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(1) Background: The etiologies of sudden sensorineural hearing loss (SSHL) remain unclear. The level of mean particulate matter with a diameter of 2.5 μm or less (PM2.5) was not associated with SSHL, but the maximum PM2.5 level exhibited a negative association with SSHL in Korea. Exposure to nitrogen dioxide (NO 2 ) for 2 weeks increased the risk of SSHL. The lag effects of SSHL after air pollution exposure were limited. We aimed to evaluate the association of SSHL with air pollution exposure to determine whether air pollution exposure caused delayed effects. (2) Methods: This observational study used inpatient data obtained from electronic health records at the Tri-Service General Hospital from 2011 to 2019. The data of all SSHL patients were retrieved. The air quality dataset from Songshan station from 2011 to 2019 was used. The main outcomes were the relative risks (RRs) of SSHL associated with PM2.5, O 3 , and NO 2 exposures within 1 month. The relationships between these factors were examined using distributed lag nonlinear time series models. (3) Results: The RR of SSHL associated with PM2.5 exposure was 1.195 (95% confidence interval (C.I.: 1.047-1.363) for a 10 unit increase at a lag of 7 days. The RR of SSHL associated with O 3 exposure was 1.14 (95% C.I.: 1.003-1.3) for a 10 unit increase at a lag of 9 days. The RR of SSHL associated with NO 2 exposure was 1.284 (95% C.I.: 1.05-1.57) for a 10 unit increase at a lag of 23 days. (4) Conclusions: In our study, SSHL was confirmed to be associated with air pollution exposure with a lag effect. We discussed possible mechanisms to explore possible biological hypotheses and support further research. Large-scale studies including participants with other ethnicities and causal relationships are needed to confirm our findings.

Background: The association between increased neutrophil-to-lymphocyte ratio (NLR) and multiple sclerosis has been demonstrated in several studies. The monocyte-to-lymphocyte ratio (MLR) is an emerging biomarker for disease monitoring. Moreover, there has not been a published Taiwanese study to date., Aim: To investigate the correlation of NLR, MLR and white blood cell (WBC) count as possible biomarkers for predicting a 2-year relapse in patients with multiple sclerosis (MS)., Materials and Methods: A total of 641 Taiwanese patients with MS were enrolled in the present study between January 1, 2001, and December 31, 2018. We collected data on NLR, MLR, WBC count, disease-modifying therapy (DMT) use, and the time between first diagnosis and first relapse in all patients within a 2-year duration., Results: In the relapse group, there were significantly more patients with NLR >median or MLR >median (p = 0.006 and p = 0.020, respectively). There were also more patients with WBC count >median, although the difference was not statically significant (p = 0.069). The adjusted hazard ratio for relapse and NLR >median was 1.61(p = 0.008). The adjusted hazard ratio for relapse and MLR >median was 1.43 (p = 0.044). Patients with NLR >median or MLR >median had a significantly (p = 0.008 and p = 0.039, respectively) increased risk of MS relapse in the 2 years, compared with those who had NLR

Algal reefs are one of the world's rare and poorly understood ecosystems. They are mainly distributed in the Mediterranean Sea, but one notable exception-an intertidal algal reef ecosystem in northwestern Taiwan-stretches for 27 km along the coast of Taoyuan, making it probably the largest algal reef coast found in shallow water. Despite the reef's rarity and striking characteristics, the coastal land that it is part of has undergone a series of developments and is now surrounded by industrial parks. Brachyuran crabs are one of the most abundant and visible groups of organisms in the intertidal zone. In the present study, we investigated the brachyuran crab community in this reef to provide a more detailed record of brachyuran crab species compositions in this intertidal algal reef ecosystem and illustrate the characteristics of this understudied ecosystem by comparing its species diversity and abundance with three natural variables- sampling time, tidal level, and season-in a wildlife refuge and north of the refuge. Two methods were used in the study: a qualitative method (to determine the species richness) and a quantitative method (to estimate the population density). We identified a total of 52 brachyuran species from 13 families in the habitats. The highest species richness was found in Datan G2, north of the wildlife refuge. The crab species composition in this algal reef is different from its compositions in coral and rocky reefs. Our analysis indicated that the species abundance is affected by multiple factors, and a single investigation is not enough to reflect the true population density of brachyuran crabs on this reef. In addition, we found that the sites outside the wildlife refuge were in much better condition than those in the wildlife refuge, and should therefore be included in the wildlife refuge. In particular, Datan, located north of the wildlife refuge, had the highest species richness, and the area's species composition was different from that of the nearby wildlife refuge. Thus, we strongly recommend that a) the Datan area be protected to maintain this high crab diversity and b) further research be performed to better understand brachyuran crab biology in the intertidal algal reef ecosystem.

