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Teenage pregnancy is a major public health concern. However, few studies have investigated the relationship between pediatric bipolar disorder and early pregnancy, and whether bipolar disorder medications reduce the risk of early pregnancy remains unknown. In total, 3218 adolescent girls with bipolar disorder and 32,180 controls matched for age, family income, residence, and time of enrollment were enrolled in this study from 2001 to 2009. Early pregnancy, defined as pregnancy occurring in patients younger than 20 years old, was identified during the follow-up period from enrollment until the end of 2011. After adjustment for demographic data, psychiatric comorbidities, and bipolar disorder medications, adolescent girls with bipolar disorder had 20 times the risk of early pregnancy (hazard ratio [HR] = 20.63, 95% confidence interval [CI] [15.68, 27.16]) and about 25 times the risk of repeated early pregnancy (HR = 24.59, 95% CI [15.20, 39.78]) compared with those without bipolar disorder. Long-term use of both mood stabilizers (HR = 0.34, 95% CI [0.23, 0.52]) and atypical antipsychotics (HR = 0.32, 95% CI [0.20, 0.51]) was associated with a reduced risk of early pregnancy. Bipolar disorder was associated with an increased risk of early pregnancy in adolescent girls. Bipolar disorder medications reduced this risk. The results suggest that interventions targeting the vulnerable population of adolescent girls with bipolar disorder are warranted to prevent early pregnancies. [ABSTRACT FROM AUTHOR]

Outlying islands are affected by the environment and economy, and fishery resources are the first to experience these impacts. Therefore, it is necessary to actively and effectively transform traditional fisheries in outlying islands. This is the case in Penghu County (Penghu Islands), located on the outlying islands of Taiwan. The transformation to recreational fishery can increase the additional income of traditional fisheries during the fishing moratorium through the development of recreational fishery boats by fishermen. Recreational fishery means the fishery using fishing vessels for recreational purposes or for passengers to harvest aquatic organisms on the reef or to engage in sightseeing on the islets. Therefore, this study will explore the key factors for the successful route planning of fishermen who switch to recreational fishery boats to assist the fishermen in successfully transitioning and enabling recreational fishery to flourish. In the research, using the method of the Analytic Hierarchy Process (AHP) expert questionnaire, it was found that the key factors affecting the route planning of recreational fishery boats are "boat conditions", "berthing conditions", "operating environment", and "sightseeing potential". After the expert questionnaire, a weight comparison of each level was performed, and it was found that "operating environment" was the most important factor, followed by "tourism potential". However, the key factors of the "natural environment" and "cultural environment" are more important under the influence of the "operating environment". Under the influence of "tourism potential", "attractiveness" is a key factor, as is the "accessibility" factor. In this study, the four main fishing ports in Penghu County were also used for empirical discussion. The study results showed that Magong Fishing Port was the first choice for transformation, followed by Chikan Fishing Port. The results of this study can be used as a reference for fishermen and officials in developing a subsidy scheme for fishing boat operation, and they can be used as a reference for transforming traditional fisheries in outlying islands into recreational fishing to develop recreational fishery boats and leisure tourism industries. This research can help fishermen to attach importance to the development of recreational fishing activities and promote the stable growth of the fishery industry environment. [ABSTRACT FROM AUTHOR]

Taiwan currently faces an aging population and an increased mortality rate caused by cardiovascular disease. Therefore, preventing cardiovascular disease and constantly tracking people's physiological conditions are very important. Photoplethysmography (PPG) can be used to instantaneously monitor and measure the physiological information of each person. Compared with using electrocardiography, measurement using PPG is less expensive and more convenient. However, PPG has high susceptibility to motion artifacts. To analyze the physiological information in PPG signals with higher accuracy, the negative effects of motion artifacts on PPG signals must first be eliminated. In this study, the independent components of PPG signals were separated by independent component analyses (i.e., of the PPG noises and signals) to separate raw signals from motion artifacts. Subsequently, the PPG signals contained in the independent components were selected and the frequency spectrum was used to analyze the locations of the PPG signal components. Next, to eliminate motion artifacts, a multi-bandpass filter that the raw signals could pass through was specifically designed for this study. In our experiment, motion artifacts were created using two types of finger movements: random finger shaking and rapid finger shaking. In this study, research results included the waveforms of the filtered PPG signals in the frequency and time domains, independent ingredients after the separation of independent components, and the measurements of the heart rate. [ABSTRACT FROM AUTHOR]

