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This study examines the influence of harmonious passion (HP) and obsessive passion (OP) to online shopping dependency. The results show that both HP and OP might lead to online shopping dependency and online shoppers with OP are more dependent on online shopping activities. In addition, this study also found out that HP and OP could be denoted as a sequence of different intensities of passion, where HP might be a necessity of OP.

Research on internet technologies has attracted increasing interest in the past decade, as indicated by a growing number of conceptual and empirical articles. Studies [1,2] on internet usage show the following trend during the past two decades. Growth of internet users over the world from 2000 to 2012 has an increase of 566% and Asia has the growth of 842%. Currently, over 2.5 billion people in the world use the internet. 41% of all men and 37% of all women in the world use the internet. 41% of the world’s households can connect to the internet. For people in the developed economies, Internet usage is already a part of daily life activities. Up to 78% of all households in the developed economies are connected to the internet. However, only 28% of all households in the developing world can connect to the internet. Recently, industry practitioners and policy makers have devoted themselves on introducing Internet in the developing and underdeveloped economies. Now, Internet is not a privilege only for people living in developed economies. More than 1 billion Internet users live in Asia. The popularity of Internet is booming in developing and undeveloped economies. In Africa, Internet penetration rate in households from 2009 to 2013 has 27% annual growth. The annual growth in Asia and the Pacific is 15% [1]. Fixed broadband prices are dropped by more than 82% over the past five years as industry report by InternetWorldStats.com. More countries, like Taiwan, South Korea, Hong Kong, Japan, and Bulgaria raise most of their fixed broadband subscriptions to high-speed broadband. In the past five years, mobile devices move to our daily life and make an astonishing growth. The global mobile-cellular penetration rate approaches almost 100% all over the world. In 2013, there are 7.1 billion people in the world and number of mobile-cellular subscriptions is almost 6.8 million, in which more than half of them are in the Asia-Pacific region. Mobile broadband subscriptions have an average annual bandwidth growth rate of 40% from 2007 to 2013. The high popularity of mobile device makes possible of using Internet everywhere as people want. These statistics reveal that our Internet world is changed to higher speed, cheaper price, and more users by both fixed and mobile connection. This tendency generates an urgent demand on technologies and applications on internet and mobile systems. Improving network speed makes heavy bandwidth applications, like multimedia, to be feasible. More users increase system scale for creating the requirement of new system structure. Therefore, we assemble this special issue to provide a platform for advance Internet research. This special issue comprising of seven papers is focused on the various aspects of internet and computer technology development. Five of them are excellent papers selected from the proceedings of the 3rd International Conference on Internet Studies (NETs2012), which were held in Bangkok, Thailand, August 17-19, 2012. The other two papers are selected from the 2nd conference on Applied and Theoretical Information Systems Research (ATISR) held in Taipei, Taiwan, December 27-29, 2012. The aims of NETs2012 and 2nd ATISR conferences are to serve as forums for scholars of relative disciplines of Internet studies, especially on discussing advanced techniques of internet protocol, system development, and computer technology. Papers were selected both including the basis of fundamental ideas and system development techniques. The papers are organized as follows. The paper titled "Framework for Distributed e-Learning Management System" proposes a concept of distributed e-learning management system by using RESTful web services to improve the efficiency limitation of using only one single server. The paper titled "An Exchange Framework for Intrusion Alarm Reduction in Mobile Ad-hoc Networks" presents a secure alarm exchange framework for proactive MANET(Mobile Ad Hoc Network) routing protocols and use Optimized Link State Routing model (OLSR) for the implementation. The paper titled "OOPProPHET: A New Routing Method to Integrate the Delivery Predictability of ProPHET-Routing with OOP-Routing in Delay Tolerant Networks” presents a method to integrate the delivery predictability of ProPHET-Routing with OOPProPHET-Routing method to achieve a good tradeoff between the delivery ratio and the numbers of forwarding packets. The paper titled " A Centralized State Repository Approach to Highly Scalable and High-Availability Parallel Firewall” implements a highly scalable, high-available parallel firewall with centralized state repository intending for high-speed connection environment. The paper titled " An Adaptive Reversible Image Watermarking Scheme Based on Integer Wavelet Coefficients” presents an integer wavelet transform based reversible image watermarking scheme to improve the embedded capacity for raising the performance over network usage. The paper titled "Proposal of an Exploitation-oriented Learning Method on Multiple Rewards and Penalties Environments and the Design Guideline” presents a new XoL(exploitation-oriented Learning) method that can treat multiple rewards and penalties on machine-learning system effectively. The paper titled "Bare metal provisioning to OpenStack using xCAT” presents an approach for extending OpenStack to support bare metal provisioning through xCAT(Extreme Cloud Administration Toolkit) over cloud computing. We would like to thank Prof. Prabhat Mahanti, Editor-in-Chief of Journal of Computers, and Dr. George J. Sun, Executive Editor of Academy Publisher, for giving us the opportunity to organize this special issue and for their great help in the organization of this issue. We thank all authors for their submissions and all reviewers for their sedulous work in evaluating these submissions. We sincerely hope that you enjoy reading these distinguished papers.

A case of furuncular myiasis was reported for the first time in a 29-year-old young Taiwanese traveler returning from an ecotourism in Peru. Furuncle-like lesions were observed on the top of his head and he complained of crawling sensations within his scalp. The invasive larva of botfly, Dermatobia hominis, was extruded from the furuncular lesion of the patient. Awareness of cutaneous myiasis for clinicians should be considered for a patient who has a furuncular lesion and has recently returned from a botfly-endemic area.

Background This study investigated whether long-term treatment with antiepileptic drugs (AEDs) had negative effects on statural growth and serum calcium levels in children with epilepsy in Taiwan. Methods Children with epilepsy treated with one prescription of AEDs (monotherapy) for at least 1 year were selected. The AEDs included valproic acid (VPA; Deparkin) in 27 children (11 boys and 16 girls) aged 4-18 years, oxcarbazepine (Trileptal) in 30 children (15 boys and 15 girls) aged 5-18 years, topiramate (Topamax) in 19 children (10 boys and 9 girls) aged 6-18 years, and lamotrigine (Lamicta) in eight children (5 boys and 3 girls) aged 5-13 years. Patients with a history of febrile convulsions were selected as the controls. Results One year of VPA treatment significantly impaired the statural growth of pediatric patients with epilepsy (p Conclusions These results raise serious concerns about the growth of pediatric epilepsy patients who use AEDs, and potentially the need to closely monitor growth in children with epilepsy and adolescents under AED treatment, especially VPA.

