of salvage hormone therapy. Conclusions: High-dose-rate brachytherapy plus EBRT can achieve satisfactory biochemical control with acceptable complications for T1c to T3a prostate cancer patients. [Copyright &y& Elsevier]

The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil) and control (water vapor) conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromatherapy showed a greater reduction in preoperative anxiety than those in the control groups. Aromatherapy may be a useful part of a holistic approach to reducing preoperative anxiety before ambulatory surgery. [ABSTRACT FROM AUTHOR]

Abstract: Food hazards can appear at any stage of global food supply chains, making it essential to define critical control points to capture the data about ingredients, manufacture and dates-certain (sell-by, use-by), etc., and provide it in a transparent manner to supply chain participants and consumers. The government of Taiwan has appointed a non-profit research organization to conduct a pilot project to launch a potential national-wide food traceability system to increase the intangible value of purchased food and to enhance food safety. This paper discusses a financially viable business model for a Radio Frequency Identification (RFID) application to a food traceability system. We conduct a case study of RFID implementation in the chain of convenience stores in Taiwan. The Taiwanese experiment may have implications for policy-makers, industry and public health officials elsewhere. [Copyright &y& Elsevier]

Abstract: We investigated the molecular epidemiology and OXA-type carbapenemase genes of 83 imipenem-resistant Acinetobacter spp. collected from 2 university hospitals (hospitals A and B) and a regional hospital (hospital C) during 2007 in Taiwan. Genotyping by pulsed-field gel electrophoresis identified 51 pulsotypes. None of the pulsotypes established predominance throughout the 3 hospitals. Multiplex polymerase chain reaction of blaOXA genes showed that 100% (18/18), 91%(31/34), and 100% (31/31) of the Acinetobacter spp. collected from hospital A, B, and C, respectively, possessed blaOXA-51–like genes. None of the strains carrying blaOXA-23–like and blaOXA-24–like genes were found in hospital A. The coexistences of blaOXA-51–like/blaOXA-23–like and blaOXA-51–like/blaOXA-24–like genes detected in hospitals B and C were 26% (9/34) and 12% (4/34) and 58% (18/31) and 3% (1/31), respectively. Among blaOXA-23–like gene-carrying isolates collected from hospitals, clonal spread of strains carrying the blaOXA-23 gene was detected in the regional hospital but not the other 2 university hospitals. The results suggest that interhospital dissemination of imipenem-resistant Acinetobacter spp. was not found in these hospitals. The increasing percentage of OXA-23 in OXA-type carbapenemases in Acinetobacter spp. from the regional hospitals to medical centers deserves further attention in Taiwan. [Copyright &y& Elsevier]

Introduction. A number of literature has now identified the role of impaired nitric oxide synthase/nitric oxide pathway in the endothelium as the central to the development of erectile dysfunction (ED) and benign prostate hyperplasia-related lower urinary tract symptoms (BPH/LUTS). Recently a few studies have reported the associations between endothelial nitric oxide synthase ( eNOS) G894T gene polymorphisms and ED. However, there has been no report investigating the eNOS G894T genetic susceptibility factor for both ED and BPH/LUTS. Aim. To investigate the possible associations among eNOS G894T polymorphism, ED, and BPH/LUTS in a Taiwanese population. Main Outcome Measures. Patients with ED were defined as those having a 5-item International Index of Erectile Function-5 <21. Methods. In all, 372 Taiwanese men underwent a free health screening were enrolled. All the men had complete clinical data and questionnaires taken. The eNOS G894T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism method. Results. Three hundred seventy-two men had a mean (standard deviation) age of 60.2 (8.8) years. With multivariate analysis, our data identified that aging, diabetes mellitus (DM), and eNOS G894T gene polymorphism were three independent common risk factors for both ED and BPH/LUTS ( P < 0.001, P = 0.036, and P = 0.039 for ED; P = 0.034, P = 0.004, and P = 0.016 for BPH/LUTS, respectively). The eNOS 894T allele carriers had significantly higher prevalence of ED (77.9% vs. 60.4%, P = 0.012) and higher International Prostate Symptom score (IPSS) (13.3 ± 10.7 vs. 9.3 ± 7.8, P = 0.001) than G allele carriers. Conclusions. Our results showed that aging, DM, and eNOS 894T allele carrier gene polymorphism were the three independently common risk factors for both ED and BPH/LUTS in the Taiwanese population. The eNOS 894T allele carriers had significantly higher frequencies of ED and higher IPSS, suggesting that eNOS G894T gene polymorphisms may play an implication as a genetic susceptibility factor for both ED and BPH/LUTS. Lee YC, Wu WJ, Liu CC, Wang CJ, Li WM, Huang CH, Yeh HC, Ke HL, and Huang SP. The associations among eNOS G894T gene polymorphism, erectile dysfunction, and benign prostate hyperplasia-related lower urinary tract symptoms. J Sex Med 2009;6:3158–3165. [ABSTRACT FROM AUTHOR]

