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EFL (English as a foreign language) students usually learn by rote when they study English grammar. They usually memorize all the grammar rules mechanically instead of learning grammar in a structured way. Researchers have suggested that students can internalize knowledge via using knowledge construction tools and collaborated learning activities. Therefore, in this study, a grammar concept mapping-based collaborative English mobile gaming approach has been developed. A quasi-experiment on an English course was carried out in an elementary school to evaluate the learning achievement of the low- and high-achieving students. Moreover, the students' learning behavioral patterns were explored by analyzing their interactive logs in the mobile discussion forum. The results showed that the students using the proposed approach revealed significantly higher English grammar achievements than those who learned with the collaborative English gaming approach; moreover, the grammar concept mapping strategy can help the low-achieving students to have better learning achievements, and to realize the concept structure of English grammar to internalize their knowledge. In addition, it was also found that the low-achieving students had significantly higher mental load than the high-achieving students, implying that the use of the grammar concept mapping approach provided a challenging but helpful task to help the low achievers focus on the gaming process and successfully organize the grammar structures they had learned.

C-type lectins play a crucial role as pathogen-recognition receptors for the dengue virus, which is responsible for causing both dengue fever (DF) and dengue hemorrhagic fever (DHF). DHF is a serious illness caused by the dengue virus, which exists in four different serotypes: DEN-1, DEN-2, DEN-3, and DEN-4. We conducted a genetic association study, during a significant DEN-2 outbreak in southern Taiwan, to explore how variations in the neck-region length of L-SIGN (also known as CD209L, CD299, or CLEC4M) impact the severity of dengue infection. PCR genotyping was utilized to identify polymorphisms in variable-number tandem repeats. We constructed L-SIGN variants containing either 7- or 9-tandem repeats and transfected these constructs into K562 and U937 cells, and cytokine and chemokine levels were evaluated using enzyme-linked immunosorbent assays (ELISAs) following DEN-2 virus infection. The L-SIGN allele 9 was observed to correlate with a heightened risk of developing DHF. Subsequent results revealed that the 9-tandem repeat was linked to elevated viral load alongside predominant T-helper 2 (Th2) cell responses (IL-4 and IL-10) in K562 and U937 cells. Transfecting K562 cells in vitro with L-SIGN variants containing 7- and 9-tandem repeats confirmed that the 9-tandem repeat transfectants facilitated a higher dengue viral load accompanied by increased cytokine production (MCP-1, IL-6, and IL-8). Considering the higher prevalence of DHF and an increased frequency of the L-SIGN neck's 9-tandem repeat in the Taiwanese population, individuals with the 9-tandem repeat may necessitate more stringent protection against mosquito bites during dengue outbreaks in Taiwan. [ABSTRACT FROM AUTHOR]

Neonatal hypoglycemia is a common metabolic occurrence among small for gestational age (SGA) neonates. This study aims to determine the incidence of early neonatal hypoglycemia and confirms the potential risk factors among term and late preterm SGA neonates in a well-baby newborn nursery of a tertiary medical center in Southern Taiwan. We performed a retrospective medical record review of term and late preterm SGA (birth weight <10 percentile) neonates, born between January 1, 2012 and December 31, 2020, in the well-baby newborn nursery, of a tertiary medical center in Southern Taiwan. Blood glucose monitoring was routinely performed at 0.5, 1, 2, and 4 h of life. Antenatal and postnatal risk factors were recorded. Mean blood glucose level, age of occurrence, symptomatic hypoglycemia, and need for intravenous glucose treatment of early hypoglycemia in SGA neonates were documented. 690 SGA neonates in the nursery met the criteria and were retrospectively enrolled in the study, 358 of whom (51.80%) were male and 332 (48.10%) female. Of 690 enrolled SGA neonates, 134(19.42%) SGA neonates developed hypoglycemia during a well-baby nursery stay. Among these neonates, 97% of early hypoglycemic episodes occur during the first 2 h of life. The lowest blood glucose level was 46.78 ± 11.13 mg/dL, recorded in the first hour of life. Among the hypoglycemic 134 neonates, 26 (19.40%) neonates had to be transferred from the nursery to the neonatal ward and they required intravenous glucose treatment to achieve euglycemia. 14 (10.40%) neonates had symptomatic hypoglycemia. A multivariate logistic regression analysis revealed that cesarean delivery, small head circumference, small chest circumference, and low 1-min Apgar score were significant risk factors for early hypoglycemia in these neonates. Periodic routine blood glucose level monitoring within the first 4 h of life in term and late preterm SGA neonates is required, especially those with cesarean delivery and low Apgar score. [ABSTRACT FROM AUTHOR]

Aim: The study investigated the relationship between chronic diseases and health problems, emotional health status, health literacy, health self‐management attitude, and health management self‐efficacy in older patients with schizophrenia. It is expected to provide multiple health perspectives in the care of older patients with schizophrenia and improve their health literacy and self‐management. Design: A cross‐sectional study. Methods: Data collection from 2020/09 to 2021/10, the study of older patients with schizophrenia who were diagnosed with schizophrenia and were over 50 years, live in residential mental rehabilitation institutions in eastern Taiwan as older people. Data were collected on demographic variables, chronic diseases, health problems, health literacy, healthy management self‐efficacy, and attitudes. Results: The study results show 61.49 years (SD = 6.57), the gender, health literacy, and health management self‐efficacy can effectively explain the variance of health self‐management state by 18.5% (F(3,116) = 10.01, p < 0.000), in which health literacy (β = 0.28, t = 3.07, p = 0.003) and health management self‐efficacy (β = 0.19, t = 2.03, p = 0.04) that in the analysis of predictors, emotional health status, and health literacy not only have significant explanatory power on health management self‐efficacy and the performance of physical functions but are also important factors affecting the quality of life among the elderly; the important influencing factor of health management self‐efficacy and health self‐management behaviour is health literacy. Therefore, health literacy is crucial to the health attitudes of older patients with schizophrenia. Conclusion: This study found that increased health literacy among older patients with schizophrenia can enhance their attitude and ability to manage their health. Implications for the Profession and No Patient or Public Contribution: Nursing can provide nursing measures related to individual health literacy to help patients improve their health literacy, maintain the health of chronic older patients with schizophrenia, reduce elderly schizophrenia disability, enhance patients' ability to manage their self‐efficacy and health self‐management attitude, and improving the health and quality of life of patients. [ABSTRACT FROM AUTHOR]

The concentrations level and distribution of 16 US EPA polycyclic aromatic hydrocarbon (PAHs) from the water treatment plant (WTP), sewage treatment plant (STP), and industrial water treatment plant (ITP) sludge in Taiwan were determined and then assessed the sources, and potential toxicity (carcinogenic polycyclic aromatic hydrocarbons [CPAHs] and toxic BaP equivalent [TEQ]). Results indicated that the total concentrations of PAHs ranged between 58 and 16,436 μg/kg dw. Among the 17 samples, the 2-4 ring of total PAHs were the predominant compound in three kinds of treatment plant (> 60%). Especially, ITP1 owns 95.8% of 2-4 ring of total PAHs and ITP3 owns 54% of five- and six-ring of total PAHs. The molecular indices and principal component analysis (PCA) were used to determine the source contributions, with the results showing that the contributions of combustion/grass, coal or wood combustion and combustion/ liquid (oil) fossil fuel combustion. A PAH toxicity indicated by TEQ was 2.5–506 μg TEQ/g dw. Although, the results indicated that these were not recommended for land applications, but analyses are beneficial to develop effective management strategies for controlling PAH discharge in treatment plants and establishing strategies for its reuse in managing pollutants. [ABSTRACT FROM AUTHOR]