Background: Myasthenia gravis (MG) is an autoimmune disease involving the neuromuscular junction. Myasthenic crisis (MC), which is characterized by respiratory failure and the requirement of mechanical ventilation in patients with MG, is still a medical emergency despite the decrease in mortality with the advances in acute management. Hemogram is a cost-effective test for evaluating hematological complications and systemic inflammation, and hemogram data have been used to predict various clinical outcomes of several diseases. The relationship between hemogram and MG has been discussed, but the role of hemogram data in predicting the prognosis of MC patients has not been established., Methods: To identify whether hemogram data can predict in-hospital mortality in patients with MC, we retrospectively investigated 188 myasthenic crisis events from the Chang Gung Research Database between April 2001 and March 2019. Demographic and clinical characteristics were collected, as well as hemogram data before intubation and extubation. The endpoints were mortality during mechanical ventilation and mortality after extubation., Results: The overall in-hospital mortality rate was 22%. Multivariate logistic regression analysis for predicting mortality during mechanical ventilation showed that old age at MC onset (OR = 1.039, p = 0.022), moderate-to-severe anemia (OR = 5.851, p = 0.001), and extreme leukocytosis (OR = 5.659, p = 0.022) before intubation were strong predictors of mortality, while acute management with plasma exchange or double-filtration plasmapheresis (PE/DFPP) significantly decreased mortality (OR = 0.236, p = 0.012). For predicting mortality after extubation, moderate-to-severe anemia before extubation (OR = 8.452, p = 0.017) and non-treated with disease-modifying therapy before MC (OR = 5.459, p = 0.031) were crucial predictive factors., Conclusion: This study demonstrated that both old age at MC onset and moderate-to-severe anemia are important predictors of in-hospital mortality in patients with MC, and extreme leukocytosis is another crucial predictor of mortality during mechanical ventilation. The suggested mechanism is that anemia-induced hypoxia may enhance the release of proinflammatory cytokines, exacerbate systemic inflammation, and lead to multiple organ dysfunction syndrome and, finally, mortality., (© 2021. The Author(s).)

Background: Microelectrode recording (MER)-guided deep brain stimulation (DBS) remains the standard electrophysiological procedure to place the DBS lead at the optimal target. When single-track MER or test stimulation yields suboptimal results, trajectory adjustments are needed. Intraoperative computed tomography (iCT) can be useful to visualize the microelectrode and verify possible adjustments. The aim of this study was to evaluate the effect of iCT in MER during frameless stereotactic DBS for Parkinson disease (PD)., Methods: We retrospectively collected 28 PD patients, of whom 19 received iCT and 9 did not, and measured intracranial volume, cerebral volume, cerebrospinal fluid volume, and pneumocephalus volume. Euclidean distance was assessed according to merged preoperative brain CT and magnetic resonance imaging and postoperative brain CT., Results: Fifty-six hemispheres in the 28 patients were analyzed for MER tracks. The patients who received iCT had a significantly lower mean number of MER tracks (1.6 vs. 2.6, P = 0.013) and lower mean Euclidean distance (2.2 mm vs. 2.7 mm, P = 0.033) compared with those who did not receive iCT. Although there was a trend of a decrease in pneumocephalus using intraoperative imaging, there was no significant difference in surgical time., Conclusions: iCT can reduce the number of MER tracks and increase surgical accuracy. Further studies are warranted to investigate whether iCT can reduce surgical complications and improve surgical outcomes., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Aortic dissection is a rare but severe complication of percutaneous transluminal angioplasty and stenting (PTAS) for stenosis of the subclavian artery (SA). This retrospective study was designed to evaluate the risk factors and outcomes of patients with severe stenosis of the SA who underwent PTAS complicated by aortic dissection., Methods: Between 1999 and 2018, 169 cases of severe symptomatic stenosis of the SA underwent PTAS at our institute. Of them, six cases complicated by aortic dissection were included in this study. We evaluated the demographic features, technical factors of PTAS, and clinical outcomes in these six patients., Results: Aortic dissection occurred in 5.3% (6/113) of all left SA stenting cases but in none of the right SA stenting cases. All patients had hypertension and a high severity of SA stenosis (85.0 ± 13.0%, 60%-95%). Five of the six patients received balloon-expandable stents (83.3%). All patients had spontaneous resolution of the aortic dissection with conservative treatment. In a 63.33 ± 33.07 (7-118) month follow-up, five of the six patients (83.3%) had long-term symptom relief and stent patency., Conclusion: Aortic dissection occurred in patients who underwent PTAS for severe stenosis of the left SA, mainly with balloon-expandable stents. We suggest using self-expandable stents and angioplasty with an undersized balloon during PTAS for severe stenosis of the left proximal SA to prevent aortic dissection., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2021, the Chinese Medical Association.)