The validity and reliability of serum Tg measurements is central to accurate diagnosis and cost-effective management of patients with differentiated thyroid carcinoma. Serum Tg is one of the most difficult biochemical tests for a laboratory to maintain at a high level of precision and reliability across the long clinical sampling interval typically employed when monitoring this condition. Physicians should be aware that the diagnostic value of serum Tg measurement is method-dependent, and that intermethod differences still approach 30% even after methods have been standardized on the new CBR reference preparation. This dictates that, ideally, serial serum Tg measurements in a patient should always be made in the same laboratory by the same method. Physicians need to consider a number of factors before selecting a laboratory to perform Tg measurements in patients with differentiated thyroid carcinoma. These factors include assay sensitivity, as judged by the discrimination between lower limit of the euthyroid range and the functional sensitivity limit, as well as assay specificity, especially with respect to serum TgAb interference. laboratories should use a sensitive TgAb immunoassay (not hemagglutination) to prescreen sera for TgAb and report the TgAb level if positive. Furthermore, it is the laboratory's responsibility to advise physicians fully about any change in Tg method as well as the direction of TgAb interference expected with that method. When TgAb is present, the serum Tg level should be a measure of the total (free and TgAb-bound) serum Tg level. Typically, IMA methods underestimate the serum total Tg level, especially when serum TSH is suppressed, whereas RIA methods tend to overestimate the serum total Tg level. The interpretation of a serum Tg level in a TgAb-positive patient should be made with caution and with consideration to any changes in TgAb levels. Serial TgAb monitoring of TgAb-positive patients may provide a physician with additional prognostic information on outcome. Precise, reproducible serial serum Tg measurements are critical, especially when patients are judged to have a high risk for recurrence, have tumors that are inefficient serum Tg secretors (as judged from the relationship between the preoperative serum Tg value and tumor mass or the serum Tg response to endogenous TSH stimulation), or have very high serum Tg values requiring dilution. In such patients, the banking of left-over sera (frozen) for concurrent intra-assay remeasurement with a more recent specimen significantly increases the clinical value of the test and facilitates earlier detection of recurrence or progression (see Fig. 2). Differentiated thyroid carcinoma is frequently diagnosed in young patients with decades of life expectancy. After their initial surgical treatment, these patients need life-long monitoring, because late recurrences and death from the disease can occur. The use of high-quality serum Tg measurements can significantly improve the cost-effective management of this disease by identifying low-risk patients in whom periodic radioiodine scans or therapy may be deferred in favor of serial serum Tg monitoring (on L-T4 suppression therapy). With this approach, expensive imaging procedures can be targeted to the minority of patients who are at high risk for recurrence.

The interactive relationship between Cu deficiency and depressed synthesis of certain neurotransmitters has been recognized. To investigate the effects of dietary Cu supplementation on the catecholamine levels in genetically obese mice, male obese (ob/ob) mice and their lean (+/?) counterparts were administered either a control diet (4.0 mg/kg) or a Cu-supplemented diet (50 mg/kg) for 4 wk. The ob/ob mice that were fed a control diet showed lower liver and higher plasma levels of Cu. Depressed levels of plasma and brain catecholamines were also found in ob/ob mice that were fed the control diet. The ob/ob mice that received a Cu-supplemented diet showed significant increases in the levels of catecholamine in the plasma and brain. This study showed that catecholamine levels in ob/ob mice can be increased by dietary Cu supplementation. However, the interaction between Cu and sympathetic nervous activity in obesity was not elucidated in this study.

Profunda femoris artery (PFA) injury is a rare complication following fracture of the femoral neck. Here, we present a case of a patient with an injured branch of the PFA following internal fixation with cannulated hip screws for a femoral neck fracture. Computed tomography angiography revealed active bleeding from the ascending and descending branches of lateral femoral circumflex artery. We suspected that the cause of the vessel laceration was the sharp tip of the guidewire used during surgery or the closed reduction performed during surgery. The patient was successfully treated with coil embolization. With early recognition and prompt radiological intervention, this rare complication following fracture fixation surgery can be treated without the need for additional surgery.

Although Neisseria meningitidis is one of the major causes of meningitis in children and adolescents, meningococcal disease should also be considered as part of the differential diagnoses in the newborn period.

A 10-year-old girl with no previous history developed a sore throat without fever 4 weeks prior to admission. Antibiotics were not given and the symptoms subsided within 4–5 days. About 2 weeks later, she developed palpebral oedema and decreased urine output followed by low-grade fever during a 5-day vacation in Bali. She did not receive any medical treatment except for some antipyretic drug. Two days later, she was referred to our hospital because of fever and facial swelling. On admission, physical examination revealed a body temperature of 39.8 C, pulse rate 118/min, respiratory rate 38/min and blood pressure of 132/77 mm Hg. She also developed an erythematous rash over the neck, trunk and proximal regions of all limbs. The rash was evanescent, not itching and became prominent with the development of fever, with some raised areas and a serpiginous border (Fig. 1). Her throat showed congestion and tonsillar enlargement. Cardiac examination revealed a grade 2/6 systolicmurmurover theapexof theheart.Laboratory investigations revealed the following: haemoglobin 10.6 g/ dl, elevated ESR at 30 mm/h, normal total and differential white blood cell counts, normal blood urea nitrogen and serum creatinine. Urinalysis showed proteinuria (+++), 25–30 RBCs/hpf and abundant dysmorphic RBCs. The 24-h urine collection showed aprotein loss of 2.838 g/day. Creatinine clearance was 44 ml/min. Blood and urine cultures were negative. Serum complement levels revealed decreased C3 (14.6 mg/dl,normal 79–152 mg/dl) and normal C4 (26.4 mg/dl). Rheumatoid factor was negative and the anti-double strainDNAantibodywas negative. A chest X-ray film revealed cardiomegaly and an ECG showed poor R wave progression. Echocardiography showed mild mitral, aortic valve regurgitations and tiny tricuspid, pulmonary valve insufficiencies. Moreover, pericardial effusion was also present.

Streptococcus viridans is usually considered to be nonpathogenic in healthy patients. Some strains become penicillin-resistant and cause life-threatening infections in immuno-compromised patients. We report an immunocompetent boy who had community-acquired S. viridans pneumonia that was resistant to penicillin. Clinicians should note local patterns of virulence and antibiotic resistance in S. viridans and adjust treatment strategies accordingly.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, and CD4+T cells form the core immunopathogenic cascade leading to chronic inflammation. Traditionally, Th1 cells (interferon-γ-producing CD4+T cells) driven by interleukin 12 (IL12) were considered to be the encephalitogenic T cells in MS and experimental autoimmune encephalomyelitis (EAE), an animal model of MS. Currently, Th17 cells (Il17-producing CD4+T cells) are considered to play a fundamental role in the immunopathogenesis of EAE. This paper highlights the growing evidence that Th17 cells play the core role in the complex adaptive immunity of EAE/MS and discusses the roles of the associated immune cells and cytokines. These constitute the modern immunological basis for the development of novel clinical and preclinical immunomodulatory therapies for MS discussed in this paper.