This study employed an onboard emission measurement system to measure the real-world emission factors of particulate matter (PM), particle-bound polycyclic aromatic hydrocarbons (PAHs), and gaseous air pollutants for different types of diesel-fueled non-road construction machines operated inside confined spaces within a brick manufacturing factory located in Taiwan. To the best knowledge of the authors, this is the first study that reports real-world PM, PAH, and gaseous pollutant emission factors for non-road engines in Taiwan. The mean real-world fuel-specific emission factors of PM, carbon monoxide, total hydrocarbons, and nitric oxide were 0.712–1.17, 8.27–17.9, 3.04–5.77, and 38.1–96.8 g/kg-fuel, respectively, for the test machines. Likewise, mean ΣPAHs emission factors ranged from 157 to 230 μg/kg-fuel for three types of test machines. Further, the average emission of particle-bound PAH per unit PM emission ranged from 213 to 384 μg-PAH/g-PM. Among the analyzed PAHs, the medium-molecular weight (3- and 4-ring) compounds contributed to the largest share of particle-bound PAH emissions. However, in terms of Benzo[a]pyrene equivalent (BaPeq) toxicity, the high-molecular weight (5- and 6-ring) PAHs were more important, as they had the highest BaPeq toxic emission factors. This study provides detailed composition and emission factors of particle-bound PAHs in non-road diesel construction machine emissions, which may be useful as a chemical fingerprint for source apportionment studies. [ABSTRACT FROM AUTHOR]

Mitigating ground-level ozone (GLO) remains challenging due to its highly nonlinear formation process. Thus, understanding GLO pollution trends is crucial for developing effective control strategies, especially Kaohsiung industrial city, Taiwan. Based on the long-term monitoring data set of 2011–2022, temporal analysis reveals that monthly mean GLO peaks in autumn (40.66 ± 5.10 ppb), carbon monoxide (C O) and major precursors such as nitrogen oxides (N O x) , nonmethane hydrocarbons (N M H C) reach their highest levels in winter. The distinct seasonal variation of air pollutants in Kaohsiung is primarily influenced by the unique blocking effect of the mountainous area under the northeasterly wind, as the city is situated downwind, causing high GLO levels during autumn due to the accumulation of stagnant air hindering the dispersion of pollutants. Over the 12 years (2011–2022), the deseasonalized trend analysis was conducted with p < 0.001, revealing a stabilization trend of GLO (+0.04 ppb/yr) from a previous sharp increase. The observed improvement is credited to a drastic decrease in total oxidants (O x) at −0.63 ppb/yr due to significantly reducing their precursors. Furthermore, the effectiveness of precursor reduction is also supported by GLO daily maximum profile changes. While high GLO events (>120 ppb) decrease, days within midrange (60–80 ppb) rise from 24.4% to 33.3%. A notable difference emerges when comparing daytime and nighttime GLO. While daytime GLO decreased at −0.22 ppb/yr, nighttime GLO increased at +0.34 ppb/yr. Weakened nocturnal titration effects accounted for the nighttime increase. The distinct spatial variations in GLO trends on a citywide scale underscore that areas with complicated industrial activities may not benefit from a continuing reduction of precursors compared to less-polluted areas. The findings of this study hold significant implications for improving GLO control strategies in heavily industrialized city and provide valuable information to the general public about the current state of GLO pollution. [Display omitted] • Deseasonalized trends of major pollutants over Kaohsiung (2011–2022) are reported. • Autumn has the highest ground-level ozone levels, followed by spring, winter and summer. • Deseasonalized ground-level ozone trend remained stable under a drastic decrease of total oxidants. • Air quality improvement was supported by high ozone (>120 ppb) reduced while midrange ozone (60–80 ppb) raised. • Notable opposing trends between daytime (−0.22 ppb/yr) and nighttime (+0.34 ppb/yr). [ABSTRACT FROM AUTHOR]

The article offers information on cost-effectiveness analysis of trastuzumab emtansine in treating HER-2 positive advanced breast cancer in Taiwan. Topics include reports that T-DM1 has not been approved for reimbursement by Taiwan's National Health Insurance Administration (TNHIA); therefore, performed a cost-utility analysis of T-DM1 as a second-line treatment compared to LC from the perspective of the TNHIA.

Background: Patients with reduced ejection fraction have high rates of mortality and readmission after hospitalization for heart failure. In Taiwan, heart failure disease management programs (HFDMPs) have proven effective for reducing readmissions for decompensated heart failure or other cardiovascular causes by up to 30%. However, the benefits of HFDMP in different populations of heart failure patients is unknown.Method: This observational cohort study compared mortality and readmission in heart failure patients who participated in an HFDMP (HFDMP group) and heart failure patients who received standard care (non-HFDMP group) over a 1-year follow-up period after discharge (December 2014 retrospectively registered). The components of the intervention program included a patient education program delivered by the lead nurse of the HFDMP; a cardiac rehabilitation program provided by a physical therapist; consultation with a dietician, and consultation and assessment by a psychologist. The patients were followed up for at least 1 year after discharge or until death. Patient characteristics and clinical demographic data were compared between the two groups. Cox proportional hazards regression analysis was performed to calculate hazard ratios (HRs) for death or recurrent events of hospitalization in the HFDMP group in comparison with the non-HFDMP group while controlling for covariates.Results: The two groups did not significantly differ in demographic characteristics. The risk of readmission was lower in the HFDMP group, but the difference was not statistically significant (HR = 0.36, p = 0.09). In patients with ischemic cardiomyopathy, the risk of readmission was significantly lower in the HFDMP group compared to the non-HFDMP group (HR = 0.13, p = 0.026). The total mortality rate did not have significant difference between this two groups.Conclusion: The HFDMP may be beneficial for reducing recurrent events of heart failure hospitalization, especially in patients with ischemic cardiomyopathy.Trial Registration: Longitudinal case-control study ISRCTN98483065 , 24/09/2019, retrospectively registered. [ABSTRACT FROM AUTHOR]

Purpose: Only few studies have investigated medial epicondyle (MEC) lesions, particularly in the 12-18 age group. To the best of our knowledge, no study has compared ultrasonography (US), radiography and magnetic resonance imaging (MRI) in detecting MEC lesions. The aims of this study were to examine the value of US for detecting MEC lesions and to investigate correlations among diagnostic tools.Methods: A prospective, comparative study was performed. Young baseball players from southern Taiwan were recruited, and basic characteristics, as well as passive range of motion (pROM) of the upper extremities, were recorded. Screening US was performed to identify MEC lesions, and players with MEC lesions received follow-up plain radiography and MRI.Results: A total of 299 young baseball players were screened using US, and 28 of 299 players with possible MEC lesions were identified with a positive predictive value (PPV) of 88% according to MRI findings. The MEC lesions were primarily comprised of unfused ossicles and bony fragmentation. Other diagnoses, including UCL strain and medial epicondylitis, were also found by MRI in players with abnormal US screening results. The pROM of shoulder external rotation (ER) of the throwing hand was significantly reduced in players with MEC lesions (p = 0.006).Conclusions: Bony cortical discontinuity or fragmentation over the MEC warrants further research, and US provides good PPV for types of MEC lesions. Decreased shoulder ER may relate to MEC lesions and should be taken into consideration. The use of US may facilitate early detection and intervention.Level Of Evidence: IV, Cross-sectional study. [ABSTRACT FROM AUTHOR]