Milkfish, Chanos chanos, is one of the major inland cultured fish species in Taiwan. Variations in land resources and climate have led to the application of two distinct culture practices of milkfish polycultures with white shrimp, Penaeus indicus. This study applies a translog cost function model to analyze the production scale economy and input demand price elasticity of four milkfish polyculture systems with two different culture periods (OWC and NOWC) and two different white shrimp–milkfish fry stocking ratios (low SMR: 10–55 fry/ha; high SMR: 56–100 fry/ha). The findings show that the four milkfish polyculture systems require different operational adjustments to increase production while reducing the average culture cost. More specifically, overwinter cultures (OWC) have economies of scale. Farmers may reduce the average cost by expanding the production scale. Non-overwinter polycultures (NOWC) with high SMR are at the stage of decreasing return to scale, meaning that gains in output of milkfish cannot reduce the average cost. In terms of input factor use, farmers of OWC systems with high SMR are sensitive to fluctuations in the fry price since fry constitutes the input factor exhibiting the highest own-price elasticity. Moreover, fry and feed of OWC households with high SMR have high levels of substitutability, whereas fry and other input exhibit substitutability in OWC systems with low SMR. In NOWC farming households with high SMR, fry and capital have substitutability. It is thus recommended to modify the input factor use according to the culture mode and the white shrimp–milkfish stocking density ratio. Moreover, the study found that NOWCs have considerably higher SMR than OWCs, which may lead to a deterioration of the water quality in NOWC fishponds and lower survival rates. It is thus recommended to reduce the SMR to 31:1 to achieve economies of scale in production and increase the survival rate of milkfish and white shrimp. [ABSTRACT FROM AUTHOR]

Taiwan currently faces an aging population and a rise in mortality rate caused by cardiovascular disease. Therefore, the prevention of cardiovascular disease and the constant tracking of physiological information are crucial. Photoplethysmography (PPG) is used to instantaneously measure and monitor a person's physiological information. Compared with electrocardiography, PPG measurements are more convenient and less expensive. However, PPG is more susceptible to the effects of motion artifacts. To accurately analyze the physiological information contained in PPG signals, the negative effects of motion artifacts on PPG signals must first be eliminated. In this study, independent component analysis was employed to separate independent components (i.e., PPG signals and noise) from raw signals with motion artifacts. Subsequently, independent components containing PPG signals were selected and the locations of the PPG signal components in the frequency spectrum were analyzed. Next, the raw signals were passed through a multi-bandpass filter specifically designed for this study to eliminate motion artifacts. Motion artifacts were created for an experiment using two types of finger movements: vertical and horizontal finger movements. From the independent component analysis of the independent components, the waveforms of the filtered PPG signals in the time and frequency domains were acquired, which were then compared with the results of heartbeat measurement. [ABSTRACT FROM AUTHOR]

Purpose: To assess the association between serum testosterone (T) and metabolic syndrome (MS) in different age groups in Taiwanese men. Materials and Methods: Male participants, regardless of age or any underlying disease, were identified from MJ Health Screening Center in Taiwan from 2007 to 2016 for this cross-sectional study. They were divided into three groups according to age, and further classified according to MS diagnosis. Basic patient characteristics with relevant parameters were obtained. One-way ANOVA of mean T values between different numbers of measures that exceeds the cut-off values of MS components was performed to assess the relationship of T and MS. Logistic regression analysis was also used to estimate the risk for MS with each increment in T, age, and BMI. Results: A total of 4,931 men were included. The MS group had significantly lower serum T levels compared to the non-MS group in each age group. The one-way ANOVA found the mean value of T was significantly higher in patients without MS component (6.19± 2.12 ng/mL) than those with 1– 5 MS components (with one MS component: 5.48± 2.13 ng/mL, two MS components: 4.93± 2.03 ng/mL, three MS components: 4.37± 1.60 ng/mL, four MS components: 4.13± 2.89 ng/mL, five MS components: 3.74± 1.27 ng/mL, and P< 0.001). There was no significant difference between the patients with three components and the patients with four or five components. Logistic regression models with age stratification showed T with lower odds ratio (OR) for MS after adjusting for BMI in those ≥ 65 years old (OR=0.693; 95% CI=0.559– 0.858; P< 0.001); 50– 64 years old (OR=0.868; 95% CI=0.802– 0.940; P< 0.001) and < 50 years old (OR=0.810; 95% CI=0.758– 0.865; P< 0.001). Conclusion: Lower serum T was strongly associated with MS, with the predictive value increasing with age in Taiwanese men. [ABSTRACT FROM AUTHOR]

