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Utilizing an inquiry-learning space (ILS) via the Go-Lab platform, we investigated students' technology acceptance, knowledge integration [KI] process, and learning outcomes of both the high-achiever KI student and low-achiever KI student. This study aimed to understand how students engage in knowledge integration tasks using an inquiry-learning space to learn Mendelian genetics and realize the relationship between student KI and domain knowledge. Using a quasi-experimental design, we examined 41 seventh-grade students in Taiwan completing Mendelian genetics KI tasks in ILS, pre/post-testing of domain knowledge tests, and a technology acceptance questionnaire. The analysis of students' interaction in the ILS and domain knowledge tests was conducted through descriptive statistics, t-tests, Pearson's correlation, and content analysis to indicate the direction and relationship between students' KI processes and learning outcomes. A technology acceptance questionnaire was analyzed through descriptive statistics and Pearson's correlation to reveal whether students accepted learning on the Go-Lab platform. The study showed that (i) students responded positively to the perceived usefulness of the Go-Lab platform, (ii) the high-achiever KI students could gradually construct links from simple to complex and diverse among genetic ideas, and the low-achiever almost built simple links, but (iii) the high-achiever and low-achiever KI students had similar learning outcomes. These findings have implications that the instruction design of knowledge integration tasks promotes students' Mendelian genetics conceptual understanding and KI progress.

This research uses board games as teaching material to develop students' decision-making ability and basic scientific literacy and to foster students' value for nature and social caring by working with socioscientific issues. The board game structure contains four perspective systems: ecological, economic, cultural, and political. In the game processing, students must handle, consider, and understand the different role players' positions and face different missions that involve socioeconomic and environmental conflicts. When making any decisions, students affect the follow-up game behaviors and develop tendencies. The board game instruction was field-tested with 38 high-school students from two different high schools. Students played the board game for a total of 200 minutes. Students' scientific conceptions concerning biodiversity (closed-ended) and perspectives on socioscientific issues (open-ended) were assessed before and after the board game lesson. The results showed that students in both high schools significantly increased their understanding of biodiversity concepts, with a high level of effect size (Cohen's d equal to 1.40 and 1.06, respectively, for the two schools). In the semistructured interviews, the interviewed students were able to reflect on the value of animals and provide various opinions about animal conservation and economic development.

Objectives: This study aimed to identify predictors of remission or low disease activity (LDA) in patients with rheumatoid arthritis (RA) and low-ultrasound inflammation. Methods: A total of 80 patients with RA who fulfilled the 1987 ACR criteria for RA with a disease activity score of 28 joints (DAS28) > 3.2 were recruited. Over 1 year of therapy, we conducted blood tests every 6 months to examine erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), monocyte chemotactic protein-1 (MCP-1), neuraminidase 3 (Neu3), and α-2,3-sialyltrasnferse I (ST3Gal-1) levels in B cells and monocytes. Additionally, we evaluated physical function by using the Health Assessment Questionnaire–Disability Index (HAQ-DI). Data on demographic and clinical parameters were collected, and musculoskeletal ultrasonography was performed twice a year on 12 specific joints to assess synovial changes. One year later, we compared all collected data and laboratory or ultrasound results between patients achieving remission or LDA and those who did not in order to determine the predictors. Results: Age, the presence or absence of rheumatoid factor, and the number of conventional disease-modifying anti-rheumatic drugs used were not correlated with remission or LDA for DAS28 or Simplified Disease Activity Index formulas. However, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores were associated with a higher likelihood of achieving remission or LDA for DAS28-ESR. Negative anticyclic citrullinated peptide (CCP) and low HAQ-DI scores were predictors of remission or LDA for DAS28-MCP-1. Interestingly, having less than two comorbidities is a good predictor of a combined remission/low disease activity state for SDAI and DAS28-MCP-1. Furthermore, Neu3 and ST3Gal-1 levels and ST3Gal-1/Neu3 ratios in B cells and monocytes had no significant correlation with total ultrasound scores. Nevertheless, monocyte ST3Gal-1 and Neu3 correlated significantly with DAS28-ESR >5.1 and DAS-MCP-1 >4.8 (both categories belong to high disease activity), respectively (rho = 0.609 with p = 0.012, and rho = 0.727 with p = 0.011, respectively). Monocyte ST3Gal-1/Neu3 ratios connected with DAS28-ESR >5.1 and 3.3 < SDAI ≦ 11 (low disease activity), respectively (rho = 0.662 with p = 0.005, and rho = 0.342 with p = 0.048, respectively). Conclusions: In patients with RA in Taiwan, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores are predictors of remission or LDA for DAS28-ESR, which differ from the predictors for DAS28-MCP-1. Moreover, monocyte ST3Gal-1, Neu3, and their ratios correlated with different disease activity categories of DAS28-ESR, DAS28-MCP-1, and SDAI scores. [ABSTRACT FROM AUTHOR]