Nutritive sucking is the approach of obtaining primary food for newborns within six months. However, completing the precise coordination of sucking-swallowing-respiratory actions under oral feeding is usually difficult for preterm infants and may affect the body and neural development of the premature infant. For this reason, how to obtain the quantitatively physiological information related to oral feeding is useful for physicians making more accurate clinical diagnoses for oral feeding disorders. However, there is still lack of monitoring systems for evaluating the feeding skill of infants quantitatively and objectively. The assessment of the feeding skill or the diagnosis of oral-feeding disorders still depends on the clinical experience of medical staffs. In this study, a novel wireless monitoring system is proposed to evaluate the feeding behavior of infants quantitatively and objectively and analyze the characteristics of these actions under oral feeding. Here, a specific feeding bottle and an optical probe are also designed and successfully applied to non-invasively monitor the sucking and respiratory actions, and a microphone is also applied to monitor the swallowing action. From the experimental results, the sucking and swallowing rate increases and the respiratory rate decreases with the increase of the infant age. Moreover, the duration increases and the interval of sucking-action sequence decreases with the increase of the infant age respectively. The proposed system successfully assesses the feeding behavior of preterm infants and may provide an objective evaluation tool for oral feeding ability and identifying the risk of infant developmental delay in the future. [ABSTRACT FROM AUTHOR]

Dengue has broad clinical presentation with unpredictable clinical evolution and outcome. We aimed to evaluate the utility of C-reactive protein (CRP) levels for distinguishing between mild and severe cases in the early phase of the dengue illness. We retrospectively evaluated adults with dengue from 2006 to 2014, according to 1997 and 2009 World Health Organization (WHO) criteria for severity. Of 191 included patients, 32.9% had nonshock dengue hemorrhagic fever (DHF), 3.1% dengue shock syndrome (DSS), and 7.9% severe dengue. The risk of DHF/DSS and severe dengue is significantly related to the increasing levels of CRP. Of 191 patients, 97 had CRP levels measured during the febrile (days 1–3); 85 during the critical (days 4–6); and 9 during the convalescent (days 7–10) illness phases. During the febrile phase, there was significant higher CRP level for DSS versus DF/nonshock DHF and severe dengue versus nonsevere dengue, with CRP cutoff level 30.1 mg/L (area under the receiver operating characteristic curve (AUC), 0.938; 100% sensitivity, 76.3% specificity) and 24.2 mg/L (AUC, 0.717; 70% sensitivity, 71.3% specificity), respectively. Our study highlights the utility of the CRP levels in early prediction of DSS and severe dengue in adult patients. [ABSTRACT FROM AUTHOR]

The particle size distributions and leaching characteristics of polybrominated diphenyl ethers (PBDEs) in the bottom ashes of two Taiwanese municipal solid waste incinerators (MSWIs A and B) were investigated to evaluate PBDE leaching into the environment through reutilization of bottom ashes. The PBDE contents in the bottom ashes of the MSWIs (29.0-243 ng/g) could be two orders higher than those in rural and urban soils. The PBDE fraction of the bottom ashes was more distributed in larger particles (> 0.25 mm). Similar trends were found for the PBDE contents in the bottom ashes and their PBDE leaching concentrations, revealing that the elevated PBDE contents in the bottom ashes may lead to a higher PBDE leaching mass. The leaching of PBDEs is attributed to diffusion driven by the concentration gradient and effective surface area. The normalized leaching ratios (NLRs) of PBDEs for the bottom ashes of the MSWIs are about four orders greater than those of PBDE-related raw materials and products, and this may be due to their porous structures having much greater effective surface area. The elevated NLRs of PBDEs thus deserve more attention when bottom ashes are recycled and reutilized as construction materials. [ABSTRACT FROM AUTHOR]

Abstract: In this study, ambient air samples from different atmospheric environments were examined for both PBDE and PCDD/F characteristics to verify that combustion is a significant PBDE emission source. The mean±SD atmospheric PBDE concentrations were 165±65.0pgNm−3 in the heavy steel complex area and 93.9±24.5pgNm−3 in the metals complex areas, 4.7 and 2.7 times higher than that (35.3±15.5pgNm−3) in the urban areas, respectively. The statistically high correlation (r =0.871, p <0.001) found between the atmospheric PBDE and PCDD/F concentrations reveals that the combustion sources are the most likely PBDE emission sources. Correspondence analysis shows the atmospheric PBDEs of the heavy steel and metals complex areas are associated with BDE-209, -203, -207, -208, indicative of combustion source contributions. Furthermore, the PBDEs in urban ambient air experience the influence of the evaporative releases of the commercial penta- and octa-BDE mixtures, as well as combustion source emissions. By comparing the PBDE homologues of indoor air, urban ambient air, and stack flue gases of combustion sources, we found that the lighter brominated PBDEs in urban ambient air were contributed by the indoor air, while their highly brominated ones were from the combustion sources, such as vehicles. The developed source identification measure can be used to clarify possible PBDE sources not only for Taiwanese atmosphere but also for other environmental media in other countries associated with various emission sources in the future. [Copyright &y& Elsevier]

Over the past few decades, Taiwan has seen striking improvements in the life expectancy of its 400 registered β-thalassemia major (β-TM) patients due mainly to adequate transfusion regimens and effective iron chelation therapy. Since 1995, Taiwanese citizens have enjoyed universal health care through National Health Insurance (NIH), receiving comprehensive treatment at minimal cost. In 1984, a national program for thalassemia prevention, control, and hematopoietic stem cell transplantation (HSCT) was initiated. Recent data show 1- and 2-year event-free survival rates of 85 and 78%, respectively. Chelation agents like deferoxamine (DFO), deferiprone (L1) and deferasirox (DFRA) are available in Taiwan, and therapy is tailored to individuals based on drug availability and tissue distribution of iron load. Intensive chelation regimens combining L1 and DFO are recommended in patients with cardiac complications, while DFRA has been found to be effective in reducing serum ferritin, with acceptable side effects. Here, we report advances in thalassemia treatment in Taiwan and suggest treatment guidelines. [ABSTRACT FROM AUTHOR]

Background/purpose: Nurses in emergency departments are high-risk groups who are most likely to experience the offense of violent behaviors. In a comparison on the occurrence of verbal and physical abuses in emergency departments, this study aimed to analyze the correlation of staff properties and occupational conditions in an attempt to provide a reference on violence prevention.Methods: Eleven hospitals in southern Taiwan were selected and a survey of 267 nurses was conducted. The results were analyzed by percentage, Pearsons chi2 test and logistic regression.Results: The 236 valid questionnaires showed that nurses experienced significantly more verbal abuse (92%) than physical abuse (30%). The highest occurrence of verbal abuse was 49% in night shift, and the physical abuse was 44% in overnight shift. Long waiting (89%), difference in cognition (87%), and lack of communication (82%) were the common causes. The occurrences of verbal abuse and physical abuse were significantly correlated to less-informed (odds ratio [OR], 1.67 and 1.22, respectively) and basic-level nurses (OR, 2.30 and 1.34, respectively). In addition, younger age (OR, 2.80; p < 0.01) and single status (OR, 9.09; p <0.05) were correlated with occurrence of verbal abuse, but not of physical abuse. The test on occupational conditions showed a significant correlation (OR, 0.68/0.44; p < 0.005) between the occurrence of verbal/physical abuse and whether supervisors could provide enough training to cope with violence.Conclusion: This study suggested that a well-informed nurse should be arranged to take the night/overnight shifts in order to reduce the occurrence of abuses in emergency departments. [ABSTRACT FROM AUTHOR]

Deferiprone (L1) has been recommended as an effective oral chelation therapy for patients with ß-thalassemia major (TM). From 1999 to 2004, 114 patients with TM from five treatment centers were enrolled in this program: iron (Fe) was chelated with L1 in 57 patients, deferoxamine (DFO) in 26, and combined L1/DFO therapy in 31. We found that serum ferritin (SF) was significantly lower in nine patients receiving L1 for more than 5 years ( p = 0.04), 22 patients receiving L1 for 1–2 years ( p [ABSTRACT FROM AUTHOR]