We investigated the correlation between a history of human papillomavirus (HPV) infection and alopecia areata risk. The study cohort comprised 30,001 patients with newly diagnosed HPV infection between 2000 and 2012; and with use of computer-generated randomly numbers, patients not had HPV infection were randomly selected as the comparison cohort. HPV infection cohort were matched to comparison individuals at a 1:1 ratio by age, gender and index year. All study individuals were followed up until they developed alopecia areata, withdraw from the insurance program, lost to follow-up, or until the end of 2013. Cox proportional hazards regression analysis was used to analyze the risk of alopecia areata with hazard ratios (HRs) and 95% confidence intervals (CIs) between the HPV and control cohort. The adjusted hazard ratio (aHR) of alopecia areata for HPV patients relative to controls was 2.55 (95% C.I. = 1.88–3.47) after adjusting sex, age and comorbidities. Subgroup analysis indicated that patients with HPV infections had a significantly greater risk of alopecia areata for both genders, all age subgroups, and those with mental disorder diseases. A history of HPV infection is associated with the development of subsequent alopecia areata in Taiwanese subjects. • This study reveals the association between human papillomavirus (HPV) infection and alopecia areata (AA). • Patients with HPV are at higher risk of developing AA than those without HPV infection. • HPV may be a potential trigger for AA via COX-2 and IFN-γ overproduction. • A massive data analysis containing approximately 99% of Taiwan's population of 23 million people. • The results increase awareness regarding the connection between HPV and immune mediated skin diseases. [ABSTRACT FROM AUTHOR]

Background: Tonsillectomy has been suggested as an intervention to resolve psoriasis., Objective: This study aimed to investigate the subsequent risk of psoriasis in patients who received tonsillectomy., Methods: We used data from the Taiwan National Health Insurance Research Database. The tonsillectomy group (case group) and the tonsillectomy-free group (comparison group) were matched at a ratio of 1:4 by demographic data, comorbidities, medical confounders, and the index date. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs)., Results: We identified 2021 patients as the case group and matched 8084 individuals as the comparison group. The adjusted HR (aHR) of psoriasis was 0.43 (95% CI, 0.22-0.87; P < .05). The study population is composed of a mainly male (65%) and young population (mostly younger than 50 years). Notably, patients with rheumatoid arthritis increased the risk of psoriasis (aHR, 3.97; 95% CI, 1.17-13.48; P < .05). In our stratification analysis, the risk of psoriasis decreased in almost all subgroups., Limitation: Our database did not include information on genome and the subtypes of psoriasis., Conclusion: Our study showed a decreased risk of psoriasis in the tonsillectomy group after adjustment for baseline characteristics, comorbidities, and medical confounders compared with the reference group., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2021 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Importance: The association between human papillomavirus (HPV) infection status and the natural process of kidney diseases has been neglected as an area of research. Further studies are needed to clarify factors that may alter the progression of end-stage kidney disease (ESKD)., Objective: To describe the rates of ESKD among patients with and without HPV infection., Design, Setting, and Participants: In this nationwide, population-based retrospective cohort study, data were collected from the National Health Insurance Research Database of Taiwan. A total of 76 088 individuals with HPV infection were enrolled from January 1, 2000, to December 31, 2012, and compared with a control group of 76 088 individuals who had never been diagnosed with HPV infection (at a 1:1 ratio propensity-score matched by age, sex, index year, and comorbidities) in the context of the risk of developing ESKD. Statistical analysis was performed between November 2019 and July 2020., Exposures: HPV infection was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes., Main Outcomes and Measures: The main outcome was ESKD, as recorded in the Catastrophic Illness Patients database. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs, with the control group as a reference., Results: Of 152 176 individuals (79 652 [52.3%] women; mean [SD] age, 34.4 [19.1] years), 76 088 individuals (50.0%) had HPV and 463 individuals (0.3%) developed ESKD. Incidence of ESKD was lower in individuals with HPV history than in those without HPV history (3.64 per 10 000 person-years vs 4.80 per 10 000 person-years). In the fully adjusted multivariate Cox proportional hazards regression model, individuals with a history of HPV infection had a significant decrease in risk of ESKD (adjusted HR, 0.72; 95% CI, 0.60-0.87) after adjusting for demographic characteristics, comorbidities, and comedications. In the subgroup analysis, individuals ages 50 to 64 years with HPV infection had a statistically significantly lower risk of ESKD compared with individuals ages 50 to 64 years with no HPV infection (adjusted HR, 0.48; 95% CI, 0.34-0.68; P < .001), while there was no significant reduction in risk for the other age groups (ie, 0-19, 20-49, and 65-100 years)., Conclusions and Relevance: In this study, a history of HPV infection was associated with a lower risk of subsequent ESKD. The mechanism behind this protective association remains uncertain. Future studies are required to clarify the possible biological mechanisms.