The study discusses individuals' skepticism to blog product review by an empirical survey. ANCOVA and Partial Least Square (PLS) were used to analysis the data. This study found that subjects were much skeptical about advertisement than blog product reviews. The influences on skepticism of influence and experience were moderated by product. Skepticism will reduce of the credibility of message and induce negatively product attitude. The credibility will positively influence subjects' product attitude and then lead to intention to purchase and to recommend the product to others.

Congenital nasal epidermoid cyst without associated facial dysmorphism is an uncommon anomaly that is often asymptomatic. We report a case of occult nasal epidermoid cyst in a 12-year-old boy with initial nonspecific symptoms of fever, headache, abdominal pain, vomiting, and diarrhea. An enhanced magnetic resonance imaging (MRI) showed a cystic lesion in the frontal skull base with expansion of the foramen cecum and the perpendicular plate of the ethmoid bone, accompanied with meningitis. An emergent surgical intervention was undertaken, and an infected epidermoid cyst was confirmed by pathology. He recovered uneventfully during a 4-week treatment with parentally-administered antibiotics. This significant case report demonstrates the importance of MRI in the early diagnosis of a life-threatening intracranial infection from an otherwise occult infected congenital nasal epidermoid cyst in children.

An outbreak of methicillin-susceptible Staphylococcus aureus pyoderma occurred in the nursery of a tertiary-care referral center. All strains retrieved from the outbreak, including one from a nurse's infected finger, were typed by arbitrarily primed polymerase chain reaction and automated ribotyping. The results indicated that the spread of the outbreak was probably facilitated by contamination of the nurse with paronychia.

Acute gouty arthritis results from monosodium urate (MSU) crystal deposition in joint tissues. Deposited MSU crystals induce an acute inflammatory response which leads to damage of joint tissue. Pycnogenol (PYC), an extract from the bark of Pinus maritime, has documented antiinflammatory and antioxidant properties. The present study aimed to investigate whether PYC had protective effects on MSU-induced inflammatory and nitrosative stress in joint tissues both in vitro and in vivo. MSU crystals upregulated cyclooxygenase 2 (COX-2), interleukin 8 (IL-8) and inducible nitric oxide synthase (iNOS) gene expression in human articular chondrocytes, but only COX-2 and IL-8 in synovial fibroblasts. PYC inhibited the up-regulation of COX-2, and IL-8 in both articular chondrocytes and synovial fibroblasts. PYC attenuated MSU crystal induced iNOS gene expression and NO production in chondrocytes. Activation of NF-κB and SAPK/JNK, ERK1/2 and p38 MAP kinases by MSU crystals in articular chondrocytes and synovial fibroblasts in vitro was attenuated by treatment with PYC. The acute inflammatory cell infiltration and increased expression of COX-2 and iNOS in synovial tissue and articular cartilage following intra-articular injection of MSU crystals in a rat model was inhibited by coadministration of PYC. Collectively, this study demonstrates that PYC may be of value in treatment of MSU crystal-induced arthritis through its anti-inflammatory and anti-nitrosative activities.

Background and PurposeLimited information is available regarding the role Panton-Valentine leukocidin (PVL) plays in methicillin-susceptible Staphylococcus aureus (MSSA). In this study, we compared the frequency of the PVL gene between MSSA strains isolated from patients with MSSA infections and MSSA strains isolated from patients with evidence of MSSA nasal colonization. We also explored the role that the PVL toxin plays in the ability of MSSA to cause disease as well as the phylogenetic relationship between these S aureus strains.MethodsThe presence of MSSA strains was screened among children aged

Periodic fever, aphthous stomatitis, pharyngotonsillitis, cervical adenopathy (PFAPA) syndrome, which is characterized by periodic episodes of high fever, aphthous stomatitis, pharyngitis, and cervical adenitis, is of unknown etiology and manifests usually before 5 years of age. A patient with periodic fever, aphthous stomatitis, pharyngotonsillitis, cervical adenopathy syndrome simultaneously presenting with genital ulcers has not been reported previously. We describe a 12-year-old Chinese girl with a 2-year history of periodic fever, aphthous stomatitis, pharyngotonsillitis, cervical adenopathy syndrome who exhibited vulvar ulcers accompanying an episode of febrile periodic fever, aphthous stomatitis, pharyngotonsillitis, and cervical adenopathy. Although during a 1-year follow-up this girl did not manifest typical symptoms/signs of Behçet's disease except recurrent oral aphthae and genital ulcers, it is possible that periodic fever, aphthous stomatitis, pharyngotonsillitis, cervical adenopathy syndrome and Behçet's disease could have overlapping manifestations. Furthermore, this report would add to the evidence of a wide variation in the clinical symptomatology of PFAPA syndrome.

Varicella is a common and mild disease in healthy children. However, when patients are in immunocompromised conditions, such as receiving chemotherapy for cancer treatment, they are highly vulnerable and it can even prove lethal. Herein, we report a 14-year-old boy with acute lymphoblastic leukemia who was receiving chemotherapy for induction with vincristine, idarubicin, L-asparaginase, and prednisolone, presented with typical varicella skin lesions and varicella-zoster virus was detected in his serum by real-time polymerase chain reaction (PCR). His condition was advanced to multiple organs failure, including fulminant hepatitis, disseminated intravascular coagulation, and myocarditis despite acyclovir administration. After a combined therapy with intravenous acyclovir and high-dose intravenous immunoglobulin, his condition was dramatically improved. We suggest that IVIG may be used immediately with acyclovir when immunocompromised patients with varicella advanced to dissemination are identified.

Summary Both erythropoietin (EPO) and haem oxygenase-1 (HO-1), an anti-oxidative stress protein, have proven protective roles in experimental autoimmune encephalomyelitis (EAE), a reliable animal model of multiple sclerosis. In this study, EPO delivered intraperitoneally could reduce disease severity in myelin oligodendrocyte glycoprotein (MOG)–EAE mice. To assess the effect of EPO on endogenous HO-1 in EAE, we investigated expression of HO-1 mRNA by real-time polymerase chain reaction (RT–PCR), protein expression centrally and peripherally by Western blot and immunohistochemistry and mean fluorescence intensity of splenic HO-1 by flow cytometry. A significantly higher expression of HO-1 in both the central nervous system (CNS) and spleen was shown in EPO-treated MOG–EAE mice than in controls. We further examined the immunomodulatory effect of EPO in EAE, and via RT–PCR demonstrated significantly lower expression of interferon-γ, interleukin (IL)-23, IL-6 and IL-17 mRNA, and significantly higher expression of IL-4 and IL-10 mRNA in CNS of EPO-treated MOG–EAE mice than in controls. Using flow cytometry, we also observed a significantly decreased ratio of both T helper type 1 (Th1) and Th17 lymphocyte subsets isolated from CNS and a significantly increased ratio of splenic regulatory CD4 T cells in EPO-treated MOG–EAE mice. In addition, we demonstrated that MOG-specific T cell proliferation was lower in the EPO-treated group than in controls and showed amelioration of EAE by adoptive transfer of splenocytes from EPO-treated MOG–EAE mice. Together, our data show that in EAE, EPO induction of endogenous HO-1 and modulation of adaptive immunity both centrally and peripherally may involve the repression of inflammatory responses.