Microplastic (MP) pellets were sampled from six sandy beaches around Taiwan in order to investigate the concentrations and compositions of POPs, including: PCDD/Fs, PBDD/Fs, PBDEs, PCBs, PBBs, and their congeners. The concentrations of PCDD/Fs on the surface (C s) of MP pellets from the six sampling sites were from 1.9 to 14.6 pg∙g−1, while the overall concentrations within MPs (C t) were from 95.0 to 1110.6 pg∙g−1. As PCDD/Fs were adsorbed into the inner part of MPs, a ratio of the total concentrations to surficial concentration of MPs (C t /C s) was as high as 355.2 times. The C t /C s of other POPs were also significant, such as PBDEs being found up to 8068 times, which could be attributed to artificial addition during manufacturing processes as flame-retardant substances. Primary compositions of PCDD/Fs, PBDD/Fs, and PBDEs on the MPs in our POP congener analysis were all found containing species with higher number of chlorine or bromine, which were adsorbed on the MP surface more easily due to their relative higher K OW. [Display omitted] • POPs could reach to the inner part of the pellets via diffusional transport mechanism. • The ratio of overall to surficial concentration of PCDD/Fs in microplastic pellets was found as high as 355.2 times. • The Ct/Cs ratio for PBDEs was up to 8069 times, possibly due to artificial addition as flame retardant. • Congeners with higher numbers of Cl or Br were generally easily adsorbed on the surface of microplastics. [ABSTRACT FROM AUTHOR]

Evaluating the efficacy of air pollution control policies is an essential part of the decision-making process to develop new policies and improve existing measures. Since 2005, Fujian Province of Mainland China and Taiwan across the Taiwan Strait have both implemented aggressive air pollution control policies designed based on different principles, but a comprehensive evaluation of these control policies on PM 2.5 pollution levels is still lacking. In the current study, we assessed the effects of these policies in the Taiwan Strait Region from 2005 to 2018 using full-coverage, high-resolution PM 2.5 generated by a satellite-driven machine learning model. A ten-fold cross-validation for our prediction model showed an R 2 value of 0.89, demonstrating that these predictions can be used for policy evaluation. During the 14-year period, PM 2.5 levels in all areas of Fujian and Taiwan underwent a significant decrease. Separate regression models for policy evaluation in Taiwan and Fujian showed that all considered policies have mitigated PM 2.5 pollution to various degrees. The Clean Air Action Plans (CAAP) is the most effective control policy in Taiwan, while the Action Plan of Air Pollution Prevention and Control (APPC-AP) and Three-year Action Plan for Blue Skies (3YAP-BS) as well as their provincial implementation plans are the most successful in Fujian. The effectiveness of control policies, however, varies by land-use types especially for Taiwan. • PM 2.5 levels were estimated in the Taiwan Strait Region at 1-km resolution from 2005 to 2018 • The most effective control policies to lower PM 2.5 levels in Taiwan and Fujian were analyzed • The effectiveness of control policies varies by land use type in Taiwan [ABSTRACT FROM AUTHOR]

While the sources of releasing dioxins have received much attention, the health risks of incinerators are studied considerably more than those of other sources, such as metallurgical industry. Furthermore, risk assessments focus primarily on the effects of single sources; few have addressed the aggregate risks from multiple sources in a region. When many sources of dioxins exist in an area, such as the Industrial Park located in the densely populated district—Siaogang District in southern Taiwan where 17 primary known PCDD/F stationary emission sources are clustered, is the aggregate exposure to these sources imposing high risks even though individual sources comply with emission standards? The study combined the multimedia and multiple pathway exposure modeling and site-specific exposure scenario to assess dioxin risks contributed by the 17 emission sources in the District, including municipal waste incinerators, medical waste incinerators, sinter plants, electric arc furnace, secondary aluminum smelters, cement kilns, etc. The average cancer risk of a resident living in the District was found to be 3.43E−04 under the site-specific exposure scenario. The top emission source is the sinter plant, followed by the electric arc furnace. The information has driven the local government to conduct more complete assessment and at the same time to consider enforcing a stricter local standard of dioxin emissions in the Siaogang District. [Copyright &y& Elsevier]

This study set out to identify possible PCDD/F emission sources for different atmospheric environments in a highly industrialized city located in southern Taiwan. We collected stack flue gas samples from five main stationary emission sources of the municipal solid waste incinerators (MSWIs), medical waste incinerators (MWls), electric arc furnaces (EAFs), secondary aluminum smelters (ALSs), and sinter plants to assess the characteristics of their PCDD/F emissions. For mobile sources, congener profiles reported in U.S. EPA's database for unleaded gas-fueled vehicles (UGFV) and diesel-fueled vehicles (DFV) were directly adopted owing to lack of local data. The congener profiles of the 2,3,7,8-substituted PCDD/Fs were selected as the signatures of these PCDD/F emission sources. We conducted PCDD/F samplings on atmospheric environments of four categories, including background, residential area, traffic area, and industrial area. Through PCA and cluster analyses, we found that traffic areas were most influenced by PCDD/F emissions from UGFV and DFV, while those of industrial areas were mainly influenced by metallurgical facilities and MWIs. The above results were further examined by using the methodology of the indicatory PCDIJ/Fs. We confirmed that traffic areas were contributed by traffic sources, but industrial areas were simply affected by metallurgical facilities rather than MWIs. In conclusion, besides the use of PCA and cluster analyses, the methodology of the indicatory PCDD/Fs should be conducted for further validation in order to prevent misjudgment [ABSTRACT FROM AUTHOR]

Mercury (Hg) is a toxic metal known to be detrimental to human health and wildlife survival due to its serious toxicity to the central nervous system. In this study, measurements of atmospheric mercury in Taiwan over three years suggested significantly higher total Hg concentrations (p < 0.001) during the dry season compared with the wet season for both urban and industrial sites, indicating that precipitation played a role through scavenging Hg. Total gaseous mercury (TGM) was the main component in air accounting for >90% of the total Hg, which included particulate mercury (Hg p). Furthermore, extreme Hg concentrations were observed at sites near cement works (TGM: 18 ng m−3; Hg p : 913 pg m−3) and iron-steel plants (TGM: 24.3 ng m−3; Hg p : 871 pg m−3), indicating a strong role for these two stationary emission sources to Hg concentrations in ambient air. This study contributes to improved understanding of atmospheric mercury speciation and concentrations near iron-steel plants and cement works. [Display omitted] • Higher Hg concentrations were measured during dry season than wet season. • TGM was the dominant species accounting for >90% of the total Hg. • Extreme concentrations were measured nearby cement works and iron-steel plants. [ABSTRACT FROM AUTHOR]