Background: Due to differences in genetic background, it is unclear whether the genetic loci identified by the previous genome-wide association studies (GWAS) of pancreatic cancer also play significant roles in the development of pancreatic cancer among the Taiwanese population. Methods: This study aimed to validate the 25 pancreatic cancer GWAS-identified single nucleotide polymorphisms (SNPs) in a case-control study (278 cases and 658 controls) of pancreatic cancer conducted in Taiwan. Statistical analyses were conducted to determine the associations between the GWAS-identified SNPs and pancreatic cancer risk. Gene-environment interaction analysis was conducted to evaluate the interactions between SNPs and environmental factors on pancreatic cancer risk. Results: Among the 25 GWAS-identified SNPs, 7 (rs2816938 (~ 11 kb upstream of NR5A2), rs10094872 (~ 28 kb upstream of MYC), rs9581943 (200 bp upstream of PDX1) and 4 chromosome 13q22.1 SNPs: rs4885093, rs9573163, rs9543325, rs9573166) showed a statistically significant association with pancreatic cancer risk in the current study. Additional analyses showed two significant gene-environment interactions (between poor oral hygiene and NR5A2 rs2816938 and between obesity and PDX1 rs9581943) on the risk of pancreatic cancer. Conclusions: The current study confirmed the associations between 7 of the 25 GWAS-identified SNPs and pancreatic risk among the Taiwanese population. Furthermore, pancreatic cancer was jointly influenced by lifestyle and medical factors, genetic polymorphisms, and gene-environment interaction. Additional GWAS is needed to determine the genetic polymorphisms that are more relevant to the pancreatic cancer cases occurring in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Carriers of the ALDH2*2 allele have impaired alcohol metabolism and are more susceptible to the development of alcohol‐related cancers, including head and neck cancer (HNC). Screening for ALDH2*2 allele may identify high‐risk individuals for alcohol health education. Although genotyping of ALDH2 is the most accurate way to identify ALDH2 deficiency, it may not be practical due to the cost and requirement for genotyping service. Methods: This study evaluated the accuracy of the alcohol flushing questionnaire to identify ALDH2 deficiency in a case–control study of HNC conducted in Taiwan using data collected from 904 patients with HNC and 1,078 controls. Results: Overall, alcohol flushing questionnaire had a high sensitivity (89%) of identifying ALDH2*2 carriers among the control subjects and a good sensitivity (79%) among the patients with HNC. The sensitivity of the alcohol flushing questionnaire in identifying ALDH2*2 carriers was affected by alcohol use, with a lower sensitivity among individuals who consumed alcohol, particularly among current regular (drinking alcohol once per week or more) alcohol drinkers. Conclusions: The current validation study showed that the alcohol flushing questionnaire may be a reasonable method to identify ALDH2‐deficient individuals. However, current regular users of alcohol who reported no alcohol flushing may need to undergo genotyping of ALDH2 for a more accurate assessment of the ALDH2 status. In this validation study of the alcohol flushing questionnaire with subjects from a hospital‐based case‐control study of head and neck cancerconducted in Taiwan, we found that the alcohol flushing questionnaire had a high sensitivity (89%) of identifying ALDH2*2carriers among the control subjects and a good sensitivity(79%) among the HNC patients. The sensitivity of the alcohol flushing questionnaire in identifying ALDH2*2carriers was affected by alcohol use, with a lower sensitivity among current regular alcohol drinkers. [ABSTRACT FROM AUTHOR]