Skin infection and/or nasal carriage of Staphylococcus aureus in children with atopic dermatitis (AD) is a risk factor for exacerbating disease or subsequent recurrent S. aureus infection. The purpose of the study is to evaluate the antibiotic susceptibilities of S. aureus strains from AD children and determine the most appropriate choice of antibiotics.Nasal swabs from 168 healthy children with AD and 20 AD children with concurrent skin and soft-tissue infections (SSTI) were collected in 2005-2008. S. aureus strains were further analyzed for and compared with antibiotic susceptibilities.There were 78 (46.4%) healthy children with AD colonized with S. aureus, and 24 (30.8%) were methicillin-resistant S. aureus (MRSA). Among the 20 SSTI-infecting strains, 12 (60%) were MRSA. Antimicrobial susceptibility testing showed that, after penicillin, colonizing and SSTI-infecting strains had the highest rates of resistance to erythromycin (50% and 70%, respectively). All isolated strains were susceptible to vancomycin, rifampin, and mupirocin. Multi-drug resistance was found in 70% of the colonizing and 50% of the SSTI-infecting strains. D-test assay revealed inducible clindamycin resistance in 75% of the colonizing strains. The most prevalent resistance gene was ermB which was present in 94.9% and 92.9% of colonizing and SSTI-infecting strains, respectively.This study found that colonizing and SSTI-infecting strains of S. aureus from AD children had a high prevalence of MRSA and multi-drug resistance. Trimethoprim-sulfamethoxazole, rifampin, fusidic acid and mupirocin appear to be more suitable for treatment and decolonization of S. aureus in AD children.

Peroxisome proliferator-activated receptor-gamma (PPAR-gamma), COX-2 and 15-lipoxygenase (LOX)-1 have been shown to be involved in tumour growth. However, the roles of PPAR-gamma, COX-2 or 15-LOX-1 in gastric tumourigenesis remain unclear. Here, we investigate the role of 15-LOX-1 induction by honokiol, a small-molecular weight natural product, in PPAR-gamma and COX-2 signalling during gastric tumourigenesis.Human gastric cancer cell lines (AGS, MKN45, N87 and SCM-1) were cultured with or without honokiol. Gene and protein expressions were analysed by RT-PCR and Western blotting respectively. Small interfering RNAs (siRNAs) for COX-2, PPAR-gamma and 15-LOX-1 were used to interfere with the expressions of these genes. A xenograft gastric tumour model in mouse was used for in vivo study.PPAR-gamma and COX-2 proteins were highly expressed in gastric cancer cells. Inhibitors, or siRNA for COX-2 or PPAR-gamma, significantly decreased cell viability. Honokiol markedly inhibited PPAR-gamma and COX-2 expressions in gastric cancer cells and tumours of xenograft mice, and induced apoptosis and cell death. Honokiol markedly activated cellular 15-LOX-1 expression and 13-S-hydroxyoctadecadienoic acid (a primary product of 15-LOX-1 metabolism of linoleic acid) production. 15-LOX-1 siRNA could reverse the honokiol-induced down-regulation of PPAR-gamma and COX-2, and cell apoptosis. 15-LOX-1 was markedly induced in tumours of xenograft mice treated with honokiol.These findings suggest that induction of 15-LOX-1-mediated down-regulation of a PPAR-gamma and COX-2 pathway by honokiol may be a promising therapeutic strategy for gastric cancer.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in skin and soft tissues are increasing in children in Taiwan. This study investigated the outcomes of therapy with or without appropriate antibiotics among children with CA-MRSA skin and soft tissue infections (SSTIs), and analyzed the outcomes of management among children with Panton-Valentine leukocidin (PVL)-positive strains and PVL-negative strains.In this retrospective study, data for CA-MRSA SSTIs from 107 children younger than 18 years were analyzed. Worsening infection or other surgical therapy were considered treatment failure. Antimicrobial therapy was considered appropriate if it included at least 1 agent to which the organisms showed in vitro susceptibility.The rate of successful treatment was 90.7% (97 episodes). Eighty six children (80.4%) underwent incision and drainage as part of their initial therapy. Four of 5 children (80%) treated with an appropriate antibiotic initially were treated successfully, compared with 93 of 102 children (91.2%) who did not receive an appropriate antibiotic agent (p = 0.394; Fisher's exact test). Treatment failed for 5 of the 39 patients (12.8%) with PVL-positive SSTI CA-MRSA compared with only 1 treatment failure among 11 patients (9.1%) with PVL-negative SSTI CA-MRSA (p = 1.0; Fisher's exact test).The high rate of successful treatment among children with uncomplicated CA-MRSA SSTIs, even when given inappropriate antibiotic therapy, suggests that treatment of these uncomplicated infections without appropriate antibiotic therapy is possible. Incision and drainage may play an important role in the treatment of uncomplicated SSTIs.

Neglected or chronic rupture of the Achilles tendon usually needs a reconstruction procedure. Many graft sources have been reported for this procedure, such as a proximal V-Y gastrocnemius tendon flap, flexor hallucis longus tendon, fascia lata, plantaris tendon, synthetic materials, and peroneus brevis. However, how to fix the graft at the calcaneal site remains controversial.An alternative technique to anatomically reconstruct the Achilles tendon using an autogenous peroneal longus tendon with EndoButton-CL fixation at the calcaneal site for treatment of a patient who had a chronic neglected rupture of the Achilles tendon is described.The patient was allowed to begin gentle exercise, such as swimming and cycling 12 weeks after surgery, and encouraged to augment rehabilitation of hindfoot eversion and ankle plantar flexion. The ankle plantar flexion and hindfoot eversion strength was not reduced after active rehabilitation in 2.5 years of follow-up.Our technique reuses two small central incisions, thus, preserving skin integrity as much as possible to reduce wound breakdown or infection. The management of chronic or neglected Achilles tendon rupture by autogenous peroneal longus tendon with EndoButton-CL fixation at the calcaneal site is an anatomic and safe, but technically demanding technique.

