Search

While the worldwide distribution of geogenic arsenic (As)-affected groundwater is highly overlapped with the areas with abundant groundwater, utilization of As-contained groundwater is an inevitable compromise in those areas where surface water is not enough for irrigation. Since the occurrence of As in groundwater is often accompanied by high iron (Fe) contents, the facilitation of As and Fe precipitation without adding additional oxidizers and adsorbents is considered an environmental-friendly approach to removing As in groundwater. In the present study, the oxidation/filtration dual-process with sprinkling height of 25 cm and 120 kg filter media efficiently increased the dissolved oxygen (DO) concentration (0.36–1.52 mg/L) and oxidation–reduction potential (ORP) (24–63 mV), which facilitated the formation of Fe oxides and As co-precipitation. The correlation of As removal efficiencies with their respective flow rates indicated that a decrease in groundwater Fe and an increase of Fe in sands and gravels filters as the flow rate increased evidenced the rapid oxidation of Fe to form the Fe hydroxides. In a 40-hour continuous aeration/filtration operation, As and Fe concentrations in groundwater were reduced by 79.5% and 64.88% within 40 hrs, respectively. The ease of filter replacement and cost-effectiveness in operation can be the major attractions and innovations for future field practices.

Introduction IInsomnia with objective short sleep duration (OSSD) was found to be associated with higher risks of cardiometabolic disorders, and was therefore proposed to be a phenotype associated with higher physiological hyperarousal. Previous studies further reported that insomnia with OSSD had higher autonomic arousal as measured by heart rate variability (HRV) during sleep. Since sleep duration could be determined by the interplay of arousal and sleep drive and HRV during sleep could be influenced by sleep staging and quality, the present study examined the level of arousal and sleep drive prior to sleep with EEG power and HRV to further understand the phenotyping of insomnia. Methods Ninety-four insomnia patients participated in the study and went through one night of 8-hour PSG recording. They were divided, with a cut-off of PSG total sleep time of 6 hours, into two groups: an OSSD group (N=26; mean age=37.0 ±10.3; M:F=7:19; TST=286.21±87.21 min) and an objective normal sleep duration (ONSD) group (N=68, mean age=32.95 ±10.05, M:F=12: 56, TST=414.4±28.9 min). Resting-state EEG and EKG were recorded for a 6-min period, 3-min eye-opened (EO) with fixation focus and 3 mins eye-closed (EC), prior to bedtime. Results T-tests showed no significant difference in HRV measures (SDNN, RMSD, LF, HF, LF/HF) between the two groups, but shorter R-R interval for OSSD group than ONSD group. Mann-Whitney tests for EEG power showed significantly lower theta power at F3, F4, C3, C4, and O2, and higher sigma power at F3, C3, C4, O1, and O2 during EC, as well as lower theta power at C3 and higher sigma power at O2 during EO for OSSD group in comparison to ONSD group. Conclusion The results partially support that insomnia with OSSD is associated with physiological hyperarousal as indicated by faster heart rate and higher high frequency EEG power prior to sleep. However, the lower EEG theta power prior to sleep suggest that lower homeostatic sleep drive may also play a role for the insomnia with short objective sleep duration. Support (if any) Supported by Taiwan National Science and Technology Council

Introduction Obstructive sleep apnea syndrome (OSAS) was shown to impair neurocognitive functioning, which was often attributed to hypoxia and sleep fragmentation. More recently, increased accumulation of amyloid-beta and tau protein in OSAS patients have gotten research attention and have been considered to be a possible cause of neurocognitive impairments. Positive airway pressure (PAP) treatment has been found to improve cognitive functioning in OSAS patients. The current study further explored the association of the effects of PAP treatment on neurocognitive and plasma amyloid-beta (Aβ) and tau protein levels. Methods Sixteen OSAS patients (M:F=10:6; age average = 53.35, SD = 10.43) participated in the study. A package of neurocognitive tasks (CPT-III, verbal paired association task, PASAT-R, and semantic verbal fluency) were administered and blood sample was collected both before and after a 3-month period of PAP intervention. The total tau and Aβ 42 levels in the patients’ plasma were quantified using an ultrasensitive immunomagnetic reduction assay. Results T-tests comparing cognitive performance before and after PAP treatment showed significant difference in total immediate recall score of verbal pair association task (t = 3.412, p = .002) and near significant differences in commission error on CPT-III (t = -.357, p = .097) and total score on PASAT-R (t = 1.35, p = .099). Other neurocognitive tasks as well as Aβ and tau proteins showed no significant changes. However, the change of Aβ after treatment correlated significantly with the improvement on the first immediate recall sequence (r = -.64, p = .005), and tau protein level correlated with the score on 2-sec-ISI subscale of PASAT-R (r = -.45, p = .048). Conclusion The present study showed that three months of PAP treatment was effective in improving immediate memory, but not in other cognitive functions or Aβ and tau protein levels. Moreover, some changes in memory and executive function were associated with decrease of Aβ and tau proteins. The preliminary results suggest that the neurocognitive impairment in OSAS patients might be partially associated with accumulation of Aβ and tau proteins. Future studies are needed to further confirm the findings. Support (if any)