A critical concern regarding river bed stabilization and river engineering is the short-term general scour that occurs in a field setting far from a river-crossing structure or embankment during a typhoon-induced flood. This study investigated the improvement of existing techniques that have been used to measure river bed scour. One of these techniques is the numbered-brick column or scour chains method, in which only the maximum general scour depth of river bed is observed. A wireless tracer for monitoring real-time scour was set-up with a numbered-brick column and was employed to collect synchronous data. The proposed method was successfully used to observe both real-time scour and the maximum depth at flood peak. This observation was conducted at a steep gravel-bed reach of the Shuideliaw Embankment on the intermittent Choshui River in Central Taiwan during Typhoon Soulik, which occurred in 2013. Future studies must be conducted to complete the development of an automatic real-time scour and flood monitoring system for use in severe weather and flow conditions; this would facilitate the identification of river bed scour during conditions of unstable flow and the improvement of flood prevention engineering, bridge closure detection and emergency evacuation procedures. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer is common cancer, and currently used serum markers for detecting colorectal cancer lack excellent diagnostic accuracy. In the present study, we collected matched tumor and adjacent normal tissues and serum from patients and cancer cells to demonstrate the clinical value of DJ-1 in colorectal cancer and the role of DJ-1-induced mitophagy in colorectal cancer progression. Our data indicate that DJ-1 might be clinically valuable as serum and tissue biomarkers for predicting the TNM (tumor-node-metastasis) stage in colorectal cancer patients. Besides, DJ-1 knockdown enhanced intracellular reactive oxygen species generation and damaged mitochondrial accumulation and mitophagy inhibition in metastatic colorectal adenocarcinoma cells. Since DJ-1-induced mitophagy promotes tumor progression, DJ-1 inhibition is a potential therapeutic strategy for colorectal cancer treatment. Colorectal cancer is the second most common cancer and the third cancer-associated death in Taiwan. Currently used serum markers for detecting colorectal cancer lack excellent diagnostic accuracy, which results in colorectal cancer being often recognized too late for successful therapy. Mitophagy is the selective autophagic degradation of damaged or excessive mitochondria. DJ-1 is an antioxidant protein that attenuates oxidative stress and maintains mitochondrial quality through activating mitophagy. Mitophagy activation contributes to anti-cancer drug resistance. However, the role of DJ-1-induced mitophagy in colorectal cancer progression remains unclear. In the present study, we collected matched tumor and adjacent normal tissues and serum from patients and cancer cells to demonstrate the clinical value and physiological function of DJ-1 in colorectal cancer. We found that DJ-1 increased in tumor tissues and serum; it was positively correlated with TNM (tumor-node-metastasis) stages of colorectal cancer patients. Through stable knockdown DJ-1 expression in metastatic colorectal adenocarcinoma cells SW620, DJ-1 knockdown inhibited cancer cell survival, migration, and colony formation. In SW620 cells, DJ-1 knockdown induced an incomplete autophagic response that did not affect ATP production; DJ-1 knockdown enhanced intracellular reactive oxygen species generation and damaged mitochondrial accumulation and mitophagy inhibition. It suggests that DJ-1 knockdown inhibits mitophagy that causes metastatic colorectal adenocarcinoma cells to be unable to remove damaged mitochondria and further enhance cancer cell apoptosis. Our data indicate that DJ-1 might be clinically valuable as serum and tissue biomarkers for predicting the TNM stage in colorectal cancer patients. Since DJ-1-induced mitophagy promotes tumor progression, DJ-1 inhibition is a potential therapeutic strategy for colorectal cancer treatment. [ABSTRACT FROM AUTHOR]

Because of climate change, remote mountainous areas are affected by heavy rainfall events, which frequently trigger severe natural disasters, such as mud flows, collapses, and landslides. These disasters severely affect the lives and properties of residents in remote mountainous settlements. Therefore, improving the function of immediate monitoring and early warning systems for disaster prevention is a crucial problem that is continuously studied. Improvements in natural disaster observation technology in remote mountainous areas and the continuous collection of on-site measured data can reduce risks for on-site researchers. This study, for the first time, expanded its application to the immediate monitoring of collapse and landslides by improving wireless tracer observation technology. This study focused on the remote mountainous areas of Kaohsiung City, South Taiwan. After numerous surveys, real-time monitoring, and station construction site evaluation, the observation location of this research was set to Dajin Bridge in Liugui District, Kaohsiung City. After selecting the monitoring site, various materials and equipment required for the monitoring station were prepared. According to burial operation procedures, a river channel real-time scouring monitoring station and landslides real-time monitoring station were established, and a remote wireless real-time data receiving system was developed. The results indicated no recent extreme rainfall events in the study area; thus, no scouring or landslides were observed; moreover, the lives and properties of the settlement residents in the study area were safe. The monitoring technology developed by the institute can continuously monitor environmental changes in the study area. [ABSTRACT FROM AUTHOR]