Recent science education reforms center at having students learn the practices of scientists. In this study, we aim at exploring how science curricular documents reflect the latest updates from the "practice turn" reform. To do that, we utilize the notion of the scientist's ways of doing science as a perspective to observe the distribution of components constituting scientific practices in national science curricula. Current literature provides several curriculum analysis frameworks based on taxonomies of cognitive demands or international tests. Still, those frameworks are either not intended for science curricula or limited in indicators and hence failed to capture an updating picture of science curricula that reflect the recent practice turn. We employ multiple case study research design and qualitative content analysis approach to compare learning outcomes in Taiwan and Vietnam's two national science curricula. Results from this study offer maps of scientific practices across curricular documents and relevant suggestions for stakeholders to improve science curricula. The study opens a new direction on researching science curricula to make science learning approaching the scientist's ways in reality. [ABSTRACT FROM AUTHOR]

In recent years, many universities have opened courses to increase students' knowledge in the field of nanotechnology. These have been shown to increase students' knowledge of nanotechnology, but beyond this, advanced and applied nanotechnology courses should also focus on learning motivation and scientific enquiry abilities to equip students to develop the deeper knowledge and skills required for scientific application. This paper addresses this challenge. Due to the abstract nature of many nanotechnology concepts and in order to move from abstract knowledge to hands-on learning, an inquiry-based learning approach was adopted. Among the diverse inquiry-based learning models proposed, the 5E mobile inquiry-based approach, including the steps of engagement, exploration, explanation, elaboration, and evaluation, was considered most effective to enhance learners' understanding of nanotechnology. To evaluate the effectiveness of this proposed approach, a pretest-posttest quasi-experimental design was adopted with a total of 32 university students. Two sections of Nanotechnology Engineering, a general education course, were randomly assigned as either the comparison group (18 students; receiving lecture-based instruction, and using mobile devices) or the experimental group (14 students; receiving 5E inquiry learning, and using mobile devices). Mobile devices were adopted to enhance learners' experience, provide immediate access to information online, and provide enhanced hands-on learning. The empirical results demonstrate that the experimental condition, 5E mobile inquiry learning, had a positive impact on participants' learning motivation and scientific inquiry abilities.

Background: To determine the effects of adalimumab on health-related quality of life (HRQoL) in Taiwanese patients with moderate- to-severe rheumatoid arthritis (RA) (NCT02616380). Methods: During a 24-week observational period, 100 biologic-naive patients with RA received 40 mg adalimumab subcutaneously, every 2 weeks. The primary endpoint was a change in Health Assessment Questionnaire--Disability Index (HAQ-DI) score at 24 weeks. The secondary endpoints included change in HAQ-DI at week 12, number and percentage of patients achieving a meaningful improvement in HAQ-DI at weeks 12 and 24, and changes in the 36-Item Short Form Health Survey (SF-36), EuroQol 5-dimension 3-level version (EQ-5D-3L) index, and Work Productivity and Activity Impairment (WPAI) questionnaire scores at weeks 12 and 24. Results: At weeks 12 and 24, mean changes in HAQ-DI from baseline were -0.34 ± 0.46 and -0.44 ± 0.59 (both p < 0.001), and clinically meaningful improvement in HAQ-DI was achieved by 60.4% and 59.6% of patients, respectively. SF-36, EQ-5D-3L index, and WPAI scores significantly improved (p < 0.001) from baseline to weeks 12 and 24. Exploratory analyses showed diabetes was significantly associated with changes in HAQ-DI, EQ-5D-3L, and WPAI scores whereas peptic ulcer correlated with changes in the SF-36 physical component summary T-score. Conclusion: HRQoL improved after initiation of adalimumab therapy in Taiwanese patients with moderate-to-severe RA. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the influence of febuxostat on adverse events and mortality in gout. Methods: We retrospectively enrolled patients with newly diagnosed gout and prescribed urate‐lowering therapy between 2006 and 2017 from the Taiwan National Health Insurance Database. These patients were divided into 2 groups: with and without comorbidities (n = 294 847 and 194 539). An interrupted time series analysis with adjustments for demographics, comorbidities, and comedication by propensity score‐based stabilized weights was used to compare the trend of adverse events and mortality before vs after febuxostat was introduced in 2012. Results: The proportion of febuxostat use gradually increased from 0% in 2012 to 30% in those with comorbidities and 10% in those without comorbidities in 2017. Allopurinol use decreased from 30% in 2012 to 10% in 2017. The slope of the 1‐year incidence rate of Stevens–Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) (per 10 000 patients) significantly reduced after 2012 in those with and without comorbidities (−0.375 per quarter, P =.015 and −.253 per quarter, P =.049). The slope of the 3‐year incidence rate of acute myocardial infarction (AMI) (per 1000 patients), percutaneous coronary intervention (PCI) (per 1000 patients), and all‐cause mortality (per 100 patients) significantly increased after 2012 in those with comorbidities (+0.207 per quarter, P =.013; +.389 per quarter, P =.002; +.103 per quarter, P =.001). Conclusions: Febuxostat may reduce SJS and TEN in all gout patients but increase AMI, PCI, and all‐cause mortality in gout patients with comorbidities. [ABSTRACT FROM AUTHOR]