Background: Although the current consensus recommends a standard treatment of high-dose intravenous immunoglobulin with high-dose aspirin to manage Kawasaki disease (KD), the use of different adjunctive therapies remains controversial. The aim of the current network meta-analysis (NMA) was to compare the efficacy and tolerability of different existing interventions for the initial and refractory stages of KD. Methods: An NMA of randomised controlled trials (RCTs) was conducted using the frequentist model applied after electronic searches in PubMed, Embase, ScienceDirect, ProQuest, ClinicalTrials.gov, ClinicalKey, Cochrane CENTRAL, and Web of Science. The main outcomes were reduced fever duration/diminished severity of fever subsided. The initial stage of KD was defined as the first stage to treat patients with KD; the refractory stage of KD represents KD patients who failed to respond to standard KD treatment. The cut-off points for intravenous immunoglobulin (IVIG) were low (100–400 mg), medium (1 g), and high (at least 2 g). Findings: A total of fifty-six RCTs with 6486 participants were included. NMA demonstrated that the medium-dosage IVIG + aspirin + infliximab [mean difference=−1.76 days (95% confidence intervals (95% CIs): −3.65 to 0.13 days) compared to high-dosage IVIG + aspirin] exhibited the shortest fever duration; likewise, the medium-dosage IVIG + aspirin + infliximab [odds ratio (OR)=0.50, 95% CIs: 0.18–1.37 compared to high-dosage IVIG + aspirin] exhibited the smallest incidence of coronary artery lesion (CAL) in the initial-stage KD. In the refractory-stage KD, the high-dosage IVIG + pulse steroid therapy (OR=0.04, 95% CIs: 0.00–0.43 compared to the high-dosage IVIG only) had the best rate of decline of fever; likewise, the high-dosage IVIG + ciclosporin [OR=0.05 (95% CIs: 0.00–1.21) compared to the high-dosage IVIG only] exhibited the smallest incidence of CAL. Infliximab significantly improved resolution compared to the high-dosage IVIG only group (OR=0.20, 95%CIs: 0.07–0.62) in refractory-stage KD. Interpretation: The NMA demonstrated that the combination therapy with the standard therapy of IVIG and aspirin might have an additional effect on shortening the duration of fever and lowering the CAL incidence rate in patients with acute KD. Moreover, the combination therapy with high-dose IVIG and pulse steroid therapy or cyclosporine therapy might have an additional effect on improving the rate of decline of fever and lowering the incidence rate of CAL in children with refractory KD. Because some of the findings of this NMA should be considered hypothesis-generating rather than confirmatory, further evidence from de novo randomised trials is needed to support our results. Funding: None.