The ability of sepsis to induce acute phase hearing impairment has been evaluated in septic and sepsis-surviving mice. The relationship between septicemia and long-term hearing impairment remains unknown in humans.The data were obtained from the Taiwan Longitudinal National Health Insurance Database from 2000 to 2013. We identified patients suffering from septicemia after discharge, excluding those younger than 18 years old and older than 65 years old. The comparison group was matched based on age, sex, and comorbidities. The outcome was hearing impairment occurring after septicemia. The risk factors associated with hearing impairment were established using multivariate Cox proportional hazard regression.Our study found that septicemia associated with hearing impairment had an adjusted hazard ratio (HR) of 53.11 (95% confidence interval [CI]: 41.74-67.59). The other factors related to hearing impairment in young and middle-aged septicemia survivors included male sex (adjusted HR 1.31 [95% CI: 1.14-1.5]), chronic kidney disease (adjusted HR 1.63 [95% CI: 1.38-1.94]), and otoscleroisis (adjusted HR 231.54 [95% CI: 31.61-1695.8]).Our study revealed that septicemia was associated with increased development of hearing impairment in young and middle-aged humans in the long term. Clinicians should be aware of long-term septicemia-related hearing impairment and provide prevention strategies for otopathy in septicemia survivors.

The current absence of a disease-modifying treatment for Alzheimer disease highlights the necessity for the benefits of nonpharmacological approaches. We aimed to investigate the effect of exercise in older patients with Alzheimer dementia.This is an observational, prospective cohort study in medical center. Eighty older patients with Alzheimer dementia, including 54 with mild dementia and 26 with moderate dementia, were followed up over 2 years. Patients were divided into exercise and no-exercise groups according to their weekly exercise habit. Mini-Mental State Examination (MMSE), clinical dementia rating (CDR), and senior fitness test were checked initially. We defined death and unexpected hospitalization as the outcomes.Age, sex, education years, and MMSE showed no significant differences between the groups (P > .05) in all patients. All the patients of the exercise group had significantly better left upper body strength, higher aerobic endurance, and left and right balance maintenance time than those of the no-exercise group (P < .05). There were no changes in hospitalization and mortality between the exercise and non-exercise groups during the 2-year follow-ups in all participants. However, in the mild and moderate dementia subgroups, age, sex, education years, and MMSE showed no significant differences between the groups (P > .05). The exercise group had significantly better lower body strength, left upper body strength, aerobic endurance, right upper body flexibility, lower body flexibility, balance maintenance, and agility than the no-exercise group in patients with mild dementia (P < .05). Moreover, the exercise group had significantly lesser unexpected hospitalization than the no-exercise group in the patients with mild dementia (P = .037).Despite the similarity in the status of dementia, exercise habit was found to be associated with a better senior fitness test score status. Hence, exercise can decrease unexpected hospitalization in patients with mild dementia but not those with total dementia.

Objective- Vascular smooth muscle cell (VSMC) transformation to an osteochondrogenic phenotype is an initial step toward arterial calcification, which is highly correlated with cardiovascular disease-related morbidity and mortality. TLR2 (Toll-like receptor 2) plays a pathogenic role in the development of vascular diseases, but its regulation in calcification of arteries and VSMCs remains unclear. We postulate that TLR2-mediated inflammation participates in mediating atherosclerotic arterial calcification and VSMC calcification. Approach and Results- We found that ApoE -/- Tlr2 -/- genotype in mice suppressed high-fat diet-induced atherosclerotic plaques formation during initiation but progressively lost its preventative capacity, compared with ApoE -/- mice. However, TLR2 deficiency prohibited high-fat diet-induced advanced atherosclerotic calcification, chondrogenic metaplasia, and OPG (osteoprotegerin) downregulation in the calcified lesions. Incubation of VSMCs in a calcifying medium revealed that TLR2 agonists significantly increased VSMC calcification and chondrogenic differentiation. Furthermore, TLR2 deficiency suppressed TLR2 agonist-mediated VSMC chondrogenic differentiation and consequent calcification, which were triggered via the concerted actions of IL (interleukin)-6-mediated RANKL (receptor activator of nuclear factor κB ligand) induction and OPG suppression. Inhibition experiments with pharmacological inhibitors demonstrated that IL-6-mediated RANKL induction is signaled by p38 and ERK1/2 (extracellular signal-regulated kinase 1/2) pathways, whereas the OPG is suppressed via NF-κB (nuclear factor κB) dependent signaling mediated by ERK1/2. Conclusions- We concluded that on ligand binding, TLR2 activates p38 and ERK1/2 signaling to selectively modulate the upregulation of IL-6-mediated RANKL and downregulation of OPG. These signaling pathways act in concert to induce chondrogenic transdifferentiation of VSMCs, which in turn leads to vascular calcification during the pathogenesis of atherosclerosis.