Background: The global spread of carbapenem-resistant Acinetobacter baumannii (CRAB) is now a public health problem. In Taiwan, the relationship of the CRAB circulation between long-term care facilities (LTCFs) and acute care hospitals remains unclear. Here, we use molecular epidemiologic methods to describe the transmission of CRAB isolates between a community hospital and its affiliated LTCFs., Methods: Subjects localized in eight LTCFs who were not admitted acute care hospitals in recent a year were enrolled in this study. CRAB isolates were collected during June 1, 2015 and December 31, 2015. DNA fingerprinting was performed by repetitive extragenic palindromic sequence-based polymerase chain reaction (Rep-PCR) and multilocus sequence typing (MLST). Multiplex-PCR amplification for the detection of bla OXA genes and beta-lactamase genes was performed., Results: Twenty one subjects were enrolled. The major hospital admission diagnoses among the 21 subjects were pneumonia (71.4%). Genotyping of CRAB isolates by Rep-PCR revealed that a major clone, designated as type III, comprised fifteen of 21 (71.4%) isolates taken from 5 LTCFs and one study hospital. The isolates with type III were subtyped by PubMLST into 4 ST types. The most prevalent bla OXA genes in these isolates were bla OXA-23 -like (85.70%, 18/21). Twenty isolates carried bla SHV. CONCLUSION: Clonal spread of bla OxA-23 -carrying CRABs was found around LTCFs and the affiliated hospital. In Taiwan, it is important for the government to focus attention on the importance of identifying and tracing CRAB infections in LTCFs., (Copyright © 2017. Published by Elsevier B.V.)

Backgroud/purpose: Aggregatibacter actinomycetemcomitans has emerged as one of the aetiological agents in periodontal disease. Although Type IV secretion systems (T4SSs) are widely distributed in many bacteria, the genetic features and distribution of T4SSs in A. actinomycetemcomitans remain unclear. In this study, we investigated the prevalence of A. actinomycetemcomitans serotypes and their T4SSs in a Taiwanese population., Methods: A comparative analysis of 20 A. actinomycetemcomitans genomes and their T4SSs deposited in GenBank was performed. One hundred subjects, including 20 periodontitis and 80 normal subjects, were enrolled and PCR identification of A. actinomycetemcomitans serotypes and T4SS genes were performed., Results: Of 100 subjects, serotypes C (22%) and E (11%) were most common. In addition, T4SSs were distributed in all of the serotypes. The prevalence of T4SSs and their location in plasmids in periodontitis subjects were 1.28-2 fold higher but not significantly different compared to normal subjects. Of 20 A. actinomycetemcomitans genomes, only ten with complete T4SS modules could be detected, which was highly correlated with localized aggressive periodontitis (p < 0.1). Nine of ten T4SS modules were from periodontitis subjects. Phylogenetic analysis of 10 T4SSs in A. actinomycetemcomitans showed that they were clustered into two groups, T4SS AaI and T4SS AaII , with only T4SS AaI appearing in the Taiwanese subjects., Conclusion: A. actinomycetemcomitans strains with different serotypes carrying T4SS AaI are widely distributed in a Taiwanese population. This is the first report to show the distribution and detailed comparative genomics of T4SSs in A. actinomycetemcomitans., (Copyright © 2017. Published by Elsevier B.V.)