To investigate the therapeutic potential of decoy receptor 3 (DcR3) in multiple sclerosis (MS), we used intrathecal (IT) administration of DcR3 into C57/BL6 mice with experimental autoimmune encephalomyelitis (EAE). DcR3 significantly ameliorated EAE symptoms as shown by a lower clinical score and less inflammation in the spinal cord. The expression of TNF-alpha, IFN-gamma, and IL-17 was lower in the spinal cord in IT DcR3-treated mice. Flow cytometry showed a drastic reduction in IL-17-producing CD4 T cells, slightly fewer IFN-gamma producing CD4 T cells and more IL-4-producing CD4 T cells isolated from the central nervous system (CNS) of IT DcR3-treated mice than of controls. Myelin oligodendrocyte glycoprotein (MOG)-specific T cell proliferation was significantly inhibited in DcR3-treated mice. The IL-17 concentration was lower and the IL-4 concentration higher in the supernatants of MOG-stimulated splenocytes from DcR3-treated mice. An adoptive transfer study showed that splenocytes from DcR3-treated mice retained this disease-inhibiting ability. Our data suggest that DcR3 has potential as a suppressor of CNS inflammation in EAE, which may be attributed to either direct inhibition of CNS inflammation or suppression of encephalitogenic Th17 cells. In conclusion, we demonstrate a therapeutic effect of DcR3 in EAE, suggesting its potential for treating human MS.

Lack of consumer trust is a critical obstacle to the success of online retailing. Knowledge is one important factor influencing the level of trust. However, there is no consensus on the relationship between knowledge and trust. Some studies argued a negative relationship between knowledge and trust while the others argued positive. This study discussed the relationship among knowledge, trust in online shopping, and the intention to go shopping online. The results revealed that knowledge is positively associated with trust and online shopping activities. In other words, people who know more about online shopping will trust and go shopping more online. Online retailing practice should make the public knowledgeable about online transaction security mechanisms to build users’ trust in online shopping.

Background The surgical treatment methods for recurrent dislocation of peroneal tendons are controversial. A simpler and more effective treatment method is valuable for these patients. Hypothesis A new rerouting operation designed by the authors will have satisfactory results and avoid disadvantages of the old rerouting methods. Study Design Case series; Level of evidence, 4. Methods Seventeen consecutive male patients with unilateral recurrent peroneal tendon dislocations were treated by transposition of the calcaneofibular ligament from the tubercle of calcaneofibular ligament with a 1 × 1 × 1 cm3 bone block and elevation of this tubercle with another 1 × 1 × 1 cm3 calcaneal bone block, which were fixed by a 3.5-mm cancellous screw with a washer. All patients received clinical and radiographic follow-up for at least 2 years. The preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scales were used for functional results assessment. Results All bone transposition sites healed radiographically at 6 weeks after surgery. Four patients had transient numbness over the lateral aspect of the injured foot, and 3 patients had swelling and pain involving the operative sites. All complications resolved by 3 to 5 months after the operation. No recurrent dislocation of the peroneal tendons was noted. The mean AOFAS ankle-hindfoot scale improved significantly, from 73.4 ± 5.5 preoperatively to 100 at 2- to 5-year follow-up (P Conclusion This method is a simple, reliable, and reproducible operation to treat recurrent dislocation of the peroneal tendons. It allows early return to daily, working, and sports activities with satisfactory results.

Sublingual immunotherapy has been applied for allergic diseases, but whether sublingual immunization in neonates can prevent sensitization has not been studied. In this study, we evaluate the effect of neonatal sublingual vaccination with native or denatured allergens alone or plus adjuvant on allergy prevention. Newborn BALB/c mice were sublingually vaccinated daily for the first 3 days with native or denatured ovalbumin (OVA) only, or combined adjuvant CpG or cholera toxin (CT). They were sensitized with OVA adsorbed onto alum 7 weeks after the last vaccination. Specific secretory IgA antibody responses were readily induced by neonatal vaccination with antigen plus CpG or CT, but not with antigen alone. Whereas vaccination with denatured OVA plus CpG markedly enhanced T helper 1 (Th1) responses and inhibited IgE production, vaccination with denatured OVA plus CT increased cervical lymph node cell production of interleukin-4 (IL-4), IL-5, IL-6, and serum IgG1 responses. These data demonstrate that neonatal sublingual vaccination with denatured OVA and CpG not only preferentially induces systemic Th1 responses and mucosal immunity, but also simultaneously abrogates IgE production. Neonatal sublingual vaccines may play a role for the strategy of allergy prevention.

This study presents an automatic merchandise classification approach based on similarity of product attributes. The proposed approach can automatically separate products into appropriate groups, allow consumers to rapidly and conveniently find products with similar attributes, and considerably reduce the workload associated with managing Internet stores. To illustrate the usefulness of the automatic merchandise classification method proposed here, this study includes a prototype website for making a practical comparison between this method and existing classification methods. An experiment involving 205 participants revealed that this method not only increased the efficiency of website management, but also permitted consumers to easily identify the products they required. Participants also indicated greater satisfaction when using the method proposed in this study.

BACKGROUND: Nasal carriage of Panton-Valentine leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA) is associated with community associated disease. The risk factors for and characteristics of PVL-positive MRSA colonization in the healthy pediatric population are not well understood. METHODS: Anterior nares cultures were obtained from healthy children < or =14 years of age presenting for health maintenance visits or attending 1 of 8 kindergartens during a 3-year period. A case-control study and molecular typing studies were performed. RESULTS: A total of 131 (8.1%) of 1615 children had nares cultures positive for MRSA, and 25 (1.5%) were colonized with PVL-positive MRSA. Nasal colonization of PVL-positive MRSA was significantly higher in 2006 than in 2004 (2.8% versus 0.7%; P = 0.006). By multivariate analysis, antibiotic use during the past 12 months (odds ratio, 29.37; 95% confidence interval, 10.72-80.50; P < 0.001) was the major risk factor associated with PVL-positive MRSA colonization in healthy children. Comparison of hospital MRSA strains with the community colonization strains by antimicrobial susceptibility testing, macrolide-lincosamide-streptogramin resistance gene testing, staphylococcal cassette chromosome mec typing, exotoxin profiling, and pulsed-field gel electrophoresis typing revealed that clonal spread of PVL-positive MRSA distinct from clinical hospital strains contributed to the high PVL-positive MRSA burden in the community. CONCLUSIONS: Nasal PVL-positive MRSA colonization in healthy children with no relationship to the hospital setting has increased significantly in the past 3 years, suggesting that it may be a major factor in the emergence of community-acquired MRSA disease in Taiwan. Previous antibiotic use was associated with PVL-positive MRSA colonization.

This study examined the reasons players help others in the virtual space of online games. Results of an online empirical survey indicated that both altruism and reciprocity influence prosocial behavior simultaneously. Additionally, the study found that male players are more likely than female players to seek friendship of opposite sex.