This research aimed to develop a direct-write near-field electrospinning system (DW-NFES) with three-axis positioning of controllable speed, torque and position to produce sizable and high-quality piezoelectric fibers for sensing purposes. Sensor devices with high electrical response signals were developed and tested. To achieve DW-NFES purpose, a servo motor controller was designed to develop a high response rate, accurate positioning, and stable mobile device through the calculation of bandwidth and system time delay. With this retooled system of DW-NFES, controllable and uniform size fibers in terms of diameters, stretching force, and interspaces can be obtained. Sensor devices can be made selectively without a complicated lithography process. The characteristics of this DW-NFES platform were featured by high response rate, accurate positioning, and stable movement to make fibers with high piezoelectric property. In this study, polyvinylidene fluoride (PVDF) was used to explore and enhance their sensing quality through the platform. The parametric study of the process factors on piezoelectric sensing signals mainly included the concentration of electrospinning PVDF solution, high voltage electric field, and collection speed. Finally, the surface morphology and piezoelectric properties of the as-electrospun PVDF fibers were examined by scanning electron microscopy (SEM) and characterized by electrical response measurement techniques. The results showed that the fiber spinning speed of the DW-NFES system could be increased to ~125 from ~20 mm/s and the accuracy precision was improved to ~1 from ~50 &mu, m, compared to conventional step motor system. The fiber diameter reached ~10 &mu, m, and the electrospinning pitch reached to as small as ~10 &mu, m. The piezoelectric output voltage of the electrospun fibers was increased ~28.6% from ~97.2 to ~125 mV, the current was increased ~27.6% from ~163 to ~208 nA, suggesting that the piezoelectric signals can be enhanced significantly by using this retooled system. Finally, an external control module (Arduino-MAGE) was introduced to control the PVDF piezoelectric fiber sensors integrated as a sensing array. The behavior of long-term sedentary patients can be successfully detected by this module system to prevent the patients from the bedsores.

Background: Although the current consensus recommends a standard treatment of high-dose intravenous immunoglobulin with high-dose aspirin to manage Kawasaki disease (KD), the use of different adjunctive therapies remains controversial. The aim of current network meta-analysis (NMA) was to compare the efficacy and tolerability of different existing interventions for the initial stage and the refractory stage of KD. Methods: The current NMA of randomized controlled trials (RCTs) was conducted under the frequentist model. Findings: Total fifty-six RCTs with 6,486 participants were included. The NMA demonstrated that the medium intravenous immunoglobulin (IVIG) + aspirin + infliximab [mean difference=−1.76 days (95% confidence intervals (95%CIs): −3.65 to 0.13 days) compared to high IVIG + aspirin] had the shortest fever duration; likewise, the medium IVIG + aspirin + infliximab [odds ratio (OR)=0.50, 95%CIs: 0.18 to 1.37 compared to high IVIG + aspirin] had the least CAL incidence in the initial-stage KD. The high IVIG + pulse steroid therapy (OR=0.04, 95%CIs: 0.00 to 0.43 compared to the high IVIG only) had the best fever subsided rate; likewise, the high IVIG + ciclosporin [OR=0.05 (95%CIs: 0.00 to 1.21) compared to the high IVIG only] had the least CAL incidence in the refractory-stage KD. Interpretation: The current NMA demonstrates that the addition of infliximab plus current standard therapy might be the best treatment for acute KD. Conversely, ciclosporin plus IVIG serves as the best choice for lower the CAL incidence in refractory KD. Further controlled trials are warranted to confirm these findings. Funding Statement: The authors of this work did not receive any grant supports. Brendon Stubbs is supported by a Clinical Lectureship (ICA-CL-2017-03-001) jointly funded by Health Education England (HEE) and the National Institute for Health Research (NIHR). Brendon Stubbs is part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. Brendon Stubbs is also supported by the Maudsley Charity, King’s College London and the NIHR South London Collaboration for Leadership in Applied Health Research and Care (CLAHRC) funding. This paper presents independent research. The views expressed in this publication are those of the authors and not necessarily those of the acknowledged institutions. Declaration of Interests: The authors report no financial interests or potential conflicts of interest.

Background This study aimed to evaluate the demographic, clinical features, laboratory data, pathology and other survey in pediatric patients with cryofibrinogenemia. Methods A 12-year retrospective chart review identified eight pediatric patients at Mackay Memorial Hospital, Taipei, Taiwan. Results The female-to-male ratio was 3:1. The mean age at symptom onset and of diagnosis was 10.3 ± 4.6 years and 12.3 ± 4 years, respectively. One child (12.5%) had primary cryofibrinogenemia. The common symptoms were purpura, arthralgia, and muscle weakness (100%). On laboratory examination, cryofibrinogen was positive in all patients. All patients had increased anti-thrombin III while 87.5% and 62.5% had abnormal protein S and protein C, respectively. All eight also complained of neurologic symptoms. One had vertebral artery narrowing, two showed increased T2-weighted signal intensity on the thalamus or white matter, and one had acute hemorrhagic encephalomyelitis on brain magnetic resonance imaging. Conclusions This study reports on the presentations of cryofibrinogenemia, which is rare in children. Most cases are associated with autoimmune disease and have severe and complex presentations. Central nervous system involvement is common.