Indoor microbial communities have important implications for human health, especially in health-care institutes (HCIs). The factors that determine the diversity and composition of microbiomes in a built environment remain unclear. Herein, we used 16S rRNA amplicon sequencing to investigate the relationships between building attributes and surface bacterial communities among four HCIs located in three buildings. We examined the surface bacterial communities and environmental parameters in the buildings supplied with different ventilation types and compared the results using a Dirichlet multinomial mixture (DMM)-based approach. A total of 203 samples from the four HCIs were analyzed. Four bacterial communities were grouped using the DMM-based approach, which were highly similar to those in the 4 HCIs. The α-diversity and β-diversity in the naturally ventilated building were different from the conditioner-ventilated building. The bacterial source composition varied across each building. Nine genera were found as the core microbiota shared by all the areas, of which Acinetobacter, Enterobacter, Pseudomonas, and Staphylococcus are regarded as healthcare-associated pathogens (HAPs). The observed relationship between environmental parameters such as core microbiota and surface bacterial diversity suggests that we might manage indoor environments by creating new sanitation protocols, adjusting the ventilation design, and further understanding the transmission routes of HAPs.

Background: Acinetobacter baumannii and Staphylococcus aureus have persisted as 2 major pathogens worldwide., Aim: We designed a prevalence study to investigate the prevalence of nasal carriage of S aureus and A baumannii in long-term-care facilities (LCTFs) and their collaborative community hospitals. In addition, we aimed to clarify persistent or nonpersistent carriage of the 2 organisms among residents of LTCFs., Methods: We performed a prevalence study concerning nasal carriers of A baumannii and S aureus in 3 LTCFs and 1 collaborative community hospital., Results: Seventy subjects were enrolled and clustered into 3 groups: the elderly sick group (n = 24), the elderly healthy group (n = 33), and the healthy health care worker group (n = 13). Nasal samples were collected, and the nuc and mecA genes of S aureus and the bla OXA gene of A baumannii were analyzed by polymerase chain reaction. Among the 3 groups, the rate of nasal carriage of S aureus was approximately 0%-15%. However, the rate for A baumannii was approximately 54%-92%. Notably, the persistent carrier rate of A baumannii in the elderly sick group was 83.3% (20 out of 24) despite a 12.5% (3 out of 24) rate of carbapenem-resistant A baumannii., Conclusions: We emphasized that the persistent nasal carriage of A baumannii in LTCFs could be another portal of exit to cause A baumannii infection in Taiwan., (Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

This is the first report to show an insidious outbreak of armA- and blaOXA-72-carrying Acinetobacter baumannii sequence type 512 (ST512) at a study hospital in northern Taiwan. Multilocus sequence typing revealed that this was a ST512 clone. All of the isolates with ST512 carried a novel 12,056-bp repGR2 in combination with a repGR12-type plasmid. This plasmid, designated pAB-ML, had one copy of the blaOXA-72 gene that was flanked by XerC/XerD-like sites and conferred resistance to carbapenems., (Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.)

In this study, we applied a 16S ribosomal RNA (rRNA) metagenomics approach to survey inanimate hospital environments (IHEs) in a respiratory care center (RCC). A total of 16 samples, including 9 from medical devices and 7 from workstations, were analyzed. Besides, clinical isolates were retrospectively analyzed during the sampling period in the RCC. A high amount of microbial diversity was detected, with an average of 1,836 phylotypes per sample. In addition to Acinetobacter, more than 60 % of the bacterial communities present among the top 25 abundant genera were dominated by skin-associated bacteria. Differences in bacterial profiles were restricted to individual samples. Furthermore, compliance with hand hygiene guidelines may be unsatisfactory among hospital staff according to a principal coordinate analysis that indicated clustering of bacterial communities between devices and workstations for most of the sampling sites. Compared to the high incidence of clinical isolates in the RCC, only Staphylococcus and Acinetobacter were highly abundant in the IHEs. Despite Acinetobacter was the most abundant genus present in IHEs of the RCC, potential pathogens, e.g., Acinetobacter baumannii, might remain susceptible to carbapenem. This study is the first in Taiwan to demonstrate a high diversity of human-associated bacteria in the RCC via 16S rRNA metagenomics, which allows for new assessment of potential health risks in RCCs, aids in the evaluation of existing sanitation protocols, and furthers our understanding of the development of healthcare-associated infections.

The measurement of lower back mobility is essential in the assessment of lower back pain including ankylosing spondylitis. Original Schober's test (OST) and modified Schober's test (MST) are popularly conducted in daily rheumatology and orthopedics clinical practices. To our knowledge, this report is the only anthropometric reference study in a normal oriental population. The OST declined with age from 5.0 cm in the youngest (20-30 years old) to 3.1 cm in the aged (70-80 years old) male subjects and from 3.6 cm to 2.4 cm in the female subjects. The male OST was significantly more than the female OST. There was a good correlation between OST and MST in each of the three age groups of both sexes.