Abstract: This study investigates the atmospheric occurrence of persistent organic pollutants (POPs) over the Pacific Ocean near southern Taiwan and the northern Philippines. We determined sixty-six compounds, including polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), dioxin-like polychlorinated biphenyls (DLPCBs), polybrominated diphenyl ethers (PBDEs), as well as polychlorinated diphenyl ethers (PCDEs), polybrominated dibenzo-p-dioxins and dibenzofurans (PBDD/Fs), and polybrominated biphenyls (PBBs), in air samples simultaneously collected from the offshore oceanic atmosphere (n=6) and over a rural area (n=2). We calculated the atmospheric World Health Organization 2005 toxic equivalency levels (WHO2005-TEQ), for the total dioxin-like POPs, including PCDD/Fs, DLPCBs, and PBDD/Fs, being 0.00612pg WHO2005-TEQ/m3 and 0.0138pg WHO2005-TEQ/m3 over the ocean and land, respectively. We found unexpected lower averaged atmospheric PBDE concentrations in the rural area (15.9pg/m3) than over the ocean (31.1pg/m3) due to higher levels of the BDE209 congener, although the difference was not statistically significant. We have compared and reported our field results with previously published datasets over the global oceans, which suggest PCBs and PBDEs are the dominant chemical contaminants in the global oceanic atmosphere among these halogenated POPs (e.g. PCBs and Σdi-hepta PBDEs could be found in the range of 0.09–48.7 and 8.07–94.0pg/m3, respectively, including our dataset). However, there are still very few investigations on the global atmospheric levels of PBDD/Fs, PCDEs and PBBs and our data sums to these earlier studies. Finally, we point out that the halogenated POPs originated from Taiwan or the continental East Asia which could easily reach remote ocean sites via atmospheric transport. [Copyright &y& Elsevier]

We measured the concentrations of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) from the flue gas and the ambient atmosphere of a power plant fueled by heavy oil in northern Taiwan. The mean emission concentration and I-TEQ concentration of total PCDD/Fs were 0.292ng/Nm3 and 0.016ng I-TEQ/Nm3, respectively. All PCDD/F emission concentrations in the flue gas were supposed to meet the Environmental Protection Administration Executive Yuan, R.O.C. standard (1.0ng I-TEQ/Nm3 from 2008). Furthermore, the mean I-TEQ concentration in the ambient atmosphere was 0.011pg I-TEQ/Nm3, which was much lower than the environmental quality standards for dioxins in Japan (0.6pg TEQ/Nm3). Also, the PCDD/F emission factor was 0.188ng I-TEQ/L fuel, which was comparable to the data issued in US EPA [EPA, Locating and estimating air emissions from sources of dioxins and furans, Office of Air Quality Planning and Standards, Research Triangle Park, NC, DCN No. 95-298130-54-01, 1997] (0.2ng I-TEQ/L of fuel). Also, the result of the correlations of PCDD/Fs and operational parameters illustrated that the positively significant correlation (r =0.502, p =0.048) was found only between PCDD/Fs (I-TEQ) and the flue gas emission temperature (125–157°C). However, PCDD-TEQ/PCDF-TEQ ratios were statistically significantly associated with the decreased flue gas flow (r =−0.659, p =0.006), moisture (r =−0.612, p =0.012) and flue gas temperature (r =−0.503, p =0.047). For proper environmental management of dioxins, it is necessary to establish a complete emission inventory of PCDD/Fs, and, in particular, the government should pay more attention to power plants to address the information shortage. [Copyright &y& Elsevier]

Abstract: Thermal treatment technology was used to remove polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) from heavily contaminated soil. For a soil with an original PCDD/F content of 35,970ng International Toxic Equivalents (I-TEQ)/kg, >99.99% PCDD/F removal efficiency was obtained with a primary furnace at two different treatment temperatures (750°C and 850°C), while a secondary furnace at 1200°C gave >98% decomposition efficiency. The total PCDD/F I-TEQ contents in treated soils at 750°C and 850°C were 1.56ngI-TEQ/kg and 2.15ngI-TEQ/kg, respectively, which were far below the soil pollution standard of Taiwan (1000ngI-TEQ/kg soil). Although air pollution control devices had significant effects on the removal of PCDD/Fs, the total I-TEQ concentrations in the upstream flue gas of PUF cartridge at 750°C and 850°C (2.61ngI-TEQ/Nm3 and 2.38ngI-TEQ/Nm3, respectively) were still higher than the stationary emission limit of the Taiwan EPA (0.5ngI-TEQ/Nm3). The above results also suggested that additional APCDs, such as activated carbon injection in front of the filter are needed to enhance PCDD/F removal efficiency. [Copyright &y& Elsevier]

Atopic dermatitis (also known as atopic eczema) is a chronic relapsing inflammatory skin disease commonly seen in children, with increasing prevalence over the past few decades in many countries including Taiwan. The management of pediatric atopic dermatitis can be challenging, particularly as treatment options are expanding with the emergence of novel systemic and topical anti-inflammatory medications in recent years. The Taiwan Academy of Pediatric Allergy, Asthma and Immunology (TAPAAI) has developed the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis, which provides a concise overview of its epidemiology, clinical characteristics and diagnosis, mechanisms, treatments, and education. The contents of this guideline integrate the principles of recent national and international guidelines for the diagnosis and management of atopic dermatitis, latest research findings, and expert opinions of experienced pediatric allergy specialists in Taiwan. For practical purposes, this guideline presents simplified and easy-to-use diagnostic criteria and severity grading for pediatric atopic dermatitis. A stepwise treatment algorithm is also proposed to expedite rational, cost-effective, and evidence-based management strategy. This guideline, developed based on current best evidence and real-world experience of pediatric allergy experts in Taiwan, is intended to facilitate practical, up-to-date management of pediatric atopic dermatitis among physicians., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2022. Published by Elsevier B.V.)

Improvement in outcomes of children with acute myeloid leukemia (AML) is attributed to several refinements in clinical management. We evaluated treatment outcomes of Taiwanese pediatric AML patients in the past 20 years. Overall, 860 de novo AML patients aged 0-18 years and registered in the Childhood Cancer Foundation of R.O.C during January 1996-December 2019 were included. Survival analysis was performed to identify factors that improved treatment outcomes. Regardless of treatment modalities used, patients during 2008-2019 had better 5-year event-free survival (EFS) and overall survival (OS) rates than patients during 1996-2007. For patients received the TPOG-AML-97A treatment, only 5-year OS rates were significantly different between patients diagnosed before and after 2008. Patients with RUNX1-RUNX1T1 had similar relapse-free survival rates, but 5-year OS rates were better during 2008-2019. However, the survival of patients who received hematopoietic stem-cell transplantations (HSCT) did not differ significantly before and after 2008. For patients without relapse, the 5-year OS improved during 2008-2019. Non-relapse mortality decreased annually, and cumulative relapse rates were similar. In conclusion, 5-year EFS and OS rates improved during 2008-2019, though intensities of chemotherapy treatments were similar before and after 2008. Non-relapse mortality decreased gradually. Further treatment strategies including more intensive chemotherapy, novel agents' use, identification of high-risk patients using genotyping and minimal residual disease, early intervention of HSCT, and antibiotic prophylaxis can be considered for future clinical protocol designs in Taiwan.

The COronaVIrus Disease 2019 (COVID-19), which developed into a pandemic in 2020, has become a major healthcare challenge for governments and healthcare workers worldwide. Despite several medical treatment protocols having been established, a comprehensive rehabilitation program that can promote functional recovery is still frequently ignored. An online consensus meeting of an expert panel comprising members of the Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation was held to provide recommendations for rehabilitation protocols in each of the five COVID-19 stages, namely (1) outpatients with mild disease and no risk factors, (2) outpatients with mild disease and epidemiological risk factors, (3) hospitalized patients with moderate to severe disease, (4) ventilator-supported patients with clear cognitive function, and (5) ventilator-supported patients with impaired cognitive function. Apart from medications and life support care, a proper rehabilitation protocol that facilitates recovery from COVID-19 needs to be established and emphasized in clinical practice., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest relevant to this article., (Copyright © 2020. Published by Elsevier B.V.)