Introduction Objective sleep duration has been suggested to be a novel biomarker in the phenotyping of insomnia (Vgontzas & Fernandez-Mendoza, 2013). It was hypothesized that insomnia phenotype with PSG-defined short sleep duration (< 6 hours) is associated with physiological hyperarousal, while the phenotype with normal sleep duration (≥ 6 hours), is associated with anxious-ruminative psychological profile and poor resources for coping with stress. The aim of this study was to assess whether these two insomnia phenotypes differ in terms of self-reported psychological and physiological features. Methods A total 45 (mean age=36.6, female=76%) insomnia patients underwent a polysomnographic evaluation, completed several self-rating scales (include ISI, BAI, BDI, FIRST, DBAS, and PSAS), and were split into two groups base on their objective sleep duration (cut-off 6 hours). Results When compared to the short sleep group using independent sample t-test, the normal sleep group showed a significant higher mean score on FIRST (t= -2.13; p< .05). The short sleep group showed non-significant trends to have higher mean scores on BDI and BAI. The scores on the other scales showed no significant differences between the two groups. The FIRST score correlated positively with the score of DBAS (r= 0.32; p< .05) and the total (r= 0.36; p< .05) and cognitive-subscale scores (r= 0.41; p< .01) on PSAS. The BAI score correlated positively with the score of the total (r= 0.53; p< .001) and somatic subscale (r= 0.59; p< .001) on PSAS. Conclusion These results support the hypotheses that the normal sleep phenotype tends to be more vulnerable to the impact of stress, especially on sleep, due to pre-sleep cognitive hyperarousal. Since the BAI scale contains more items regarding physiological symptoms of anxiety disorders, the tendency of higher BAI score in short sleep group may indicate that the short sleep phenotype has higher physiological arousal, which supports the phenotyping model proposed by Vgontzas and Fernandez-Mandoza. Support (if any)

In this study, a new type of fiber-based mechanomyography (MMG) sensor was developed and used as a motion on/off trigger sensor for a lower limb rehabilitation exoskeleton (LLRE). Piezoelectric material, polyvinylidene difluoride (PVDF), was applied to fabricate a MMG sensor, using the near-field electrospinning technology to electrically spin PVDF fibers to ∼5-10 μm in diameter. PVDF fibers attached on an interdigitated (IDT) electrode with different pole pairs and interspaces were packaged into a MMG sensor. This MMG sensor was stuck on the thigh muscles to detect and acquire human motion intention signal, then trigger the controller and actuate the LLRE. The LLRE multi-axis control system included a master and four slave controllers. The master controller released the command signal to control the slave controllers via controller area network (CAN). A multi-axis control system was developed to actuate the joints of hips and knees of both legs by the LLRE. In the study, commercial electromyography (EMG) sensors were also to compare with the as-made MMG sensors. Results showed that the maximum signal amplitude of the commercail EMG sensor was about ∼0.2 V, whereas the MMG sensor was about ∼2.8 V. The signal-to-noise ratio (SNR) of EMG was about ∼4, while that of MMG was about ∼25. From physiological signals captured from the MMG sensor for the human walking with the LLRE, this new sensor improved the sensitivity in driving the LLRE.

Background The recurrence rate of Henoch-Schönlein purpura (HSP) is 2.7%–30%, with varied average intervals between the first and second episodes. Few studies have explored the incidence and risk factors for recurrent HSP. Methods We used a 16-year nationwide database to analyze the incidence of recurrent HSP. Patients with HSP were identified, and risk factors for recurrent HSP were explored. Kaplan-Meier and Cox regression model analyses were performed, and covariates were adjusted in the multivariate model. Results From January 1, 1997 to December 31, 2012, among 2,886,836 individuals in the National Health Insurance Research Database, 1002 HSP patients aged 10 days (adjusted hazard ratio, 8.13; 95%CI, 2.51–26.36; p 10 days should be notified regarding the possibility of recurrence. Electronic supplementary material The online version of this article (10.1186/s12969-018-0247-8) contains supplementary material, which is available to authorized users.