Purpose The aim of this study was to compare the initial fixation strength of tendon grafts between different sizes of bioabsorbable interference screws (BioScrew; Linvatec, Largo, FL) with bioabsorbable bead (EndoPearl; Linvatec) augmentation through biomechanical analysis of a porcine femoral bone model. Methods Forty pairs of porcine femurs and porcine flexor digitorum profundus tendons were divided into control and study groups. In the control group 8 × 30–mm BioScrews alone (n = 10) were inserted, whereas different sizes of BioScrews, measuring 7 × 30 mm (n = 10), 8 × 30 mm (n = 10), and 9 × 30 mm (n = 10), with 8–mm EndoPearl augmentation were inserted individually for fixation of tendon grafts in the study groups. All specimens were cyclically loaded with axial forces between 50 and 250 N at 1 Hz for 3,000 cycles and then incrementally loaded to failure at a rate of 150 mm/min. Results BioScrews with EndoPearl augmentation had a significantly higher failure load than BioScrews alone (8–mm BioScrew alone v 8–mm BioScrew and EndoPearl, P v 7 mm and 9 mm, P = .201 and P = .871, respectively), stiffness (8 mm v 7 mm and 9 mm, P = .789 and P = .823, respectively), displacement (8 mm v 7 mm and 9 mm, P = .695 and P = .781, respectively), and bone mineral density ( P = .728 for all comparisons) except insertion torque (8 mm v 7 mm and 9 mm, P = .045 and P = .518, respectively) between study groups. Less tendon laceration by the screw thread was noted in the group in which smaller-sized BioScrews were used. Conclusions When EndoPearl augmentation was used, smaller-sized BioScrews (BioScrew size 1 mm smaller than bone tunnel) offered equivalent graft fixation strength to BioScrews of similar or larger sizes. Clinical Relevance Smaller-sized BioScrews can be chosen if EndoPearl augmentation has been used, and EndoPearl augmentation may reduce the risk of tendon rupture while BioScrews are inserted.

Surveillance data of colonization by Haemophilus influenzae in Taiwan are lacking. This study aimed to define the nasopharyngeal carriage rate of H. influenzae among children younger than 5 years in northern Taiwan, and to determine the antibiotic susceptibility, serotype and the clonal relationship of these isolates.Nasopharyngeal specimens were obtained from 511 healthy children younger than 5 years. All H. influenzae isolates were serotyped. The minimal inhibitory concentrations for various antibiotics were determined. Pulsed-field gel electrophoresis (PFGE) was used for clonal analysis.Among 511 children, 269 (52.6%) had been vaccinated with at least one dose of H. influenzae type b (Hib) conjugate vaccine, 236 (46.2%) were unvaccinated and 6 (1.2%) had no vaccination records available. Twenty six H. influenzae strains were isolated. There were three Hib isolates and the others were nontypeable H. influenzae (NTHi). The carriage rate for Hib was 0.6% (3/511) and of NTHi was 5% (23/511). Three (1.27%) of the 236 unvaccinated children were carriers of Hib, whereas none of the 269 vaccinated children carried Hib. Two out of the three Hib isolates and 14 (60.9%) of 23 NTHi isolates were ampicillin-resistant. Multidrug resistance was found in 7 (26.9%) of the isolates. Among the isolates, 61.5% were beta-lactamase producers; there were no beta-lactamase-negative ampicillin-resistant isolates. The PFGE restriction patterns showed a wide diversity of genotypes.There is very low nasopharyngeal carriage of Hib among children younger than 5 years in northern Taiwan. This may explain why the incidence of invasive Hib disease is also low in Taiwan. In addition, we found a high prevalence of beta-lactamase-positive ampicillin-resistant nasopharyngeal H. influenzae isolates.

Consumer trust is a critical enabler to the success of online retailing and knowledge is one important factor influencing the level of trust. However, there is no consensus on the relationship between knowledge and trust. Some studies argued a negative relationship between knowledge and trust while the others argued positive. This study discussed the relationship between knowledge, trust in online shopping, and the intention to go shopping online. The results revealed that knowledge is positively associated with trust and online shopping activities. In other words, people who know more about online shopping will trust and go shopping more online. Online retailing practice should make the public knowledgeable about online transaction security mechanisms to build userspsila trust in online shopping.

This paper proposes a novel method of analyzing data to find important information about the context of research papers. The proposed CCTVA (Collecting, Cleaning, Translating, Visualizing, and Analyzing) method helps researchers find the context of papers on topics of interest. Specifically, the method provides visualization information that maps a research topic's evolution and links to other papers based on the results of Google Scholar and CiteSeer. CCTVA provides two types of information: one type shows the paper's title and the author, while the other shows the paper's title and the reference. The goal of CCTVA is enable both novices and experts to gain insight into how a field's topics evolve over time. In addition, by using linkage analysis and visualization, we identify five special phenomena that can help researchers conduct literature reviews.

[corrected] Chilaiditi's syndrome (CS) is the condition for which radiological evidence of symptomatic colonic interposition between the liver and diaphragm is presented, although the syndrome is infrequently seen.We reviewed patients with CS in our hospital in the past 15 years (3 patients, from July 1990 to June 2005) and case reports in the literature (10 patients). The diagnosis was made by abdominal computed tomography or roentgenograms of the chest and abdomen.There were thirteen patients (6 males, 7 females) enrolled in our study. Their ages ranged from 6 months to 11 years old. The predisposing factors included aerophagia (46.2%), diaphragmatic eventration (23.1%), constipation (23.1%), and abdominal blunt trauma (7.7%). The common clinical manifestations included abdominal pain (69.2%), vomiting (38.5%), abdominal distension (30.7%), constipation (23.1%), and respiratory distress (23.1%). The roentgenograms of the chest and abdomen (n=13) showed elevation of the right hemidiaphragm occupied with mass-like opacity. Abdominal computed tomography (n=4) revealed hepatodiaphragmatic colonic interposition. Most patients were managed conservatively (n=8). Only four patients with recurrent symptoms received surgical correction. All of them had relief of symptoms after treatment. CS appears to be a clinically and radiologically benign syndrome and has a good outcome. For its management, conservative treatment is the first-line option. Other methods includes surgery.We concluded that this rare syndrome could be kept in mind when young children present with recurrent respiratory distress, abdominal distension or abdominal pain accompanied by predisposing factors such as aerophagia, constipation, diaphragmatic eventration, or blunt trauma. Operative correction is necessary if recurrent symptoms are present.

Hafnia alvei infections are uncommon and occur mainly in adult patients featuring underlying illnesses. Its isolation in pediatric cases is even more unusual. We report a rare case of sepsis combined with urinary tract infection caused by H. alvei in a 39-day-old infant who did not appear to feature any underlying disease. The infant was successfully treated with ceftriaxone over a 14-day period. In this case, we want to remind clinicians that the possibility of an extraintestinal invasive infection such as bacteremia or urinary tract infection caused by H. alvei should be taken into account in young infants who feature no apparent underlying disease. [J Formos Med Assoc 2007;106(3 Suppl):S39-S43]

In previous work, virtual force has been used to simulate the motions of virtual creatures, such as birds or fish, in a crowd. However, how to set up the virtual forces to achieve desired effects remains empirical. In this work, we propose to use a genetic algorithm to generate an optimal set of weighting parameters for composing virtual forces according to the given environment and desired movement behaviour. A list of measures for composing the fitness function is proposed. We have conducted experiments in simulation for several environments and behaviours, and the results show that compelling examples can be generated with the parameters found automatically in this approach.