Background: The aims of this study were to understand the molecular epidemiology of integron-associated gene cassettes in Acinetobacter baumannii across four hospitals in northern Taiwan and to clarify the relationship between the presence of integrons and antibiotic-resistant phenotypes., Methods: Sixty-five A. baumannii isolates, collected from the patients of four regional hospitals in northern Taiwan in 2009, were tested for the presence of integrons and their associated gene cassettes. The susceptibility difference between integron-positive and integron-negative A. baumannii strains was analyzed. Antibiotic-resistant phenotypes among A. baumannii with different types of gene cassette array combinations were also compared., Results: Around 72% of the A. baumannii isolates carried class 1 integrase genes. Despite this, only three gene cassette arrays were found in the integrons. Integron-positive strains were significantly more resistant to all the tested antibiotics than the integrase-negative strains. All the four types of A. baumannii with different gene cassette array combinations were multidrug-resistant in nature. Gene cassette array aacA4-catB8-aadA1 existed in all the integron-positive A. baumannii isolates. Repetitive-sequence-based PCR (rep-PCR) results revealed the prevalence of one major cluster of imipenem-resistant A. baumannii strains (84%) in the four regional hospitals., Conclusions: The presence of integrons with associated antimicrobial resistance gene cassettes can be used as a representative marker of multidrug resistance in A. baumannii. Some prevalent gene cassette arrays may exist among epidemiologically unrelated A. baumannii strains.

There have been increasing reports of bla(OXA-23)-carrying strains of carbapenem-resistant Acinetobacter baumannii (CRAB), which has become a significant public health concern in Taiwan. To determine the origin of these CRAB strains, the prevalence of CRAB and bla(OXA-23)-carrying CRAB in a regional hospital was analysed retrospectively. The genome of A. baumannii TYTH-1 was completely sequenced and annotated. Multiple comparative genomics studies, including phylogenetic analysis, functional comparison via the Clusters of Orthologous Groups (COGs) database, and determination of variance in GC profiles in the whole genome and gene arrangements in resistance islands, were performed using 11 completely sequenced A. baumannii genomes. bla(OXA-23)-carrying CRAB isolates became dominant clones in 2007. A comparative genomics analysis revealed a common strain lineage between Taiwanese strains (TYTH-1 and TCDC-AB0715) and Chinese strains (MDR-TJ and MDR-ZJ06). Phylogenetic studies and GC profiles showed that the genome of TYTH-1 was closest to MDR-ZJ06. However, the resistance island of TYTH-1 (RI(TYTH-1)) was nearly identical to that of RI(MDT-TJ). The functional category for COGs was similar in the tested genomes. The results reveal that dissemination of bla(OXA-23)-carrying CRAB in Taiwan may have been mediated by the transfer of people between Taiwan and China during 2007. The global spread of CRAB is now a worldwide public health problem. In Taiwan, the government needs to focus more attention on the importance of identifying and tracing resistant pathogens and issuing notifications of CRAB infections., (Copyright © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.)

Acinetobacter baumannii has emerged recently as a major cause of health care-associated infections due to the extent of its antimicrobial resistance and its propensity to cause large nosocomial outbreaks. Here we report the genome sequence of Acinetobacter baumannii TYTH-1 isolated in Taiwan during 2008.

Background and Purpose: This study was conducted to investigate the molecular epidemiology and antimicrobial susceptibility of multidrug-resistant (MDR) Acinetobacter baumannii to three types of antibiotics., Methods: One hundred and thirty-four specimens of MDR A baumannii were collected from three branches (Taipei, Dalin, and Hualien branches) of Buddhist Tzu Chi Hospital, which are located in northern, southern, and eastern Taiwan, during 2007. Genotyping was performed by pulsed-field gel electrophoresis. Antibiotic susceptibilities to colistin, rifampicin, and tigecycline were determined. The synergistic effects of rifampin and colistin were also evaluated., Results: Antibiotic susceptibility testing showed that 10.4%, 47.8% and 45.5% of the MDR A baumannii isolates are resistant to colistin, rifampicin, and tigecycline, respectively. A majority of the rifampicin-resistant isolates (62.7%) were found in the Haulien branch, whereas 62.2% of tigecycline-resistant isolates were found in the Taipei branch. The combination of colistin and rifampicin had a synergistic effect on all of the isolates. Genotyping by pulsed-field gel electrophoresis identified 17, 23, and 11 pulsotypes in the Taipei, Dalin, and Haulien branches, respectively. Furthermore, 74.5% of isolates in the Haulien branch were identified as one of three pulsotypes. Among 37 rifampicin-resistant and 22 tigecycline-resistant MDR A baumannii isolates found in the Haulien branch, 51.3% (19/37) and 50% (11/22) of the isolates belonged to the same clone, respectively., Conclusion: This study confirms the high prevalence of resistance to rifampicin and tigecycline in MDR A baumannii in the three hospitals that were studied, and the high proportion of identical strains that exist in eastern Taiwan., (Copyright © 2011. Published by Elsevier B.V.)