Understanding physiological responses and osmoregulatory mechanisms for dealing with salinity stress is essential to clarify how amphibians living in coastal areas adapt to fluctuating salinity levels. Euryhaline species are rare among reported tadpole species inhabiting saline habitats, and few studies addressed the osmoregulatory mechanisms. We quantified the effects of salinity acclimation on survival, osmolality, water content, ion concentration, and gill Na + , K + -ATPase (NKA) expression of euryhaline tadpoles of Fejervarya cancrivora, to examine time-course changes of osmoregulatory responses of tadpoles subjected to salinity stress and how osmoregulatory mechanisms were involved in the process. Acclimation to 10 ppt for 24 h increased tadpole survival of F. cancrivora in 15 ppt, and it activated osmoregulatory mechanisms such as increase in NKA expression, which enabled them to maintain a stable osmolality below that of the surrounding media, to reach lower sodium and chloride concentrations of body fluid, and to modulate dehydration at higher salinities. The minimum required acclimation period is shorter than that reported previously on this species and non-euryhaline tadpoles. This study highlights that these physiological mechanisms are ecologically relevant and critical for tadpoles living in coastal brackish waters, improving their survival in coastal microhabitats with highly variable salinity levels., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To evaluate whether traversal through the central part of a pulmonary lesion by a biopsy needle, and other factors, increases the risk of hemoptysis in patients undergoing CT-guided percutaneous transthoracic needle biopsy (PTNB)., Materials and Methods: From July 2012 to November 2016, 227 patients undergoing 233 procedures were recruited as our study population. Patients were classified according to the occurrence of hemoptysis. Radiological assessments were performed by reviewing multiplanar reconstructed CT images. Other factors complicating PTNB-related hemoptysis were classified into (1) patient-related variables: age, gender, presence of emphysema; (2) lesion-related variables: size, location, distance to pleura, characteristics, presence of and degree of enhancement, histopathology of biopsy results; and (3) procedure-related variables: lesion depth, patient's body position., Results: Twenty-two cases (9.4%) experienced hemoptysis. Univariate analysis revealed that subsolid lesions (p = 0.031) and lesion depth > 1 cm (p = 0.049) were risk factors. Traversal through the central part of the lesion by the biopsy needle was not a risk factor., Conclusion: Traversal through the central part of the lesion by the biopsy needle is not a risk factor of PTNB-related hemoptysis, but subsolid lesions and lesion depth > 1 cm increase the risk of hemoptysis.

Chun-Yen Huang and Hui-Chen Lin (2016) Organisms face direct challenges from a variety of abiotic factors in the environment. Changes in dissolved oxygen are one of the most common types of these challenges. The gills of some fish species can compensate for ambient oxygen changes by exhibiting morphological and functional plasticity that give the gill the ability to modify its structure. In the previous studies of aquatic air- breathing fish with an accessory air-breathing organ (the labyrinth organ), we found morphological and functional specializations between the 1st and 4th gills in the genus Trichogaster . This study investigated morphological and functional changes in the gills and labyrinth organ of the aquatic air-breathing fish T. microlepis over a 28- day period of oxygen uptake stresses. The experimental design was as follows: (1) a control group (held under normoxia with air-breathing respiration (ABR) allowed); (2) a hypoxic group (held under hypoxia with ABR); and (3) a restricted group (held under normoxia without ABR). We recorded the cumulative mortality of the fish and the frequency of ABR between the control and hypoxic groups, conducted morphological examinations of the lengths of gill filaments and lamellae of gills and determined the relative abundance of carbonic anhydrase II (CAII) and Na+/K+-ATPase (NKA). Mortality in the restricted group was higher than those in the control and the hypoxic groups. The frequency of ABR in the hypoxic condition was higher than that in the control. The lengths of the lamellae in the 1st, 3rd and 4th gills in the restricted group were significantly longer than those in the control group after 14 and 28 days. In addition, the relative abundance of CAII was significantly increased only in the labyrinth organ in the hypoxic group compared to the control group on day 3. The relative abundance of proliferating cell nuclear antigen also was significantly increased in the 1st gill, 4th gill and the labyrinth organ in the restricted group compared to the control group on day 14. This study showed, for the first time, that the 4th gill in T. microlepis , which is generally much-reduced compared to the other gills, can have elongated lamellae when fish are subjected to the restricted group for 28 day. The relative abundance of CAII in the labyrinth organ was significantly higher under hypoxic group than under control group on day 3.