Table S2. The percentage and duration of steroid use in each episode. (DOCX 18 kb)

Table S1. The generic name of steroid used in current cohort. (DOCX 133 kb)

Summary This study evaluated the biogeochemical interactions between arsenic (As) and sulfur (S) in groundwater to understand the natural and anthropogenic influences of S redox processes on As mobilization in the Lanyang Plain, Taiwan. Cl − and the sulfate isotopic composition δ 34 S [ SO 4 ] were selected as conservative tracers. River water and saline seawater were considered as end members in the binary mixing model. Thirty-two groundwater samples were divided into four types of groundwater (I, pyrite-oxidation; II, iron- and sulfate-reducing; III, sulfate-reducing; and IV, anthropogenic and others). The binary mixing model coupled with discriminant analysis was applied to yield a classification with 97% correctness, indicating that the DO/ORP values and δ 34 S [ SO 4 ] and Fe 2+ concentrations are effective redox-sensitive indicators. Type I groundwater is mostly located in a mountainous recharge area where pyrite oxidation is the major geochemical process. A high 18 O enrichment factor e [ SO 4 – H 2 O ] and high 34 S enrichment factor e 34 S [ FeS 2 – SO 4 ] indicate that disproportionation and dissimilatory sulfate reduction are both involved in Type II and Type III groundwater. The process of bacterial sulfate reduction may coprecipitate and sequester As, a mechanism that is unlikely to occur in Type II groundwater. The presence of high As and Fe 2+ concentrations and enriched δ 34 S [ SO 4 ] in Type II groundwater suggest that biogeochemical reactions occurred under anaerobic conditions. The reductive dissolution of As-bearing Fe oxyhydroxides together with microbial disproportionation of sulfur explains the substantial correlations among the high As concentration and enriched δ 34 S [ SO 4 ] and Fe 2+ concentrations in the iron- and sulfate-reducing zone (Type II). The As concentration in Type III groundwater (sulfate-reducing) is lower than that in Type II groundwater because of bacterial sulfate reduction and coprecipitation with As. Furthermore, the dissolution of sulfate minerals is not the major source of aqueous SO 4 , based on the sulfur isotopic composition of solid-phase sulfate (δ 34 S [sulfate mineral] ). Finally, the anthropogenic influence of fertilizers with wide S isotopic ranges is proposed as the plausible sulfate budget in Type IV groundwater. The results of this study suggest that the As release into groundwater involves the reductive dissolution of As-bearing Fe-hydroxides, bacterial sulfate reduction, and microbial disproportionation in the Lanyang Plain.

This study applied advanced multivariate methods and risk assessment to evaluate the characteristics of polycyclic aromatic hydrocarbons (PAHs) in the sediment of the severely polluted Erjen River in Taiwan. High-molecular-weight PAHs (HPAHs) dominated in the rainy season. The ecological risk of PAHs in the sediment was low, whereas the total health risk through ingestion and dermal contact was considerably high. The SOM (self-organizing map) analysis clustered the datasets of PAH-contaminated sediment into five groups with similar concentration levels. Factor analysis identified major factors, namely coal combustion, traffic, petrogenic, and petrochemical industry factors, accounting for 88.67% of the variance in the original datasets. The major tributary and the downstream of the river were identified as PAH-contamination hotspots. The PMF (positive matrix factorization) was combined with toxicity assessment to estimate the possible apportionment of sources and the associated toxicity. Spills of petroleum-related products, vehicle exhaust, coal combustion, and exhaust from a petrochemical industry complex constituted respectively 12%, 6%, 74%, and 86% of PAHs in the sediment, but contributed respectively 7%, 15%, 22%, and 56% of toxicity posed by PAHs in the sediment. To improve the sediment quality, best management practices should be adopted to eliminate nonpoint sources of PAHs flushed by storm water into the major tributary and the downstream of the Erjen River. The proposed methodologies and results provide useful information on remediating river PAH-contaminated sediment and may be applicable to other basins with similar properties that are experiencing resembled river environmental issues.