Objective Transforming growth factor/Smad family member 3 (TGF)-β/Smad3 signalling is essential for maintaining articular cartilage. A relationship between the genetic variants of TGF-β itself, TGF-β signalling and binding molecules, and osteoarthritis (OA) has been reported. Although variants of candidate genes have become prime targets for genetic analysis, their detailed interplay has not been documented. Our goal was to establish whether single nucleotide polymorphisms (SNPs) of TGF-β1, TGF-βRI, Smad3 and tissue inhibitor of metalloproteinases 3 (TIMP3), and their interactions, are associated with knee OA. Design We performed a case–control association study and genotyped 518 knee patients with OA and 468 healthy controls. All participants were genotyped for TGF-β1 (rs1800469C/T), TGF-βRI (rs1590A/G), Smad3 (rs12901499A/G and rs6494629T/C), and TIMP3 (rs715572G/A and rs1962223G/C) polymorphisms by polymerase chain reaction–restriction fragment length polymorphism analysis. Multifactor dimensionality reduction (MDR) was used to identify gene–gene interactions. Results Significant associations were observed for TIMP3 rs715572G/A polymorphisms in knee patients with OA and healthy individuals. The GA heterozygote in TIMP3 (rs715572G/A) was significantly associated with OA (p=0.007). Patient stratification using the Kellgren–Lawrence grading scale showed significant differences in TIMP3 rs715572G/A genotypes between grade 4 knee OA and controls. By MDR analysis, a two-locus model (Smad3 rs6494629T/C and TIMP3 rs715572G/A) of gene–gene interaction was the best for predicting knee OA risk, and its maximum testing accuracy was 57.55% and maximum cross-validation consistency was 10/10. Conclusions TIMP3 rs715572G/A is a candidate protective gene for severe knee OA. Gene–gene interactions between Smad3 rs6494629T/C and TIMP3 rs715572G/A polymorphisms may play more important protective roles in knee OA.

Purpose: Central venous catheterization has become the most important treatment in modern clinical medicine; however, the incidence of central line-associated bloodstream infection (CLABSI) might increase if strict sterile precautions were not followed. Hence, many countries are implementing central venous catheter (CVC) care bundle, which includes hand hygiene, maximal barrier precaution, chlorhexidine skin antisepsis, optimal catheter site selection avoiding femoral site, bundle checklist to supervise catheterization procedure, daily review of line necessity with prompt removal of unnecessary lines. These bundle cares were proved to be effective to significantly reduce the CLABSI incidence. Methods: The study described the processes and results of implementing the CVC care bundle from March 2013 to May 2014 in an 1800 beds medical center in northern Taiwan. The CLABSI was collected and compared between preintervention phase (March 2012eFebruary 2013) and post-intervention phase (March 2013eMay 2014). We organized a special cross-functional team chaired by associate superintendent of the hospital and developed the CVC cart. We also held CVC care bundle educations for all healthcare workers. Audit teams were set and compliance of bundle elements were monitored. Results: After using CVC care bundle elements and equipment, combined with monthly review and weekly audit of the healthcare workers’ compliance, the daily assessment compliance rate rose from 60% to 95% in doctor and maintained 95% and above in nurse. The number of CLABSI dropped from 172 to 137, and the CLABSI incidence rate decreased from 11.47& to 6.88& (p < 0.001). By the result, we can predict that 192 cases were reduced, and about NT$14 million was saved. Conclusions: ImplementingCVCcarebundle isan importantandeffectivemedical practice for patients’ safety. It also significantly reduces the incidence of CLABSI. Therefore, the CVC care bundle is indeed feasible and effective.

Soft tissue and superficial venous infections are uncommon extraintestinal manifestations of non-typhoidal Salmonella (NTS) infections. In contrast to affected adults, who usually show immunological impairment, the majority of children with extraintestinal NTS infections have no predisposing risk factors. Here, we report a previously healthy infant who developed hand abscess, phlebitis, bacteremia, and impending disseminated intravascular coagulation. Blood and abscess cultures showed Salmonella enterica serotype Augustenborg. This organism is an uncommon isolate in humans that can be highly pathogenic and induce rare manifestations of infection as in the present case.

The aim of this study was to investigate the effects of adjunctive lamotrigine (LTG) in refractory epilepsy in Taiwan, especially including patients who had undergone ineffective epileptic surgeries. Totally, 27 recruited children and adolescents with refractory epilepsy were treated with LTG add-on therapy, but 23 were enrolled statistically during 2 years period trial. Ten of the 23 patients (43.5%), including 5 undergoing epileptic surgeries, before had a50% reduction in seizure frequency. Surprisingly, LTG was found to have excellent response in six patients with Lennox-Gastaut Syndrome (LGS), 5 of whom had received anterior 2/3 callosotomy prior to the trial. Non-seizure related positive effects were presented in 3 patients, including greater alertness and attentiveness in 2 patients and improvement in mood in one patient. This open trial found that LTG was an effective add-on anti-epileptic drug (AED) in Taiwanese children and adolescents with refractory epilepsy and in cases with LGS even after ineffective callosotomy.

Highly virulent community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) with Panton-Valentine leukocidin (PVL) is common worldwide. Using antimicrobial drug susceptibility testing, staphylococcal cassette chromosome mec typing, exotoxin profiling, and pulsed-field gel electrophoresis typing, we provide evidence that supports the relationship between nasal strains of PVL-positive MRSA and community-acquired disease.

Intra-abdominal infection can be a life-threatening condition in children, and aggressive treatment is usually needed. The treatment should include surgical correction and drainage, and administration of antimicrobials that are effective against both aerobic and anaerobic microorganisms. This study investigated the microbiological characteristics of intra-abdominal infection of children in Taiwan.Data for bacterial specimens from 113 children (64 males), aged from 9 months to 18 years, who had community-acquired intra-abdominal infections at our hospital during a 10-year period were analyzed.In total, 113 specimens were collected, including those with only aerobes (62%), and those with mixed aerobic and anaerobic species (35%). A total of 239 aerobes and 86 anaerobes were isolated. Polymicrobial infection was found in 79% of specimens. The predominant aerobe was Escherichia coli (42%), and Bacteroides fragilis (36%) was the most frequently isolated anaerobic microorganism. Enterococcus was detected in about 14% of Gram-positive aerobic isolates. Review of the results of antibiotic susceptibility testing revealed that the Gram-positive aerobes, apart from staphylococci, had a high susceptibility rate to ampicillin, and 84% of Gram-negative aerobes were susceptible to gentamicin. In addition, B. fragilis showed a high resistance rate to clindamycin (52%) but all of these isolates were susceptible to metronidazole.Triple antibiotic combination therapy including ampicillin, gentamicin and metronidazole remains an alternative empirical antibiotic therapy for pediatric patients with mild to moderate community-acquired intra-abdominal infection.