Aquatic air-breathing anabantoids, a group of fish species characterized by the presence of a labyrinth organ and some gills, exhibit morphological variations. This study aimed to examine whether unequal gill growth begins during the early stages and described the sequence of the early gill developmental events in Betta splendens and Macropodus opercularis. To determine when the ion regulatory and gas exchange abilities first appear in the gills, mitochondria-rich cells (MRCs) and neuroepithelial cells (NECs) were examined in young B. splendens. To evaluate the relative importance of the gills and the labyrinth organ under different levels of oxygen uptake stress, the levels of carbonic anhydrase II (CAII) and Na(+)/K(+)-ATPase (NKA) protein expressions in 2 gills and the labyrinth organ were examined in M. opercularis. We found that the first 3 gills developed earlier than the 4th gill in both species, an indication that the morphological variation begins early in life. In B. splendens, the MRCs and NECs clearly appeared in the first 3 gills at 4 dph and were first found in the 4th gill until 11 dph. The oxygen-sensing ability of the gills was concordant with the ionoregulatory function. In M. opercularis, the hypoxic group had a significantly higher air-breathing frequency. CAII protein expression was higher in the labyrinth organ in the hypoxic group. The gills exhibited increased NKA protein expression in the hypoxic and restricted groups, respectively. Functional plasticity in CAII and NKA protein expressions was found between the gills and the labyrinth organ in adult M. opercularis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Group A streptococcus (GAS) is a common pathogen in children. Macrolide resistance in GAS has been described worldwide. The aims of this study are to analyze macrolide resistance of GAS isolates in southern Taiwan and to clarify the relationship of emm typing and macrolide resistance in the past decade., Methods: All GAS isolated from patients younger than 18 years at a single tertiary center in southern Taiwan were collected from 2000 to 2012. Antibiotics susceptibility to erythromycin, azithromycin, and clindamycin were determined by agar dilution method, and were interpreted by Clinical and Laboratory Standards Institute (CLSI) standards. emm typing was performed by polymerase chain reaction (PCR)., Results: A total of 301 isolates were collected during the period of 13 years. Scarlet fever (38.5%) and acute pharyngitis (32.2%) were the most common diagnosis. Decreased resistance rate of erythromycin from 53.1% in 2000 to 0% in 2010 was found, but it increased rapidly to 65% in 2011. The resistance rate of azithromycin was the lowest (4.2%) in 2005, but was higher than 15% after 2006. The involvement of the erythromycin resistance genes were mefA (53.1%), ermB (35.9%), and ermTR (10.9%). The resistance of clindamycin also increased since 2011. emm12 was the most common serotype and accounted for 44.9% of all isolates. Compared with the non-emm12 group, resistance to erythromycin, azithromycin, and clindamycin were more frequently detected in the emm12 group., Conclusion: Increased resistance of GAS to macrolide and clindamycin was found in recent years. emm12 was the main serotype for macrolide resistance., (Copyright © 2013. Published by Elsevier B.V.)