Utilizing an inquiry-learning space (ILS) via the Go-Lab platform, we investigated students' technology acceptance, knowledge integration [KI] process, and learning outcomes of both the high-achiever KI student and low-achiever KI student. This study aimed to understand how students engage in knowledge integration tasks using an inquiry-learning space to learn Mendelian genetics and realize the relationship between student KI and domain knowledge. Using a quasi-experimental design, we examined 41 seventh-grade students in Taiwan completing Mendelian genetics KI tasks in ILS, pre/post-testing of domain knowledge tests, and a technology acceptance questionnaire. The analysis of students' interaction in the ILS and domain knowledge tests was conducted through descriptive statistics, t-tests, Pearson's correlation, and content analysis to indicate the direction and relationship between students' KI processes and learning outcomes. A technology acceptance questionnaire was analyzed through descriptive statistics and Pearson's correlation to reveal whether students accepted learning on the Go-Lab platform. The study showed that (i) students responded positively to the perceived usefulness of the Go-Lab platform, (ii) the high-achiever KI students could gradually construct links from simple to complex and diverse among genetic ideas, and the low-achiever almost built simple links, but (iii) the high-achiever and low-achiever KI students had similar learning outcomes. These findings have implications that the instruction design of knowledge integration tasks promotes students' Mendelian genetics conceptual understanding and KI progress. [ABSTRACT FROM AUTHOR]

New psychoactive substances (NPS) have increasingly been illegally synthesized and used around the world in recent years. Due to the large volume and the variety of NPS, most do not have sufficient information about their addictive potential and harmful effects to human subjects. This makes it difficult to evaluate these potential substances of abuse. This study aims to build a database based on Taiwan's controlled substances, to provide quick structural and pharmacological feedback. Taiwan Controlled Substances Database (TCSD) includes the collection of controlled substances, relevant experimental and structural information, as well as computational features such as molecular fingerprints and descriptors. Two types of structural search were added: substructure search and topological fingerprint similarity search. A web framework was used to enhance accessibility and usability (https://cs2search.cmdm.tw). [ABSTRACT FROM AUTHOR]