Background: The association between Helicobacter pylori ( H. pylori ) infection and the risk of developing irritable bowel syndrome (IBS) has yet to be investigated; thus, we conducted this nationwide cohort study to examine the association in patients from Taiwan., Methods: A total of approximately 2669 individuals with newly diagnosed H. pylori infection and 10,676 age- and sex-matched patients without a diagnosis of H. pylori infection from 2000 to 2013 were identified from Taiwan's National Health Insurance Research Database. The Kaplan-Meier method was used to determine the cumulative incidence of H. pylori infection in each cohort. Whether the patient underwent H. pylori eradication therapy was also determined., Results: The cumulative incidence of IBS was higher in the H. pylori-infected cohort than in the comparison cohort (log-rank test, p < 0.001). After adjustment for potential confounders, H. pylori infection was associated with a significantly increased risk of IBS (adjusted hazard ratio (aHR) 3.108, p < 0.001). In addition, the H. pylori -infected cohort who did not receive eradication therapy had a higher risk of IBS than the non-H. pylori-infected cohort (adjusted HR 4.16, p < 0.001). The H. pylori -infected cohort who received eradication therapy had a lower risk of IBS than the comparison cohort (adjusted HR 0.464, p = 0.037)., Conclusions: Based on a retrospective follow-up, nationwide study in Taiwan, H. pylori infection was associated with an increased risk of IBS; however, aggressive H. pylori infection eradication therapy can also reduce the risk of IBS. Further underlying biological mechanistic research is needed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: Capitellar osteochondritis dissecans (COCD) is a common elbow injury in young baseball athletes. It may be asymptomatic at the early stage and may progress if left untreated. This study investigated the effectiveness of ultrasonography (US) screening for COCD in adolescent baseball players and identified risk factors of COCD., Methods: A cross-sectional analysis study was conducted among baseball athletes aged 12 to 18 years. US screening of the throwing elbow was performed in all participants, and additional magnetic resonance imaging (MRI) was arranged for those with abnormal screening results. The prevalence of COCD was calculated according to MRI results. The US findings were compared with MRI findings. Data for characteristics, joint range of motion, and quality of pain were collected and analyzed using a logistic regression model to identify the risk factors of COCD., Results: A total of 299 adolescent baseball players were screened, and 17 were found to have COCD according to US findings. MRI was performed in 15 of these 17 players, and the MRI findings further confirmed COCD in 10 players (66.7%). The presence of elbow pain while at rest, body height, and age at introduction to baseball were predictors of COCD., Conclusions: Although the effectiveness of diagnosing stage 1 COCD is satisfactory, US is a helpful tool for detecting stage 2 and higher-stage COCD. Elbow resting pain, lower body height, and introduction to baseball at a younger age are risk factors for COCD., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Previous research on baseball pitchers' wrists, elbows, and should joints contributes to our understanding of pitchers' control over delicate joint motion and ball release. However, limited research on forearm, wrist, and hand joints prevents full comprehension of the throwing mechanism. The present descriptive laboratory study quantifies angular performances of hand and wrist joints while pitching breaking balls, including fastballs, curveballs and sliders, among pitchers with different skill levels. Nineteen baseball pitchers performed required pitching tasks (10 from university and 9 from high school). A three-dimensional motion analysis system collected pitching motion data. The range of joint motion in the wrist and proximal interphalangeal (PIP) and metacarpophalangeal (MP) joints of the index and middle fingers were compared among fastballs, curveballs and sliders. Thirteen reflective markers were placed on selected anatomic landmarks of the wrist, middle and index fingers of the hand. Wrist flexion angle in the pitching acceleration phase was larger in fastballs (20.58±4.07°) and sliders (22.48±5.45°) than in curveballs (9.08±3.03°) (p = .001). The flexion angle of the PIP joint was significantly larger in curveballs (38.5±3.8°) than in fastballs (30.3±4.8°) and sliders (30.2±4.5°) (p=.004) of the middle finger. Abduction angle of MP joint on the middle finger was significantly larger in curveballs (15.4 ±3.6°) than in fastballs (8.9±1.2°) and sliders (6.9±2.9°) (p=.001) of the middle finger, and the abduction angle of index finger was significantly larger in sliders (13.5±15.0°) than in fastballs (7.2 ±2.8°) (p=.007). Hand and wrist motion and grip types affect the relative position between fingers and ball, which produces different types of baseball pitches. A larger extension angle of the wrist joint and the coordination of middle and index fingers are crucial when pitching a fastball. Abduction and flexion movement on the MP joint of the middle finger are important for a curveball. MP joint abduction and flexion movement of the index finger produce sliders. Understanding the control mechanism in a throwing hand can help improve training protocols in either injury prevention or performance improvement for baseball pitchers., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Circulation or air conditioning (AC) system was proven to improve the air quality inside the vehicles; however, the quantified study was limited. In this study, fungal concentration under various driving mode inside the vehicle was proposed. The driving conditions were classified into 4 states: (1) window closed without AC and circulation, (2) window open without AC and circulation, (3) window closed with only circulation on, and (4) window closed with only AC on. Results show that at state 4, the mean respirable fraction was 83.3%, with a number median diameter of the fungi being 1.73 μm. More attention should be paid for these smaller fungi easily penetrating into the alveoli and probably lead to allergic alveolitis. Turning on AC for reducing the normalized concentration for each size range of fungi was suggested; however, the respirable fraction increased. Those who are prone to allergies or asthma are suggested to switch between AC and the circulation mode while driving a long time.

Kawasaki disease (KD) is characterized by systemic vasculitis of unknown etiology. High-dose intravenous immunoglobulin (IVIG) is the most effective therapy for KD to reduce the prevalence of coronary artery lesion (CAL) formation. Recently, the α2, 6 sialylated IgG was reported to interact with a lectin receptor, specific intracellular adhesion molecule-3 grabbing nonintegrin homolog-related 1 (SIGN-R1) in mice and dendritic cell-specific intercellular adhesion molecule-3 grabbing nonintegrin (DC-SIGN) in human, and to trigger an anti-inflammatory cascade. This study was conducted to investigate whether the polymorphism of DC-SIGN (CD209) promoter -336 A/G (rs4804803) is responsible for susceptibility and CAL formation in KD patients using Custom TaqMan SNP Genotyping Assays. A total of 521 subjects (278 KD patients and 243 controls) were investigated to identify an SNP of rs4804803, and they were studied and showed a significant association between the genotypes and allele frequency of rs4804803 in control subjects and KD patients (P = 0.004 under the dominant model). However, the promoter variant of DC-SIGN gene was not associated with the occurrence of IVIG resistance, CAL formation in KD. The G allele of DC-SIGN promoter -336 (rs4804803) is a risk allele in the development of KD.

Background: Concerns have been raised about how the transmission of emerging infectious diseases from patients to healthcare workers (HCWs) and vice versa could be recognized and prevented in a timely manner. An effective strategy to block transmission of pandemic H1N1 (2009) influenza in HCWs is important., Methodology/principal Findings: An infection control program was implemented to survey and prevent nosocomial outbreaks of H1N1 (2009) influenza at a 2,600-bed, tertiary-care academic hospital. In total, 4,963 employees at Kaohsiung Chang Gung Memorial Hospital recorded their temperature and received online education on control practices for influenza infections. Administration records provided vaccination records and occupational characteristics of all HCWs. Early recognition of a pandemic H1N1 (2009) influenza case was followed by a semi-structured questionnaire to analyze possible routes of patient contact, household contact, or unspecified contact. Surveillance spanned August 1, 2009 to January 31, 2010; 51 HCWs were confirmed to have novel H1N1 (2009) influenza by quantitative real-time reverse transcription polymerase chain reaction. Prevalence of patient contact, household contact, or unspecified contact infection was 13.7% (7/51), 13.7% (7/51), and 72.5% (37/51), respectively. The prevalence of the novel H1N1 infection was significantly lower among vaccinated HCWs than among unvaccinated HCWs (p<0.001). Higher viral loads in throat swabs were found in HCWs with patient and household contact infection than in those with unspecified contact infection (4.15 vs. 3.53 copies/mL, log(10), p = 0.035)., Conclusion: A surveillance system with daily temperature recordings and online education for HCWs is important for a low attack rate of H1N1 (2009) influenza transmission before H1N1 (2009) influenza vaccination is available, and the attack rate is further decreased after mass vaccination. Unspecified contact infection rates were significantly higher than that of patient contact and household contact infection, highlighting the need for public education of influenza transmission in addition to hospital infection control.