Inconsistent results have been reported for the association between alcohol use and pancreatic cancer, particularly at low levels of alcohol consumption. Individuals genetically susceptible to the carcinogenic effect of alcohol might have higher pancreatic cancer risk after drinking alcohol. The current study investigated the association between alcohol use and pancreatic cancer with 419 pancreatic cancer cases and 963 controls recruited by a hospital-based case-control study in Taiwan. Gene-environment interaction between alcohol use and polymorphisms of two ethanol-metabolizing genes, ADH1B and ALDH2, on pancreatic risk was evaluated. Our results showed no significant association between alcohol drinking and an increased pancreatic cancer risk, even at high levels of alcohol consumption. Even among those genetically susceptible to the carcinogenic effect of alcohol (carriers of ADH1B*2/*2(fast activity) combined with ALDH2*1/*2(slow activity) or ALDH2*2/*2(almost non-functional)), no significant association between alcohol use and pancreatic cancer was observed. Overall, our results suggested that alcohol drinking is not a significant contributor to the occurrence of pancreatic cancer in Taiwan., (© 2021. The Author(s).)

Human papillomavirus (HPV) is recognized as a major cause of oropharyngeal cancer (OPC) in Western countries. Less is known regarding its contribution to the OPC occurring in Asia. The current study aimed to investigate the association between antibody responses to HPV16 E7 and head and neck cancer (HNC) risk in a hospital-based case-control study conducted in Taiwan with 693 HNC cases and 1,035 controls. A positive association was observed between seropositivity to HPV16 E7 and OPC risk, whereas no significant association was found in the non-OPC cases. The increased OPC risk associated with seropositivity to HPV16 E7 was more significant among nonbetel quid or noncigarette users. Seropositivity to HPV16 E7 showed moderate agreement with P16 expression in OPC. OPC patients that were seropositive to HPV16 E7 or p16 positive were more highly educated and less likely to use alcohol, betel quids, and cigarettes compared to HPV16 E7 seronegative or p16 negative OPC patients. Furthermore, patients with p16 positive OPC were more likely to be women compared to patients with p16 negative OPC, likely owing to the low prevalence of alcohol, betel quid, and cigarette users among women. Overall, this study suggested that similar to Western countries, HPV may also be an important risk factor of OPC in Taiwan. With the declining consumption of betel quids and cigarettes in Taiwan, a higher percentage of OPC cases in Taiwan will be attributed to HPV in the future. Public health measures, including HPV vaccination, need to be implemented to prevent the occurrence of HPV-positive OPC., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Many studies have reported a positive association between lower socioeconomic status (SES) and higher head and neck cancer (HNC) risk. Fewer studies have examined the impact of SES on the association between alcohol or cigarette use and HNC risk. The current case-control study (1104 HNC cases and 1363 controls) investigated the influence of education, a SES indicator, on the association between HNC and the use of alcohol, cigarettes, or betel quids in Taiwan, a country with universal health care. Our results showed a larger increase in HNC risk associated with alcohol among those with lower educational level (odds ratio [OR] = 2.07; 95% confidence interval [CI], 1.53-2.80) than those with higher educational level (OR = 1.38; 95% CI, 1.04-1.85) (heterogeneity-P = .03). Educational level had an influence on the association between alcohol use and HNC risk among those with genetic susceptibility (ALDH2-deficient) to the carcinogenic effect of alcohol. The association between cigarette or betel quid use and HNC risk was similar between the high and low educational groups. National policies and social interventions have led to the decline in the prevalence of cigarette and betel quid users in Taiwan. In contrast, due to the lack of adequate alcohol control policies, alcohol consumption in Taiwan has continued to rise. A higher impact of alcohol on HNC risk among lower SES individuals even with universal health care could be the result of insufficient alcohol control policies in Taiwan., (© 2020 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.)