Background Aeroallergen sensitization may predict higher fractional exhaled nitric oxide (FeNO) levels. Objective We evaluate cut-off values of FeNO in asthmatic children with and without positive specific immunoglobulin E (IgE) to at least one of 5 aeroallergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, cat, dog, and cockroach). Methods 564 patients with asthma and allergic rhinitis (AR) aged 5 to 18 years were enrolled into two groups. Sensitized group included 378 children with positive IgE to at least one of 5 inhaled allergens. Non-sensitized group included 186 children. Pulmonary function tests, FeNO, eosinophil counts, and IgE levels were examined. Patients were divided into preschool age (5~6 years old), elementary school children (7~11 years old) and adolescents (12~18 years old). Results In preschool children, FeNO≥15.5 ppb differentiates between non-sensitized and sensitized groups. (sensitivity 54.3%; specificity 87.5%; positive predictive value (PPV) 86.2%; negative predictive value (NPV) 57.1%; area under receiver operating characteristic curve (AUC) 0.72) Among elementary school children, the cut-off value of FeNO≥19.5 ppb showed sensitivity 66.4%; specificity 85.8%; PPV 90.5%; NPV 55.7%; AUC 0.81. In adolescents, FeNO≥27.5 ppb showed sensitivity 60.2%; specificity 85.4%; PPV 91.2%; NPV 46.1%; AUC 0.76. Conclusion In asthmatic children, aeroallergen sensitization appears to contribute to higher FeNO levels than those not sensitized. Cut-off values of FeNO which well discriminate asthmatic children with and without aeroallergen sensitization should be chose according to different ages.

Cystic fibrosis (CF) is one of the most common autosomal recessive inherited disorders among Caucasians. Comparatively, it is considered to be a rare disease among Asians. To date, only a few cases of Taiwanese CF have been published. We report four CF cases from three families. Case 1 was the first report of CF associated with a homozygosity for the CF transmembrane conductance regulator gene (CFTR gene) mutation 3849+10kb C->T in a Taiwanese patient. Cases 2 and 3 had heterozygous c. 1898+5 G->T and heterozygous p. I1023R (novel mutation) for the CFTR gene mutation. Case 4 was homozygous for the CFTR gene mutation R553X being reported in 2005 and complicated with cor pulmonale. These four patients had received 300 mg bid aerosolized tobramycin treatment every other month.

An extended column adsorption study on arsenic (As(III)/As(V)) was conducted using the developed adsorbent iron-oxide-coated natural rock. We considered a column with a diameter of 2 cm and varying bed depths, including 10 , 15 , and 20 . The breakthrough (C/C0 = 0.016) times were 31.0, 49.0, and 63.0 h and the exhaust (C/C0 = 0.90) times were 60.0, 90.0, and 110.0 h, respectively for As(III). For As(V), those were found to be (breakthrough times corresponding to C/C0 = 0.0033) 5.0, 11.0, and 18.0 h and 20.0, 27.0, and 36.0 h, respectively. The up-flow rate was maintained at 8 mL min−1. The As(III) and As(V) concentrations were 0.6 and 3 mg L−1. Bohart and Adams sorption model was employed to determine the important column design parameters. The column was designed by the bed-depth-service-time model. The adsorption capacity (N0) and the adsorption rate constant (K) calculated were 295.30 mg L−1 and 20.41 L mg−1 h−1, respectively, for As(III) and 599.82 mg L−1 and 0.233 L mg−1 h−1, respectively, f...

We report a 3-year-old girl with Kawasaki disease who presented with retropharyngeal edema and shock syndrome. This is the first reported case in Taiwan. The patient initially presented with fever, cough, and pyuria followed by rapidly progressive enlarged bilateral cervical lymphadenopathy. On the third day of the fever, computed tomography for airway compression sign found widening of the retropharyngeal space mimicking a retropharyngeal abscess. Later, an endotracheal tube was inserted for respiratory distress. A skin rash over her trunk was also noted. On the fifth day of the fever, the clinical course progressed to hypotension and shock syndrome. Because of more swelling of bilateral neck lymph nodes, computed tomography was arranged again and revealed partial resolution of the edematous changes in the retropharyngeal space. Edema of the hands and feet, bilateral bulbar conjunctivitis, and fissured lips were subsequently found. The diagnosis of Kawasaki disease was confirmed on the eighth day of fever. There was no evidence of bacterial infection. She was administered intravenous immunoglobulin (2 mg/kg) and high dose aspirin (100 mg/kg/day). One day later, the fever subsided, and her blood pressure gradually became stable. Heart echocardiography on the Day 13 revealed dilated left coronary artery and mitral regurgitation. Follow-up echocardiography six months later showed normal coronary arteries. To date, the patient has not experienced any complications. This case illustrates that retropharyngeal edema and shock syndrome can be present in the same clinical course of Kawasaki disease. Clinicians and those who work in intensive care units should be aware of unusual presentations of Kawasaki disease to decrease rates of cardiovascular complications.