Background: Thomsen-Friedenreich (T) activation in infants with neonatal necrotizing enterocolitis (NEC) has in some cases led to severe hemolysis after transfusions of plasma-containing blood components, causing some authors to advise routine screening for T activation in all infants with NEC. However, no data are available on the frequency of T activation in infants with NEC in Taiwan., Study Design and Methods: We retrospectively reviewed the medical records of 43 infants with NEC managed in our hospital from 2000 to 2007. In all cases, Arachis hypogaea lectin was used to test for T activation., Results: Of the 43 infants, 16 infants (37%) had Stage II and 27 (63%) had Stage III NEC. Four infants had trace T activation, two of whom received transfusions with washed red blood cells (RBCs) and two with unwashed RBCs. None had evidence of hemolysis. The overall mortality in this series was 16% (7/43), but none of the four babies with T activation died., Conclusion: In this series of Taiwanese infants with NEC, weak T activation was present in only 9% (4/43) of infants, and RBC transfusion did not result in hemolysis, regardless of whether washed or unwashed cells were administered. We considered routine screening for T activation and provision of prepared blood components in infants with NEC in Taiwan might be unnecessary., (© 2011 American Association of Blood Banks.)

Background: In this study, we investigated the risk factors for in-hospital mortality of children beyond infancy with and without underlying diseases., Methods: We performed a retrospective review of all deceased patients aged 1-18 years at Chang-Gung Memorial Hospital-Kaohsiung from 2000 to 2009. The patients were divided into two groups; those with and without underlying diseases. Demographic data, clinical characteristics, and initial laboratory data were analyzed to correlate the risk factors for mortality of pediatric patients with and without underlying diseases., Results: A total of 131 deceased children were found from 2000 to 2009. Forty children were previously healthy (without underlying diseases), whereas 91 had previous underlying diseases. Children with cardiovascular or central nervous system (CNS) infections had a significantly greater risk of mortality than did those without underlying diseases (p=0.004 and p=0.0004, respectively). More cardiovascular and fewer hematologic abnormalities at admission were found in patients without underlying diseases. In multiple logistic regression, it was found that cardiovascular (p=0.006) or CNS infections (p=0.012), consciousness change at admission (p=0.013), and higher liver enzyme levels were most significantly associated with deceased children without underlying diseases., Conclusion: Results from this study suggest that mortality in pediatric patients without underlying diseases is most frequently found in younger children with CNS and cardiovascular infections, consciousness change, and high liver enzyme levels at admission. Results from this analysis will provide information for the awareness of fatal outcomes in previously healthy children., (Copyright © 2011. Published by Elsevier B.V.)

Background: the C-type lectin DC-SIGN (CD209) is known to be the major dengue receptor on human dendritic cells, and a single nucleotide polymorphism (SNP) in the promoter region of CD209 (-336 A/G; rs4804803) is susceptible to many infectious diseases. We reason that variations in the DC-SIGN gene might have a broad influence on viral replication and host immune responses., Methods and Findings: we studied whether the rs4804803 SNP was associated with a susceptibility to dengue fever (DF) and/or dengue hemorrhagic fever (DHF) through genotyping analysis in a Taiwanese cohort. We generated monocyte-derived dendritic cells (MDDCs) from individuals with AA or AG genotype of rs4804803 to study the viral replication and immune responses for functional validation. A total of 574 DNA samples were genotyped, including 176 DF, 135 DHF, 143 other non-dengue febrile illnesses (OFI) and 120 population controls. A strong association between GG/AG genotypes of rs4804803 and risk of DHF was found when compared among DF, OFI and controls (p = 0.004, 3×10(-5) and 0.001, respectively). The AA genotype was associated with protection against dengue infection compared with OFI and controls (p = 0.002 and 0.020, respectively). Moreover, MDDCs from individuals with AG genotype with a higher cell surface DC-SIGN expression had a significantly higher TNFα, IL-12p40, and IP-10 production than those with AA genotype in response to dengue infection. However, the viral replication in MDDCs with AG genotype was significantly lower than those with AA genotype. With both genotypes, MDDCs revealed an increase in viral replication following the addition of anti-IP-10 neutralizing antibody., Conclusions/significance: the rs4804803 SNP in the CD209 promoter contributed to susceptibility to dengue infection and complication of DHF. This SNP with AG genotype affects the cell surface DC-SIGN expression related to immune augmentation and less viral replication.

Pandemic (H1N1) 2009 virus causes severe illness, including pneumonia, which leads to hospitalization and even death. To characterize the kinetic changes in viral load and identify factors of influence, we analyzed variables that could potentially influence the viral shedding time in a hospital-based cohort of 1,052 patients. Viral load was inversely correlated with number of days after the onset of fever and was maintained at a high level over the first 3 days. Patients with pneumonia had higher viral loads than those with bronchitis or upper respiratory tract infection. Median viral shedding time after the onset of symptoms was 9 days. Patients <13 years of age had a longer median viral shedding time than those >or=13 years of age (11 days vs. 7 days). These results suggest that younger children may require a longer isolation period and that patients with pneumonia may require treatment that is more aggressive than standard therapy for pandemic (H1N1) 2009 virus.

From 1990 to 2004, there were 23 consecutive patients with hepatoblastoma treated at Mackay Memorial Hospital in Taipei, Taiwan. There were 7 patients of stage I, 3 of stage II, 13 of stage III, and none had stage IV disease. Two siblings had congenital hepatoblastoma and both survived. Two patients were prematurity. Beckwith-Wiedemann syndrome, isosexual precocity, chronic B hepatitis presented in 1 patient each. In addition to surgery, we used cisplatin 90 mg/m/d on day 1 and epirubicin 25 mg/m/d for days 1 to 3 as first-line chemotherapy. Each course was repeated every 3 weeks. Epirubicin was chosen because of its lower cardiotoxicity. Carboplatin/etoposide and vincristine/cyclophosphamide/5-fluorouracil were the second-line chemotherapy for considering cumulative toxicity of first-line chemotherapy. If initial total excision was feasible, postoperative chemotherapy of 4 to 6 courses were given. Three patients died of progressive disease, infection, and relapse 1 each. The median duration of follow-up for 20 survived patients was 94 months. The 5-year event-free and overall survival rates were 73.9%+/-9.2% (SE) and 87%+/-7.0%, respectively. Tumor recurred in 5 patients. The commonest toxicity was febrile neutropenia. There was no cardiotoxicity event. In conclusion, with sequential combination of surgery and chemotherapy, the treatment results for hepatoblastoma were satisfactory as compared with other groups.