Poor oral hygiene is an established risk factor of head and neck cancer (HNC); however, its role in the survival of HNC patients is unclear. This study evaluated the association between oral hygiene habits, including regular dental visits, frequency of tooth brushing, and use of dental floss, and the overall survival (OS) of HNC patients using interview data collected from 740 HNC patients. In addition, the interactions between oral hygiene and the polymorphisms of TLR2 and TLR4 on the OS of HNC patients were assessed. The analysis indicated that poor oral hygiene was significantly associated with poorer OS of HNC patients (hazard ratio (HR) = 1.38, 95% confidence interval (CI): 1.03-1.86). This association was modified by a single nucleotide polymorphism, rs11536889, of TLR4. A significant association between poor oral hygiene and worse survival of HNC was observed among those with the CG or CC genotype (HR = 2.32, 95% CI: 1.41-3.82) but not among those with the GG genotype (HR = 0.95, 95% CI: 0.65-1.40). Our results suggested that poor oral hygiene is not only a risk factor but may also be a prognostic factor of HNC., (© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Although alcohol is an established risk factor of head and neck cancer (HNC), insufficiencies exist in the literature in several aspects. We analyzed detailed alcohol consumption data (amount and type of alcoholic beverage) of 811 HNC patients and 940 controls to evaluate the association between alcohol and HNC by HNC sites and by genotypes of ADH1B and ALDH2. Alcohol was associated with an increased HNC risk in a dose-response relationship, with the highest risk observed for hypopharyngeal cancer, followed by oropharyngeal and laryngeal cancers. Liquor showed a stronger positive association with HNC than beer and wine. The highest HNC risk occurred in individuals with the slow ADH1B and slow/non-functional ALDH2 genotype combination. In our study population, 21.8% of HNCs, 55.7% of oropharyngeal cancers, and 89.1% of hypopharyngeal cancers could be attributed to alcohol. Alcohol accounted for 47.3% of HNCs among individuals with the slow ADH1B and slow/non-functional ALDH2 genotype combination. The HNC risk associated with alcohol became comparable to that of never/occasional drinkers after ten or more years of cessation from regular alcohol drinking. In conclusion, alcohol use is associated with an increased HNC risk, particularly for individuals with slow ethanol metabolism. HNC incidence may be reduced by alcohol cessation.

Objectives: Although betel quid (BQ) is an established risk factor of head and neck cancer (HNC), insufficiencies exist in the literature regarding the dose-response, BQ types, HNC sites, and BQ cessation. The current study was conducted to fill these insufficiencies., Materials and Methods: A hospital-based case-control study was conducted to evaluate the association between BQ and HNC. In-person interview was conducted to collect data on BQ chewing. The current analysis included 487 men newly diagnosed with HNC and 617 male controls who were frequency-matched to the cases by age. The association between BQ and HNC was assessed using multivariable unconditional logistic regression., Results: Ever BQ chewing was associated with an increased HNC risk regardless of the BQ types. A non-linear positive association between BQ and HNC was observed, with a steep rise in HNC risk for the first 5 pack-years or 200,000 minutes of BQ consumption. Every year of BQ cessation was associated with a 2.9% reduction in HNC risk; however, the risk did not reduce to the level of non-BQ chewers even after 20 years of BQ cessation. Eliminating BQ chewing may prevent 51.6% of HNCs, 62.6% of oral cancers, and 41.3% of pharyngeal cancers in Taiwan., Conclusion: Our results supported the positive association between BQ and HNC. BQ cessation is effective in reducing HNC risk and should be encouraged. Because BQ cessation may not reduce the HNC risk to the level of non-BQ chewers, it is important to prevent the initiation of BQ chewing., Competing Interests: The authors have declared that no competing interests exist.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors originating in the gastrointestinal tract. With the introduction of molecular-targeted therapy for GISTs which has yielded remarkable outcomes, these tumors have become a model of multidisciplinary oncological treatment. Although Western clinical guidelines are available for GISTs, such as those published by the National Comprehensive Cancer Network (NCCN) and the European Society of Medical Oncology (ESMO), the clinical situations in Asian countries are different from those in Western countries in terms of diagnostic methods, surgical approach, and availability of new targeted agents. Accordingly, we have reviewed current versions of several GIST guidelines published by Asian countries (Japan, Korea, China, and Taiwan) and the NCCN and ESMO and discussed the areas of dissensus. We here present the first version of the Asian GIST consensus guidelines that were prepared through a series of meetings involving multidisciplinary experts in the four countries. These guidelines provide an optimal approach to the diagnosis and management of GIST patients in Asian countries., Competing Interests: M.-H. Ryu is a consultant for Novartis and Bayer. A. Sawaki have honoraria from Novartis, Pfizer and Bayer, and research support from Chugai. C.-Y. Tzen received honoraria from Novartis, Pfizer and Bayer. T. Nishida received research support from Novartis and honoraria from Novartis, Pfizer, Bayer, Taiho, and Eizai. L.-T. Chen have honoraria from Novartis and Bayer, and research medication and fund from Novartis. Y.-K. Kang is a consultant for Novartis and Bayer. All other authors declare no competing interests.