This study examined the As(III) adsorption efficiency on an iron-oxide based adsorbent, iron-oxide-coated natural rock (IONR), and proposes an in situ two-step mechanism, oxidation of As(III) to As(V) and its subsequent adsorption on IOCNR. In the batch study, within 6 h of contact time and at a dose of 13 g L−1, ∼98.5% As(III) (declined to ∼0.01 mg L−1) removal was achieved from the water medium, when the initial concentration was 0.6 mg L−1 at room temperature. The As(III) adsorptive capacity of IOCNR was calculated using the Langmuir isotherm 1.647 mg g−1. The effects of various parameters for As(III) adsorption, including contact time, dose, pH, initial As(III) concentrations, the presence of common cations and anions, along with some organic contaminants, were evaluated. Spontaneity and favorable adsorption of As(III) on IOCNR were evidenced from the negative Gibbs free energy changes and dimensionless equilibrium parameter. As(III) removal efficiency of the exhausted and NaOH-regenerated IOCNR decreased in the second-cycle operation. As(III) removal efficiency of IOCNR was comparable to that of the commercially available patented adsorbent LEWATIT FO36. The adsorptive behavior of IOCNR from real arsenic-bearing sample was also evaluated. Finally, small-scale household filter “SHITAL-2013” was designed and the effluent water quality was analyzed.

High arsenic (As) levels occur naturally in geothermal areas, potentially polluting downstream wetland ecosystems. The study was to determine the distribution of As among aqueous, solid, and plant phases in the Guandu Wetland of Taiwan. Chemical compounds (As, Fe, Mn, TOC, SO4 2-, and FeS2) and isotopic compositions (δ34S) in water and soil samples were analyzed to characterize the As distribution. The sequential extraction of As and total As in plant samples wasanalyzed to estimate the bioconcentration factor (BCF) and translocation factor (TF; defined as the ratio of metal concentration in the shoots to those in the roots) of As in Kandelia obovata in aqueous and solid phases. The As concentrations in plants (23.69 mg/kg) were higher than in the surrounding water (0.0018 mg/L) and soils (17.24 mg/kg). Kandelia obovata have high As bioavailability and low TF, causing easy adaptation to grow in As-contaminated wetland ecosystems. BCFplants/water (13657.92) was higher than BCFplants/soil (1.38). The uptake and bioaccumulation of As in Kandelia obovata are significant; therefore, Kandelia obovata is an As accumulator. The uptake As by the Kandelia obovata plant might depend on the oxidation of As-contained FeS2 in the aerial roots and/or adsorption of As on root surface.

In Taiwan, groundwater commonly becomes important water resources in dry periods, and/or areas lack of water storage facility due to its low cost, steady water supply and good water quality. However, improper groundwater development brings about serious decreases in groundwater levels and land subsidence which causes disasters, such as seawater intrusion or soil salination, accompanied with environmental and economic losses. It is critical to develop strategies for water resources conservation in mountainous areas. The complex heterogeneity of mountainous physiographic environment makes it challenging in the forecasts of groundwater level variations, particularly in mountainous areas. Artificial neural networks (ANNs) have been recognized as an effective modeling tool for complex nonlinear systems in the last two decades. This study aims to investigate the interactive mechanisms of groundwater at the mountainous areas of the Jhuoshuei river basin in central Taiwan through analyzing and modeling the groundwater level variations. Several issues are discussed in this study, which includes the correlation between groundwater level variation and rainfall as well as streamflow, the identification of groundwater recharge patterns and effective rainfall thresholds for estimating groundwater level variations. The results indicate: (1) the daily variation of groundwater level is closely correlated with river flow and one-day antecedent rainfall based on correlation analyses; (2) effective rainfall thresholds can be identified successfully; (3) groundwater level variations can be classified into four types for monitoring wells; and (4) the daily variations of groundwater level can be well estimated by constructed ANNs. The identified interactive mechanisms between surface water and groundwater can facilitate the mountainous water resource conservation strategy for better water management, especially irrigation water supply and for alleviating land subsidence in downstream areas in the future.