Background: Acute urticaria is a common and disturbing disorder in children and has a versatile etiology., Objective: To investigate the association of acute urticaria with Mycoplasma pneumoniae infection in hospitalized children., Methods: Hospitalized children with acute urticaria from Taiwan who did not respond to antihistamine treatment and avoidance of food allergens were studied from February 1, 2006, to July 31, 2007. These patients with urticaria were compared with those who had other respiratory tract diseases and were classified into 2 groups: urticaria patients with and without M pneumoniae infection. The presence of M pneumoniae infection was determined by positive serologic findings., Results: Sixty-five patients with acute urticaria and 49 patients with other respiratory tract diseases were enrolled in this study. Patients with urticaria had significantly less febrile duration but significantly higher platelet and lymphocyte counts than those with other respiratory tract diseases. Of the 65 patients with urticaria, 21 (32%) showed serologic evidence of M pneumoniae infection. Patients with M pneumoniae-associated urticaria received azithromycin treatment and needed a shorter time for improvement (P = .01) and complete resolution (P = .04). The total IgE levels and the results of specific IgE tests were not significantly different between urticaria patients with and without M pneumoniae infection., Conclusion: This study found that in Taiwan one-third of acute childhood urticaria leading to patient hospitalization was related to M pneumoniae infection. Therefore, children with urticaria who are not responding to antihistamine treatment and abstinence from food allergens should be encouraged to undergo serologic examinations for M pneumoniae to diagnose this antibiotic-responsive disorder.

Background: Autoimmune neutropenia in children is caused by granulocyte-specific autoantibodies. These antibodies react to the patient's own neutrophils but disappear when the neutropenia spontaneously remits. This study reviewed our experience with autoimmune neutropenia in children and investigated possible associations with HLA-DR and HLA-DQ alleles., Study Design and Methods: From 1993 to 2006, our laboratory received 155 blood samples from children with neutropenia. Of these samples, 55 had granulocyte-specific autoantibodies on the indirect granulocyte immunofluorescence test. As the children had no other disorders associated with neutropenia, they were diagnosed with primary autoimmune neutropenia. HLA-DRB1 and -DQB1 allele typing was performed in 31 cases, and the results were compared with those of 190 normal healthy unrelated Taiwanese controls., Results: The mean ages of onset and resolution of neutropenia were 9.8 months (median, 9.0 months; range, 4-28 months) and 22.5 months (median, 20.0 months; range, 13-44 months), respectively. The male-to-female ratio was 1.2:1. The mean absolute neutrophil count was 190 per microL (standard deviation, 213/microL). Most patients (74%) had antibodies against HNA-1a. Autoimmune neutropenia in children in Taiwan was significantly associated with HLA-DQB1*0503 (odds ratio, 6.48; p = 0.0002; p(c) = 0.003) allele., Conclusion: In Taiwan, autoimmune neutropenia in children is associated with HLA-DQB1*0503. The autoantibody in autoimmune neutropenia is most commonly anti-HNA-1a.

In this study, municipal solid waste incinerator fly ash was vitrified using a plasma torch. The fly ash contained rich Ca, causing a high basicity of 2.43. Pure quartz was used as an additive to adjust the basicity. BET surface area analysis, X-ray diffraction analysis, and a scanning electron microscope were used to examine the physical properties of slags. The chemical stability and the acid resistance of slags were evaluated using the toxicity characteristics leaching procedure and tests of acid bathing. The results indicate that the plasma torch effectively vitrified the fly ash. Anthropogenic metals with low boiling points, such as Cd, Pb, and Zn, were predominately vaporized into flue gas. Most of the metals with high boiling points, such as Cr, Cu, and Mn, remained in the slag. After the vitrification, hazardous metals were noticeably immobilized in all slags. However, the slags with higher amorphous volume fractions were more effective in metal immobilization and in resisting acid corrosion. This indicates that SiO(2) enhanced the formation of the glassy amorphous phase and improved the resistance of acid corrosion and the immobilization of hazardous metals.

BTX (benzene, toluene and xylene) degrading bacteria were isolated from Pacific Ocean sediment and nearshore surface water. In the seawater near a ferry dock, degrading bacteria of a relatively wide diversity were detected, including species of Pseudomonas, Rhodococcus, Exiguobacterium and Bacillus; while species of Bacillus only have been detected from the deep-sea sediment. Most of the isolates showed degradation to more than one compound. Generally better growth was obtained with p-xylene and ethylbenzene than with the other two. All the bacteria could tolerate and grow with the compounds at 5-20% (v/v). Both benzene and toluene degradation related genes had been successfully PCR cloned from the isolates of nearshore water, the detected benzene dioxygenase gene was identical among all the species and close to its soil counterpart. However, they were not detected in all the isolates from deep sea. Results in this report suggested that BTX degrading bacteria widely spread in marine environments and they might be of potentials in biotreatment of BTEX in saline environments.

From November 1, 1995 to July 31, 2004, 49 children with de novo acute myeloid leukemia (AML) were treated at our institution. One patient who was treated by a different protocol was excluded. In total, 48 patients with de novo AML were enrolled in this study. Forty-two patients with AML other than acute promyelocytic leukemia (non-APL) were treated consecutively with 2 novel protocols: Mackay Memorial Hospital (MMH)-AML-96, designed as a pilot phase, and Taiwan Pediatric Oncology Group (TPOG)-AML-97A, on the basis of MMH-AML-96 with minor modifications. Six patients with APL were treated consecutively with 2 protocols, TPOG-APL-97 and APL-2001. As of July 31, 2006, the remission rates were 79%, 92%, and 98% after 1, 2, and 3 courses of induction therapy, respectively. The 5-year overall survival was 64%+/-6.9% (SE), and the 5-year event-free survival was 60%+/-7.1%; for non-APL AML, the rates were 62%+/-7.5% and 59%+/-7.6%; for APL, 83+/-15.2 and 67+/-19.3%. Among the factors analyzed, a complete remission achieved after 1 course of induction therapy, lactate dehydrogenase <500 IU/L at diagnosis, patients without invasive fungal infection during chemotherapy, and male sex were associated with a favorable outcome.

As yet, very little is known about the polybrominated dibenzo-p-dioxins and dibenzofurans (PBDD/Fs) characteristics in the stack flue gases of incinerators. In this study, nine large-scale continuous municipal solid waste incinerators (MSWIs), two small-scale batch MSWls, and nine industrial waste incinerators (IWIs) were investigated for 2,3,7,8-substituted PBDD/Fs. The elevated PBDD/F concentrations (18.2 pg/Nm3, 4.17 pg TEQ/Nm3) of the IWIs, which were eight times higher than those of MSWIs (2.28 pg/Nm3, 0.557 pg TEQ/Nm3), are accompanied by PCDD/ Fs that are in the same range as those measured from MSWIs (0.0171-1.98 ng I-TEQ/Nm3). The obtained TEQ ratios (in percentage) of the PBDD/F to the PCDD/F concentration in the stack flue gases of the MSWls (0.72%), batch MWIs (0.18%), and IWIs (5.4%) are useful for the future estimate of PBDD/F emission quantity based on the well-established PCDD/F inventory. In addition, a significantly high correlation was found between the PBDD/F and PCDD/F concentrations, and the PBDD/F and PCDD/F congener profiles of the same emission source were similar, indicating a similar formation and substitution mechanism of bromine and chlorine in the combustion system.

In a study comparing the virus load and immune reaction between patients with primary and secondary dengue-2 (DEN-2) infections in a hospital-based analysis, we found that 40.7% (55/135) of the 135 patients had secondary DEN-2 infection following a DEN-2 outbreak in southern Taiwan. Most of the secondary infections had subclinical primary dengue infections (78.2%; 43/55). Patients with secondary DEN-2 infections had lower platelet counts, and blood interferon-alpha and virus load, but significantly higher interleukin-10 (P=0.030) and anti-DEN-1 neutralization titers (P=0.013) than those with primary infection. Patients with secondary DEN-2 infection also had a higher rate of dengue hemorrhagic fever (DHF) (61.7% vs. 36.3%). A previous subclinical dengue infection is involved in the secondary DEN-2 infection associated with altered immune reaction and higher DHF rate, but lower blood virus load.