Objectives: To estimate stroke risk in Taiwanese patients with gout. Methods: We enrolled patients from the Taiwan National Health Insurance Database, with gout diagnosed from 2000 to 2008, and followed them up until December 2018. This cohort was propensity score-matched according to birth year, sex, the date of diagnosis of gout, comorbidities, and co-medications with individuals without gout (controls) (n = 310,820 in each group). Stroke was defined as the primary diagnosis at discharge after the index date. To evaluate ischemic and hemorrhagic stroke risks, we calculated their incidence, hazard ratio (HR), and two-year moving average incidence rate. Results: The incidence (95% CI) and HR of ischemic stroke were lower in the gout group than in the control group in the first 3 years (incidence: 4.74 [4.60–4.88] vs. 5.17 [5.03–5.32] per 1000 person-years; HR: 0.92 [0.88–0.96]), then became significantly higher than in the control group after 3 years (incidence: 4.10 [4.04–4.16] vs. 3.81 [3.75–3.87] per 1000 person-years; HR: 1.08 [1.05–1.10]). Similarly, the incidence (95% CI) and HR of hemorrhagic stroke was lower in the gout group than in the control group in the first 3 years (incidence: 1.51 [1.43–1.59] vs. 1.70 [1.62–1.79] per 1000 person-years; HR: 0.88 [0.82–0.92]), then became significantly higher than in controls after 3 years (incidence: 1.43 [1.39–1.46] vs. 1.26 [1.22–1.29] per 1000 person-years; HR: 1.14 [1.10–1.18]). Conclusions: In Taiwan, patients with gout had higher risks of ischemic and hemorrhagic stroke after 3 years. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether offspring of Taiwanese mothers with systemic lupus erythematosus or rheumatoid arthritis have a higher risk of autism spectrum disorder.Methods: Using the National Health Insurance database and National Birth Registry, we identified a cohort of all live births in Taiwan between 2001 and 2012. Children born to mothers with systemic lupus erythematosus or rheumatoid arthritis were identified and matched with up to 8 controls by maternal age, 1-minute Apgar score, 5-minute Apgar score, mode of delivery, sex of the child, gestational age, birth weight and place of residence. Marginal Cox proportional hazard models were used to estimate relative risk (RR) with 95% confidence intervals (CI) for ASD in offspring.Results: Of 1,893,244 newborns, 0.08% (n=1594) were born to systemic lupus erythematosus mothers, and 0.04% (n=673) were born to rheumatoid arthritis mothers. Overall, 5 of 673 (0.74%) offspring of rheumatoid arthritis mothers, 7 of 1594 (0.44%) offspring of systemic lupus erythematosus mothers and 10,631 of 1,893,244 (0.56%) offspring of all mothers developed autism spectrum disorder. Autism spectrum disorder incidence (per 100,000 person-years) was 140.39 (95% CI, 45.58-327.62) for the rheumatoid arthritis group and 76.19 (95% CI, 30.63-156.97) for the systemic lupus erythematosus group. Autism spectrum disorder risk was not significantly higher for children born to mothers with rheumatoid arthritis (HR, 1.42; 95% CI, 0.60-3.40) or systemic lupus erythematosus (HR, 0.76; 95% CI, 0.36-1.59).Conclusions: Children born to women with systemic lupus erythematosus or rheumatoid arthritis do not have a higher risk of autism spectrum disorder. [ABSTRACT FROM AUTHOR]

Background: World Health Organization (WHO) guidelines recommend that infants should be breastfed for six month after childbirth. The average duration of breastfeeding in Taiwan still falls short of this sixth-month timeline. In order to improve the duration of breastfeeding, it is crucial to understand the factors that affect related behavior. Purpose: To explore the effects of breastfeeding self-efficacy and breastfeeding intention among exclusive-breastfeeding women during the initial six months after childbirth and to verify the reliability and validity of the infant feeding intentions scale (Chinese version). Method: Purposive sampling was used to select and enroll a total of 167 breastfeeding women from a southern metropolitan medical-teaching hospital. Data were collected using a structured questionnaire and phone interviews. Data were analyzed using SPSS 18.0, LISREL8.7, and S-Plus package software to obtain scores for the independent-sample t test, Pearson's product-moment correlation coefficient, one-way analysis of variance, survival analysis, and reliability and validity. Results: Breastfeeding self-efficacy scores ranged from 14 to 70, with a mean score of 44.80 (±11.56). Infant feeding intention scores ranged from 14 to 70, with a mean score of 12.20 (±3.14). Additionally, 29.9% of the participants breastfed exclusively for the entire six months after childbirth. Breastfeeding self-efficacy and breastfeeding intention were positively correlated (r = .45, p < .001). Education level, occupation, and breastfeeding intention were each identified as factors that significantly influenced the success of exclusive breastfeeding during the initial six months after childbirth. Conclusions/Implications for Practice: Breastfeeding self-efficacy and breastfeeding intention are correlated with breastfeeding behavior. Based on findings, medical staff should target promotion and education regarding the importance of breastfeeding particularly toward women who have lower levels of education, who are employed, and who express low initial intention to breastfeed. [ABSTRACT FROM AUTHOR]