We examined the hypothesis that Trichogaster microlepis, a fish with an accessory air-breathing organ, uses a compensatory strategy involving changes in both behavior and protein levels to enhance its gas exchange ability. This compensatory strategy enables the gill ion-regulatory metabolism to maintain homeostasis during exposure to hypoxia. The present study aimed to determine whether ionic regulation, glycogen utilization and antioxidant activity differ in terms of expression under hypoxic stresses; fish were sampled after being subjected to 3 or 12h of hypoxia and 12h of recovery under normoxia. The air-breathing behavior of the fish increased under hypoxia. No morphological modification of the gills was observed. The expression of carbonic anhydrase II did not vary among the treatments. The Na(+)/K(+)-ATPase enzyme activity did not decrease, but increases in Na(+)/K(+)-ATPase protein expression and ionocyte levels were observed. The glycogen utilization increased under hypoxia as measured by glycogen phosphorylase protein expression and blood glucose level, whereas the glycogen content decreased. The enzyme activity of several components of the antioxidant system in the gills, including catalase, glutathione peroxidase, and superoxidase dismutase, increased in enzyme activity. Based on the above data, we concluded that T. microlepis is a hypoxia-tolerant species that does not exhibit ion-regulatory suppression but uses glycogen to maintain energy utilization in the gills under hypoxic stress. Components of the antioxidant system showed increased expression under the applied experimental treatments., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The goal of this study was to explore the signaling pathway regulating the processing of proADAM17 into ADAM17 in Taiwan cobra phospholipase A2 (PLA2)-treated human leukemia U937 cells. PLA2 induced reactive oxygen species (ROS)-elicited p38 MAPK activation and ERK inactivation in U937 cells. Catalytically inactive bromophenacylated PLA2 (BPB-PLA2) and PLA2 mutants evoked Ca(2+)-mediated p38 MAPK activation, and the level of phosphorylated ERK remained unchanged. PLA2 treatment reduced mature ADAM17 expression and secreted TNF-α (sTNF-α) production. Co-treatment of SB202190 (p38 MAPK inhibitor) and catalytically inactive PLA2 increased ERK phosphorylation, ADAM17 maturation and sTNF-α production. Nevertheless, mRNA levels of ADAM17 and TNF-α were insignificantly altered after PLA2 and SB202190/BPB-PLA2 treatment. ADAM17 activity assay and knock-down of ADAM17 revealed that ADAM17 was involved in sTNF-α production. Restoration of ERK activation increased the processing of proADAM17 into ADAM17 in PLA2-treated cells, while inactivation of ERK reduced ADAM17 maturation in untreated and SB202190/BPB-PLA2-treated cells. Removal of cell surface heparan sulfate abrogated PLA2 and SB202190/BPB-PLA2 effect on ADAM17 maturation. Taken together, the present data reveal that PLA2 suppresses ERK-mediated ADAM17 maturation, thus reducing sTNF-α production in U937 cells. Moreover, the binding with heparan sulfate is crucial for the PLA2 effect., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: A constellation of factors accounts for teaching efficacy in the fundamental nursing practicum. Teachers play a critical role in terms of designing and executing an appropriate teaching plan, choosing effective methods, and holding appropriate teaching attitudes. It is thus extremely important that clinical teachers master the core characteristics of basic nursing practice., Purpose: This study aimed to illuminate the core characteristics of basic nursing practice for students for reference by clinical practicum teachers., Methods: Qualitative research was used to identify the fundamentals of nursing practice by clinical teacher. Five focus group meetings were convened during the practice period. The researchers presided over group discussions held during the normal weekly teaching schedule and lasting approximately 2-4 hours each. The content analysis was adopted to analyze the data., Results: Three major themes were proposed, including (1) student status: "novices were stymied by problems and thus improved slowly"; (2) teacher awareness: "teachers need to be aware of student capabilities, mood, and discomfort"; and (3) teaching style: "a good choice of methods should support and encourage students., Conclusions / Implications for Practice: To cultivate professional nursing knowledge and self-confidence for future professional commitment, clinical teachers must first understand the characteristics and motivations of learning of their students and then select the, skills, and attitudes appropriate to provide step-by-step guidance. Communication with staffs and the preparation of atmosphere prior to nursing practice are also essential for students. Results provide insights into the technical college environment with regard to basic-level clinical nursing practice.

The aim of the study was to test the hypothesis that the mechanism of glycogen metabolism has taken place in gills rather than in liver during Cd exposure. Male tilapia were exposed to 44.45 μM ambient Cd for 12h, and we found blood glucose significantly increased, however, lactate levels showed no significant changes. The glycogen phosphorylase (GP) activity increased immediately after 0.75 to 3h of Cd exposure in the gills, and after 1 to 6h in the liver, respectively. In addition, the glycogen level depleted faster in the gills than in the liver. Plasma cortisol level increased from 0.25 to 1h and recovered after 3h, while the glucagon did not significantly change during Cd exposure. Glucocorticoid receptor (GR) mRNA expression decreased after 0.75 h in the gills, while it significantly increased after 6h in the liver. Ca(2+), Na(+), Cl(-), and K(+) significantly decreased upon Cd exposure within 6h following Cd-induced toxic stress. We suggested that the cortisol is the spontaneous stimulation of glycogen metabolism in the gills, and it triggers a subsequent energy supply later in the liver. Taken together, the profile of glycogen metabolism between gills and liver during Cd-exposure stress provide good support to our hypothesis., (Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.)