Low ratio of mortality over incidence of gastric cancer in Asian countries including Korea and Japan could be explained by early detection after screening, different treatment strategy, or genetic disparity between the East and West. Early detection after screening program for gastric cancer and subsequent surgical treatment including appropriate lymph node dissection has been developed successfully in high risk areas such as East Asian countries. Even in countries with a low prevalence of gastric cancer, a specific screening program is recommended for any high-risk population., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: The current study evaluated the association between tea consumption and head and neck cancer (HNC) in Taiwan, where tea is a major agricultural product and a popular beverage., Methods: Interviews regarding tea consumption (frequency, duration, and types) were conducted with 396 HNC cases and 413 controls. Unconditional logistic regression was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of HNC risk associated with tea drinking, adjusted for sex, age, education, cigarette smoking, betel quid chewing, and alcohol drinking., Results: A reduced HNC risk associated with tea drinking (OR for every cup per day = 0.96, 95% CI: 0.93-0.99; OR for ≧5 cups per day = 0.60, 95% CI: 0.39-0.94) was observed. The association was especially significant for pharyngeal cancer (OR for every cup per day = 0.93, 95% CI: 0.88-0.98; OR for ≧5 cups per day = 0.32, 95% CI: 0.16-0.66). A significant inverse association between HNC and tea consumption was observed particularly for green tea., Conclusions: This study suggests that tea drinking may reduce the risk of HNC. The anticancer property of tea, if proven, may offer a natural chemopreventive measure to reduce the occurrence of HNC.

Objectives: This analysis examined the association between oral hygiene and head and neck cancer (HNC) and whether this association differed by the consumption of alcohol, betel quid, or cigarette and by the genetic polymorphisms of inflammation-related genes., Materials and Methods: Interviews regarding dental care and oral health were conducted with 317 HNC cases and 296 controls. Genotyping was performed for 6 single nucleotide polymorphisms in IL6, IL10 and PTGS2., Results: A positive association was observed between HNC and no regular dental visits (odds ratio (OR)=2.86, 95% confidence interval (CI): 1.47-5.57), brushing teeth <2times/day (OR=1.51, 95% CI: 1.02-2.23), frequent gum bleeding (OR=3.15, 95% CI: 1.36-7.28), and loss of >20 teeth (OR=2.31, 95% CI: 1.05-5.07). Analysis with dental care score (range: 0-4, 4=worst dental care), which combined regular dental visits, toothbrushing, and use of dental floss and mouthwash, showed a positive trend with HNC risk, particularly among alcohol drinkers and cigarette smokers. Multifactor dimensionality reduction analysis divided the study subjects into high- and low-risk group based on combinations of dental care score and IL6 rs1800796 genotypes. Compared to the low-risk group, the high-risk group had an OR of HNC=2.16 (95% CI: 1.44-3.25)., Conclusions: This study observed a positive association between poor oral hygiene and HNC, which appeared to differ by alcohol or cigarette consumption and the genotypes of IL6 rs1800796. Further investigations are needed to determine whether poor oral hygiene is a cause for HNC or a surrogatemarker of an unhealthy lifestyle that increases the risk of HNC., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Although the relationship between allergy and cancer has been investigated extensively, the role of allergy in head and neck cancer (HNC) appears less consistent. It is not clear whether allergies can independently influence the risk of HNC in the presence of known strong environmental risk factors, including consumption of alcohol, betel quid, and cigarette., Methods: THE CURRENT PAPER REPORTS RESULTS FROM: 1) an original hospital-based case-control study, which included 252 incident cases of HNC and 236 controls frequency-matched to cases on sex and age; and 2) a meta-analysis combining the results of the current case-control study and 13 previously published studies (9 cohort studies with 727,569 subjects and 550 HNC outcomes and 5 case-control studies with 4,017 HNC cases and 10,928 controls)., Results: In the original case-control study, we observed a strong inverse association between allergies and HNC [odds ratio = 0.41, 95% confidence interval (CI): 0.27-0.62]. The meta-analysis also indicated a statistically significant inverse association between HNC and allergies [meta-relative risk (RR) = 0.76, 95% CI: 0.63-0.91], particularly strong for allergic rhinitis (meta-RR = 0.55, 95% CI: 0.40-0.76). In addition, the inverse association between allergies and HNC was observed only among men (meta-RR = 0.67, 95% CI: 0.54-0.84) but not among women (meta-RR = 0.98, 95% CI: 0.81-1.18)., Conclusions: These findings suggest that immunity plays an influential role in the risk of HNC. Future studies investigating immune biomarkers, including cytokine profiles and genetic polymorphisms, are warranted to further delineate the relationship between allergies and HNC. Understanding the relationship between allergies and HNC may help devise effective strategies to reduce and treat HNC.