Background: The distribution and characterization of OXA-type carbapenemases in Acinetobacter sp in Taiwan has less been reported. The aim of the study was to investigate the molecular epidemiology and OXA-type carbapenemase genes in a regional hospital in Taiwan., Methods: Imipenem-resistant Acinetobacter sp were collected between 2005 and 2007 in a regional hospital. Genotyping was performed by pulsed-field gel electrophoresis. OXA-type carbapenemase genes were determined by multiplex polymerase chain reaction (PCR) and gene sequencing., Results: A total of 136 isolates were collected. Fifty-six pulsotypes were identified. None of the pulsotypes established predominance throughout the 3-year period. Multiplex PCR of blaOXA genes showed that 99% (135/136) of the Acinetobacter sp possessed blaOXA51-like genes. The coexistences of blaOXA51-like/blaOXA-23-like and blaOXA51-like/blaOXA-24-like were detected in 19% (26/136) and 1% (2/136) of the isolates, respectively. Among blaOXA-23-like gene-carrying isolates, two isolates (Pulsotypes 18 and 20) were found in 2006 and the remainder (n=24), including Pulsotypes 27 (n=18), 29 (n=1), 52 (n=3), and 53 (n=2), were found in 2007. Sequencing performed on the 26 representative isolates confirmed the presence of the blaOXA-23 carbapenemase gene. Analysis of the genetic content of blaOXA-23 showed that these genes were presumably chromosomal and associated with the upstream-located insertion sequence ISAba1., Conclusions: The emergence and imminent widespread of blaOXA-23-carrying imipenem-resistant Acinetobacter sp appeared in Taiwan during the period from 2006 to 2007., (Copyright © 2011. Published by Elsevier B.V.)

We investigated the molecular epidemiology, antibiotic susceptibility, and antimicrobial resistant gene determinants of 23 multidrug-resistant (MDR) Acinetobacter baumannii samples that were collected from 5 proximal hospitals in Taiwan during April and May 2009. Major antibiotic resistance varied from 82.6 to 100%. Fivw pulsotypes were observed to spread clonally among the 5 hospitals. PCR screening revealed high distributions of intI1 (91%), bla(OXA-23) (57%), bla(ampC) (100%), adeB (100%), adeJ (100%), and abeM (100%) genes, which were prevalent in the MDR A. baumannii isolates. Resistance gene expression was examined by reverse transcription-PCR, and showed that increased ampC expression was associated with ceftazidime resistance, but expression of adeB, adeJ, or abeM did not guarantee antimicrobial resistance phenotypes. In addition, imipenem resistance in some A. baumannii strains may be mainly modulated by genes other than bla(OXA-51-like). This is the first direct evidence indicating local spread of MDR A. baumannii in Taiwan. The resistance gene determinants are widely distributed in clonal and nonclonal-related isolates.

The relationship between the presence and types of integrons and the antimicrobial susceptibility patterns of Acinetobacter baumannii was investigated. A total of 134 non-duplicated A. baumannii isolates, 54.5% (n=73) of which were subsequently found to carry class 1 integrons, were collected from a regional hospital in Taiwan between March and September 2007. Only two types of gene cassette array, aacA4-catB8-aadA1 and aacC1-orfP-orfP-orfQ-aadA1, were identified. Susceptibility data showed that those strains carrying integrons were significantly more resistant to all antibiotics tested except ampicillin/sulbactam and imipenem. An epidemiological study revealed that the same integron could be found in different unrelated strains. These findings suggest that the presence of integrons in A. baumannii is responsible for both the horizontal transfer of antibiotic-resistance genes related to aminoglycosides and chloramphenicol and also represents a marker of multidrug resistance and epidemic potential.