All fish species in the Anabantoidei suborder are aquatic air-breathing fish. These species have an accessory air-breathing organ, called the labyrinth organ, in the branchial cavity and can engulf air at the surface of the water to assist in gas exchange. It is therefore necessary to examine the extent of gill modification among anabantoid fish species and the potential trade-offs in their function. The experimental hypothesis that we aimed to test is whether anabantoid fishes have both morphological and functional variations in the gills among different species. We examined the gills of 12 species from three families and nine genera of Anabantoidei. Though the sizes of the fourth gill arch in three species of Trichogaster were reduced significantly, not all anabantoid species had morphological and functional variations in the gills. In these three species, the specific enzyme activity and relative protein abundance of Na(+)/K(+)-ATPase were significantly higher in the anterior gills as compared with the posterior gills and the labyrinth organ. The relative abundance of cytosolic carbonic anhydrase, an indicator of gas exchange, was found to be highest in the labyrinth organ. The phylogenetic distribution of the fourth gill's morphological differentiation suggests that these variations are lineage specific, which may imply a phylogenetic influence on gill morphology in anabantoid species.

Climate change affects organisms that inhabit not only in aerial but also in aquatic environments by making water more hypoxic and acidic. In the past, we evaluated morphological and functional variations in the gills of 12 species of aquatic air-breathing fishes. The aim of the present study is to examine the degree of gill modification in the aquatic air-breathing fish, Trichogaster lalius, in response to acidic stress. This provides a link between the ecological and physiological studies. We evaluated the changes in morphology and function of the gills, labyrinth organ, and kidney when the fish were subjected to acidic water and deionized water (DW). In the first experiment, fish were sampled at 1, 2, 4, and 7 days after acidic treatment. Apparent morphological modification was observed on day 4 and recovery was noted on day 7. Protein expression and enzyme activity of vacuolar-type H+-ATPase (VHA) and the protein expression of the proliferating cell nuclear antigen (PCNA) of the 1st and 4th gill arches both increased in the 4-day and 7-day acidic groups while the enzyme activity of Na+/K+-ATPase (NKA) decreased. In the second experiment, fish were tested for changes in the 1st and 4th gill arches and kidney after exposure to DW and acidic water for 4days. The gill structure of the fish in the DW was not different from that of the control group (fresh water). The protein expression and enzyme activity of the VHA of the 1st and 4th gill arches increased in both the DW and acidic groups for 4 days. We found a decrease in the protein expression of NKA in the kidney and in the enzyme activity of NKA in the 1st and 4th gill arches in the DW and acidic groups. From these results, we suggest that T. lalius exhibited significantly different ionic regulation and acid-base regulatory abilities in the DW and acidic groups in the 1st and 4th gill arches and kidney. The responses of the gills in T. lalius were different from those fish that show apparent morphological variations between the 1st and 4th gill arches., (Crown Copyright © 2010. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was to examine the effect of seat surface inclination on postural stability and forward reaching efficiency in 10 children with spastic cerebral palsy (CP) and 16 typically developing (TD) children. The children performed a static sitting and a forward reaching task while sitting on a height- and inclination-adjustable stool at flat, three anterior-inclined, and three posterior-inclined positions. Postural stability was expressed as normalized (with body weight) peak vertical ground reaction force, center of pressure displacement in the anterior/posterior directions (COP&#95;AP), in the medial/lateral directions (COP&#95;ML), and sway ratio (COP&#95;AP/COP&#95;ML). Reaching efficiency was expressed as reaction time and movement time of arm reaching forward to a target. The results showed that seat inclination affected children's postural stability and the effects were comparable for CP and TD children in all measures except for COP&#95;ML. Children with CP presented much larger COP&#95;ML than TD children at the posterior-inclined positions relative to the flat and the anterior-inclined positions. Seat inclination affected reaching efficiency for both groups of children equally. Efficiency was better at the anterior positions than the posterior positions. Anterior-inclined positions improved postural stability and reaching efficiency. Posterior positions posed greater postural challenge and the challenge was tougher for children with CP.

Pavement cells and the mitochondria-rich cells (MRCs) are two of the main types of cells in fish gill epithelia. The pavement cells are generally responsible for gas exchange and MRCs for ion regulation. MRCs are found especially in the trailing edge and the interlamellar region of gill filament. In some species, MRCs are also observed in the gill lamellae. A previous study reported the likelihood of having lamellar MRCs in air-breathing fishes. Nevertheless, the source of lamellar MRCs is unclear. We used the air-breathing fish, Trichogaster leeri, to investigate the source of proliferated cells on the lamellae when 5-bromo-2-deoxyuridine (BrdU) was injected at different times before fish were sampled from deionized water. There were two major findings in this study. First, undifferentiated cells were found in the lamellae, as well as in the filaments. And, within 12-24 hr, a proliferated cell, identified as BrdU cell, could differentiate to an MRC in the gill lamellae. Second, the filaments and the lamellae in T. leeri responded to ionic stress differently but the proportion of the proliferated MRCs to the BrdU cells remained constant. Our results suggested that the lamellar MRCs were mainly differentiated from the cells that proliferated earlier from the lamellae.