Objective. To assess the effects of epigallocatechin-3-gallate (EGCG) on cytokine-induced Cyr61 synthesis in human osteoblastic cells and the associated signalling pathways. The therapeutic effect of EGCG on CIA in rats was also studied.Methods. The expression of Cyr61 and NF-κB pathway molecules was examined by western blotting. CCL2 expression was assessed by northern blotting and ELISA. Interaction between NF-κB and Cyr61 promoter was evaluated by electrophoretic mobility shift assay. In rat CIA, osteoblastic expression of Cyr61 was examined by immunohistochemistry and disease progression was assessed by clinical, radiographic and histological examinations.Results. EGCG inhibited Cyr61 expression stimulated by cytokines in primary human osteoblasts and human osteoblastic cell line U2OS. In U2OS, oncostatin M (OSM) induced IκB-α degradation through the mTOR/rictor/Akt pathway, and EGCG attenuated the action. Electrophoretic mobility shift assay revealed that the OSM-enhanced NF-κB/DNA binding was reduced by EGCG, possibly through abrogating nucleus localization of p65 and p50. Cyr61 enhanced OSM-induced expression of CCL2. Moreover, EGCG diminished OSM-stimulated CCL2 expression at least partially via suppressing Cyr61 induction. Co-distribution of CD68+ macrophages and Cyr61+ osteoblasts in osteolytic areas was obvious in the CIA model. Clinical, radiographic and immunohistochemical analyses revealed that administration of EGCG markedly diminished the severity of CIA, macrophage infiltration, and the number of Cyr61-synthesizing osteoblasts.Conclusion. By modulating the mTOR/rictor/Akt/NF-κB pathway, EGCG attenuated Cyr61 production in osteoblastic cells and in turn diminished macrophage chemotaxis. Our data support the therapeutic potential of EGCG on arthritis. [ABSTRACT FROM AUTHOR]

This study evaluated the application of a wireless sensor network (WSN) on a web-based vital signs monitoring system to nursing homes in Taiwan. The applicability assessment focused on the timely provision of information, information accuracy, system usability, and system accessibility of healthcare systems using a wireless sensor network. Experiments were performed under Internet-based network conditions to verify the timely information provision, especially for a web-based system, including Ajax technology. The accuracy of the information was verified from statistical analyses of the residents' daily vital sign measurements. A comparison was performed between having and not having a healthcare monitoring system in nursing homes for system usability, system accessibility, and system efficacy. The results indicate that the successful application of a WSN healthcare monitoring system is feasible for use in nursing homes in Taiwan. [ABSTRACT FROM AUTHOR]

Caridina gracilipes, an atyid shrimp of Taiwan, inhabits the fresh and brackish waters. Its life history can be classified into amphidromous and landlocked types. Recent human's transportation has caused concerns of genetic contamination between these long evolved lineages and ecological instabilities. Molecular markers with high sensitivities are required for detecting the possible introgression due to human disturbance. In the study, we described the development of 15 polymorphic microsatellite loci in C. gracilipes for genetic and ecological studies. These new markers were tested in 20 individuals of three populations. The number of alleles ranged from 6 to 17. Expected (HE) and observed (HO) heterozygosities ranged from 0.653 to 0.954, averaged at 0.865, and from 0.000 to 0.4, averaged at 0.146, respectively. All loci are significantly deviated from Hardy-Weinberg expectations due to the heterozygote deficiency. Significant genetic differentiation among populations was detected based on FST values, which were estimated from 0.82 to 0.88. [ABSTRACT FROM AUTHOR]