To investigate the kinetic Th1/Th2 immunopathogenic mechanisms of Haemophilus influenzae meningitis, we established a murine experimental model of meningitis and elucidated the Th1/Th2 immune responses in T1/T2 doubly transgenic mice based on a BALB/c background under the control of the IFN-γ (interferon-γ)/IL-4 (interleukin-4) promoters respectively. NTHi (non-typeable Haemophilus influenzae) meningitis was induced in these mice by inoculation with either a colonized (CNTHi) or invasive (INTHi) strain of NTHi. Mice inoculated with CNTHi displayed a less severe degree of disease in terms of clinical symptoms, mortality rate and brain histopathology. Conversely, INTHi-inoculated mice had more severe clinical symptoms. CNTHi-inoculated mice had a more significant Th1 response in terms of a higher percentage and longer maintenance of Th1 cells, and more production of IFN-γ from strain-specific antigen-stimulated splenocytes than INTHi-inoculated mice. In contrast, INTHi-inoculated mice had a more significant Th2 response. This was due to a significant increase in IL-4-producing CD4+ T-cells (Th2 cells) and more production of IL-4 from strain-specific antigen-stimulated splenocytes accompanied by a rapid decline of Th1 cells in INTHi-inoculated mice. In conclusion, the preferential Th1/Th2 trend in this murine model of NTHi meningitis is correlated with clinical severity as well as isolated characteristics of the pathogens themselves.

The economic implications of network topologies are studied via a monopolist's model of market networks originally proposed by Phan, et al. (2003). By embedding the market into a larger collection of network topologies, in particular, a class of scale-free networks, we extend the early analysis built upon a class of ring networks. To facilitate the study of the impacts of network topologies upon market demand, various measures concerning social welfare (the consumer's surplus), the avalanche effect, and the hysteresis effect, are formally established. Comparisons based on these measures show that network topologies matter, and their implied differences will remain even when the network size becomes large.

Between 1987 and 1989, two sequential outbreaks of nosocomial infection caused by Enterobacter cloacae occur-red in the pediatric intensive-care unit of a tertiary-care teaching hospital. Seventeen strains retrieved from the outbreaks and two control strains identified in other wards were typed by ribotyping and random amplification of polymorphic DNA (RAPD). The results indicated that the genomic pattern of strains identified between the first and second outbreaks was different. We conclude that both ribotyping and RAPD are highly discriminatory and reproducible methods for typing E cloacae. RAPD seems to be more efficacious and cost-effective.

A previously healthy 31-month-old male child became acutely ill with dyspnea and high fever 48 h after admission for acute bronchitis. He experienced sepsis and acute respiratory distress syndrome throughout the subsequent hospitalization, eventually expiring despite aggressive treatment with antibiotics and extracorporeal membrane oxygenation. Blood cultures yielded ampicillin-resistant non-typeable Haemophilus influenzae. To the best of our knowledge, this is the first reported case of fatal non-typeable H. influenzae sepsis and ARDS in a child without an underlying predisposing condition.

Streptococcus pneumoniae causes substantial morbidity and mortality worldwide. Because only limited data are available for the antibiotic resistance patterns and seroepidemiology of invasive S. pneumoniae isolates in Taiwanese children, this national surveillance of invasive pneumococcal infections in children was conducted during a 5-year period. Invasive isolates of S. pneumoniae were obtained from sterile sites (yielding blood and cerebrospinal, pleural, and intra-articular fluids) in children (aged < or =14 years) at a total of 40 regional hospitals and medical centers distributed throughout Taiwan. The collection period was between July 1999 and June 2004, with a total of 286 isolates (including 30 cerebrospinal fluids) collected. All the samples were sent to the Center for Disease Control in Taipei for serotyping and susceptibility testing. Of the 286 S. pneumoniae isolates studied, the 5 most common serotypes were 14 (28.3%), 23F (21.0%), 6B (17.1%), 19F (13.6%), and 3 (4.9%). Intermediate- and high-level penicillin resistance was determined for 50.7% and 25.5% of the isolates, respectively. Isolate resistance was demonstrated to erythromycin (93%), tetracycline (82.2%), trimethoprim/sulfamethoxazole (79.4%), cefotaxime (11.2%), and levofloxacin (0.3%). Multiple drug resistance was found for each serotype, but mostly in types 14, 23F, 6B, and 19F. Overall, 85.0% of the serotypes, 90.8% of the penicillin-nonsusceptible S. pneumoniae (PNSSP), and 90.1% of the multiple drug-resistant (MDR) isolates were covered by the heptavalent pneumococcal conjugated vaccine (PCV7). In this study, we found a diverse pulse-field gel electrophoresis pattern among MDR isolates: a high prevalence of drug resistance and a continued increasing trend in penicillin resistance among nationwide pneumococcal isolates from children in Taiwan. The highest prevalence of invasive pneumococcal disease was in children aged 2 to 5 years, and the highest PNSSP prevalence and highest PCV7 coverage were in children aged

To investigate the kinetic changes in adaptive immunity during experimental Haemophilus influenzae type b (Hib) meningitis, we established a murine meningitis model based on T1/T2 doubly transgenic mice. These mice carry two transgenes that express two distinct cell-surface markers: a human Thy1 transgene (hThy1) under the control of the murine IFN-gamma promoter, and a murine Thy1.1 transgene (mThy1.1) under the control of the murine IL-4 promoter, designated T1 and T2, respectively. Mice infected with Hib displayed severest symptoms and lowest total splenocyte counts on day 3 after infection. Simultaneously, we examined the significantly low percentage of CD19+ B cells, the relatively high level of CD4+ T cells and significantly high percentage of CD8+ T cells in Hib-infected mice. Furthermore, we observed the early induction of both Th1 and Th2 responses, in terms of the augmentation of Th1 cells (IFN-gamma-producing CD4+ T cells) and Th2 cells (IL-4-producing CD4+ T cells) in Hib-infected mice. On day 7 after infection, the Th1 response gradually declined and the Th2 response rather sustained. Two weeks after infection, both Th1 and Th2 cells were barely detectable. Moreover, we demonstrated using an antigen-specific re-stimulation test to analyze the effector function of lymphocyte subsets that CD8+ T cells contributed to more predominantly production of IFN-gamma than CD4+ T cells did; and CD4+ T cells partly contributed to the secretion of IL-4 from flowcytometry of intracellular cytokine staining. Our results support that these transgenic mice provide an available model to dissect the complex kinetic change of adaptive immunity in bacterial infectious diseases.