Background and Purpose: This study was designed to compare the change in complications of varicella infection in children requiring hospitalization before and after varicella vaccine introduction at a tertiary care hospital in southern Taiwan., Methods: Based on the results of a retrospective study conducted in the pre-vaccine era (1988-1998), a second study was carried out from 1998-2004 (post-vaccine era). In children admitted for varicella-related complications, demographic data, clinical features, microbiological findings, and outcomes were recorded and compared between the two eras., Results: A decreased annual rate of hospitalization was observed between the two eras. Age-specific hospitalization rates significantly declined in the age group of 1-10 years after vaccine introduction. Secondary skin or soft tissue infections were the most common complications in both periods (pre-vaccine era, 44.1%; post-vaccine introduced era, 56.6%). In the post-vaccine era, 23 (52%) patients had positive bacterial isolates, including 19 Staphylococcus aureus (12 oxacillin-sensitive, 7 oxacillin-resistant) and 4 coagulase-negative staphylococci; a higher rate of pneumonitis and lower rate of central nervous system involvement were also observed. No differences were observed in other complications between the two eras. In the post-vaccine era, hematological diseases were the most common underlying conditions (17/18, 94%). The case-fatality rate in the post-vaccine era (1.3%) was similar to that in the pre-vaccine era (2.2%)., Conclusions: A universal childhood varicella vaccination program would ultimately prevent the spread and potential complications of varicella. The result of this study may serve as baseline information as the national vaccination program begins.

Patients of hematological malignancies with neutropenia form one of the most susceptible host groups for microbial infection. In this study, we concentrated on the pulmonary and cutaneous manifestations of invasive fungal infections in leukemic children, aiming to make early diagnosis and intervention. Clinical, laboratory, radiological, and histopathological findings concerning 13 leukemic children who had invasive fungal infection between 1997 and 2002 were retrospectively reviewed. Seventy-seven percent (10/13) of diagnoses were made by fungal cultures and/or by histopathological evidence from various specimens, four from cutaneous lesions and six from pulmonary tissues. Candidiasis was the most common infection (69%), followed by mucormycosis (15%), fusariosis (8%), and aspergillosis (8%). Three episodes of fungemia (23%) were identified. Lung (69%) and skin (69%) were the two most common sites of disseminated fungal infections. A premortem diagnosis was documented in 92% of the patients. Pathogens other than Candida albicans (85%) accounted for the great majority of cases. The case-fatality rate was 31% of disseminated fungal infections. A vigilant assessment of any suspicious lesion by physical and radiological examinations, including a biopsy of the lesions for microbiological and histopathological studies, may provide helpful for early diagnosis of disseminated fungal infections in leukemic children.

Since the late 1990s, the epidemic of human immunodeficiency virus (HIV) infection in Taiwan has expanded dramatically. Pediatric HIV infection has also increased at an alarming pace. Nearly 40% of the HIV-infected children (<10 years) contracted infection through mother-to-child transmission (MTCT). The aims of this study were to evaluate the effects of interventions to prevent MTCT of HIV infection, and to describe the clinical and immunologic characteristics of children born to HIV-seropositive mothers in southern Taiwan. From 1995 to 2003, an observational, longitudinal study of 8 children born to HIV-infected mothers was carried out at a tertiary care university hospital. The median age at enrollment was 0.4 years (range, 1 day-7.5 years), and the mean duration of follow-up was 2.7 years. Four mothers were immigrants from southeastern Asia. Due to antenatal diagnosis of maternal HIV infection, 3 children underwent interventions, including cesarean section, prophylactic use of zidovudine, and bottle-feeding in order to prevent vertical transmission. Five children were born without interventions because of delayed diagnosis of maternal HIV infection. During follow-up, 2 children were found to be HIV-infected and 6 were not infected. The rate of MTCT was lower among patients with interventions (0% vs 40%). In HIV-exposed/non-infected children, the clinical and immunologic assessments were normal during follow-up. Both HIV-infected children progressed to the stage of acquired immunodeficiency syndrome. Early identification of HIV-seropositive pregnant women, implementations to reduce vertical transmission, and introduction of antiretroviral therapy permit optimism in the prevention and treatment of pediatric HIV infection.