Background: Safety activities have been initiated at many hospitals in Taiwan, but little is known about the safety culture at these hospitals. The aims of this study were to verify a safety culture survey instrument in Chinese and to assess hospital safety culture in Taiwan., Methods: The Taiwan Patient Safety Culture Survey was conducted in 2008, using the adapted Safety Attitude Questionnaire in Chinese (SAQ-C). Hospitals and their healthcare workers participated in the survey on a voluntary basis. The psychometric properties of the five SAQ-C dimensions were examined, including teamwork climate, safety climate, job satisfaction, perception of management, and working conditions. Additional safety measures were asked to assess healthcare workers' attitudes toward their collaboration with nurses, physicians, and pharmacists, respectively, and perceptions of hospitals' encouragement of safety reporting, safety training, and delivery delays due to communication breakdowns in clinical areas. The associations between the respondents' attitudes to each SAQ-C dimension and safety measures were analyzed by generalized estimating equations, adjusting for the clustering effects at hospital levels., Results: A total of 45,242 valid questionnaires were returned from 200 hospitals with a mean response rate of 69.4%. The Cronbach's alpha was 0.792 for teamwork climate, 0.816 for safety climate, 0.912 for job satisfaction, 0.874 for perception of management, and 0.785 for working conditions. Confirmatory factor analyses demonstrated a good model fit for each dimension and the entire construct. The percentage of hospital healthcare workers holding positive attitude was 48.9% for teamwork climate, 45.2% for perception of management, 42.1% for job satisfaction, 37.2% for safety climate, and 31.8% for working conditions. There were wide variations in the range of SAQ-C scores in each dimension among hospitals. Compared to those without positive attitudes, healthcare workers with positive attitudes to each SAQ dimension were more likely to perceive good collaboration with coworkers, and their hospitals were more likely to encourage safety reporting and to prioritize safety training programs (Wald chi-square test, p < 0.001 for all)., Conclusions: Analytical results verified the psychometric properties of the SAQ-C at Taiwanese hospitals. The safety culture at most hospitals has not fully developed and there is considerable room for improvement.

The purpose of this study was to examine altered pressure garments requested by burn patients, in Taiwan. Three hundred forty-two pressure garments needing alterations were collected from 127 burn patients at the Sunshine Foundation Organization, an nonprofit organization for burn patients, between March and September 2007, to identify the major defects found in these pressure garments and their causes. Causes of required alterations were classified according to a hierarchical coding scheme focusing on poor fit, discomfort, component part, fabric and sewing, and cosmetics to identify systematic problems for each garment type. The result of our analysis indicated that the majority of the pressure garment alterations were related to poor fit in circumferential and longitudinal dimensions of the various body parts, incorrect position and size of openings for eyes, nose, ears, and mouth, or inappropriate length or position of zippers. Information derived from this causal analysis can be applied in helping to reduce the recurrence of alterations in pressure garment, thus improving the quality and effectiveness of pressure therapy.