Background: To determine the effects of adalimumab on health-related quality of life (HRQoL) in Taiwanese patients with moderate-to-severe rheumatoid arthritis (RA) (NCT02616380)., Methods: During a 24-week observational period, 100 biologic-naive patients with RA received 40 mg adalimumab subcutaneously, every 2 weeks. The primary endpoint was a change in Health Assessment Questionnaire-Disability Index (HAQ-DI) score at 24 weeks. The secondary endpoints included change in HAQ-DI at week 12, number and percentage of patients achieving a meaningful improvement in HAQ-DI at weeks 12 and 24, and changes in the 36-Item Short Form Health Survey (SF-36), EuroQol 5-dimension 3-level version (EQ-5D-3L) index, and Work Productivity and Activity Impairment (WPAI) questionnaire scores at weeks 12 and 24., Results: At weeks 12 and 24, mean changes in HAQ-DI from baseline were -0.34 ± 0.46 and -0.44 ± 0.59 (both p < 0.001), and clinically meaningful improvement in HAQ-DI was achieved by 60.4% and 59.6% of patients, respectively. SF-36, EQ-5D-3L index, and WPAI scores significantly improved ( p < 0.001) from baseline to weeks 12 and 24. Exploratory analyses showed diabetes was significantly associated with changes in HAQ-DI, EQ-5D-3L, and WPAI scores whereas peptic ulcer correlated with changes in the SF-36 physical component summary T-score., Conclusion: HRQoL improved after initiation of adalimumab therapy in Taiwanese patients with moderate-to-severe RA., Competing Interests: Conflicts of interest: Dr. Chang-Youh Tsai, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2023, the Chinese Medical Association.)

Background: Little information is available in Asia about the real-world practice of dual antiplatelet therapy (DAPT) duration for acute coronary syndrome (ACS) and its influence on clinical outcomes.Methods and Results:The Taiwan ACS STENT Registry was a prospective, multicenter study to observe ACS patients using clopidogrel-based DAPT after percutaneous coronary intervention (PCI). The primary outcome was a composite of cardiovascular death, myocardial infarction, and stroke. Overall, 2,221 ACS patients (62 years, 83% men) were included. DAPT duration was ≤9 months in 935 (42.1%). The incidence of primary outcome was higher in patients receiving DAPT ≤9 months compared with those receiving DAPT >9 months at 1 year (3.5% vs. 1.6%, P=0.0026). The incidence of stent thrombosis (overall 0.5%) was similar between groups. Multivariable analysis showed that DAPT >9 months was associated with a significantly lower risk of primary outcome (odds ratio 0.725, 95% confidence interval 0.545-0.965)., Conclusions: Our data showed that short duration of DAPT (≤9 months) was common (42.1%) in Taiwan for ACS patients undergoing PCI. DAPT ≤9 months increased the risk of the primary outcome.

The aim of this study is to study the clinical features and diagnostic performance of IgG4 in Chinese populations with IgG4-related diseases (IgG4-RDs).The medical records of 2901 adult subjects who underwent serum IgG4 level tests conducted between December 2007 and May 2014 were reviewed.Serum concentrations of IgG4 were measured in 2901 cases, including 161 (5.6%) patients with IgG4-RD and 2740 (94.4%) patients without IgG4-RD (non-IgG4-RD group). The mean age of the IgG4-RD patients was 58.4 ± 16.1 years (range: 21-87), and 48 (29.8%) were women. The mean serum IgG4 level was significantly much higher in IgG4-RD patients than in non-IgG4-RD (1062.6 vs 104.3 mg/dL, P < 0.001) participants. For IgG4 >135 mg/dL, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR)+, and LR- were 86%, 77%, 18%, 99%, 3.70, and 0.19, respectively. When the upper limit of normal was doubled for an IgG4 >270 mg/dL, the corresponding data were 75%, 94%, 43%, 98%, 12.79, and 0.26, respectively. For IgG4 >405 mg/dL (tripling the upper limit of normal), the corresponding data were 62%, 98%, 68%, 98%, 37.00, and 0.39, respectively. When calculated according to the manufacturer's package insert cutoff (>201 mg/dL) for the diagnosis of IgG4-RD, the corresponding sensitivity, specificity, PPV, NPV, LR+, and LR- were 80%, 89%, 29%, 99%, 7.00, and 0.23, respectively. For IgG4 >402 mg/dL (>2× the upper limit of the normal range), the corresponding data were 62%, 98%, 68%, 98%, 36.21, and 0.39, respectively. For IgG4 >603 mg/dL (>3× the upper limit of the normal range), the corresponding data were 50%, 99%, 84%, 97%, 90.77 and 0.51, respectively. The optimal cutoff value of serum IgG4 (measured by nephelometry using a Siemens BN ProSpec instrument and Siemens reagent) for the diagnosis of IgG4-RD was 248 mg/dL, the sensitivity and specificity were 77.6% and 92.8%, respectively.The present study demonstrated that 2 or 3 times the upper limit of the manufacturer's reference range of the IgG4 level was a useful marker for the diagnosis of various types of IgG4-RD and the optimal cutoff level was 248 mg/dL.