summary This study explores the distribution and mobilization of As in the ecosystem of the Guandu wetlands, Taiwan. The chemical parameters, chemical sequential extraction, mineralogical compositions, and sulfur isotopic compositions (i.e., d 34 S½SO4� and d 18 S½SO4� ) of porewater and two sediment core samples (S2 and S5, locate in the inner and outer sites of the Guandu wetland) were analyzed to characterize As spatial distribution. The crucial mechanisms of the biogeochemical processes that control As mobility in wetland ecosystems were inferred. Based on factor analysis and cluster analysis, the vertical distributions of the redox zones in S2 and S5 were classified as oxidizing, transitional, and reducing zones, respectively. The mineralogical characteristics showed that adsorption and desorption are the major processes which control As retention in the surface sediment under cyclic aerobic/anaerobic conditions. Aqueous As and Fe were restrained because of oxidation, whereas aqueous Fe precipitated as amorphous metal oxides (i.e., FeO, FeOOH, and Fe2O3). Subsequently, aqueous As was adsorbed onto the surfaces of Fe(hydr)oxides, resulting in a high solid As content in the oxidizing zone. The high aqueous As content in the boundary of the transitional and reducing zones was caused by the reductive dissolution of highly dissolved Fe compounds through the microbial respiration of organic matter (OM). In the reducing zone, As 3+ can be constrained by the formation of FeS2 in sediment during bacterial sulfate reduction that is governed by the relative enrichment of the d 34 S½SO4� and d 18 S½SO4� values. Sulfur disproportionation and the redox of ele

High concentrations of naturally occurring arsenic (As) are typically found in young alluvial and deltaic deposits, and high concentrations of ammonium (NH4+) and nitrate (NO3−) are often present in groundwater affected by anthropogenic activities. In this study, on the basis of physicochemical characteristics of groundwater and the nitrogen and oxygen isotope composition of NO3−, it was inferred that the main sources of NO3− in the proximal fan of the Choushui River alluvial fan are likely to be ammonium fertilizers, manure, and septic waste; that in the mid-fan and the distal fan, the possible sources are nitrate fertilizers and marine nitrate. In the proximal fan, the oxidative state obviously promotes microbial nitrification. Denitrification occurs from the upstream region to the downstream region of the Choushui River, and therefore, the decrease in NO3− concentration along streams connecting the Choushui River to the ocean appears plausible. High DO concentrations and relatively low values of δ18ONO3 in the deeper aquifer of the proximal fan may be attributed to unconfined granular nature and groundwater pumping by agricultural activities. In the mid-fan, NO3− assimilation is the dominant response to NO3− attenuation, and denitrification is insignificant; however, high concentrations of As, NH4+ and Fe and depletion of δ15NNO3 imply the occurrence of feammox process. By contrast, denitrification evidently occurs in the distal fan, through assimilation, mineralization, and dissimilatory NO3− reduction to NH4+, resulting in depletion of NO3− and increase in NH4+ in groundwater. Feammox in the mid-fan and denitrification in the distal fan may be the main processes leading to the release of As from As-bearing Fe oxyhydroxides into groundwater.

This study examines the efficiency of the fixed-bed adsorption of As(III) on iron-oxide-coated natural rock (IOCNR) in a contaminated aquatic environment. We considered a column with a diameter of 2-cm and varying bed depths, including 10 cm, 15 cm, and 20 cm. The breakthrough ( C / C o = 0.016) times were 31.0 h, 49.0 h, and 63.0 h, and the exhaust ( C / C o = 0.90) times were 60.0 h, 90.0 h, and 110.0 h, with an up-flow rate of 8 mL/min, respectively. The volume of the contaminated water treated at the breakthrough points was 14.88 L, 23.52 L, and 30.24 L, and at the exhaust points 28.80 L, 43.20 L, and 52.80 L, respectively when As(III) concentration was 0.6 mg/L. The columns were designed using the logit method to evaluate the adsorption rate ( K ) and column efficiency ( N ). The 10-cm exhaust bed was regenerated with 4% NaOH, and its performance was evaluated. This study proposes an in situ two-step mechanism, oxidation of As(III) to As(V), and subsequent adsorption on IOCNR. A column (10 cm) performance of real arsenic-bearing groundwater was evaluated. Results indicate that the treated effluent water quality is suitable for domestic use. Moreover, the experimental results agreed well with the geochemical modeling using computer program PHREEQC.

Summary The purpose of the study is to assess the applicability in estimating the mountain block recharge (MBR) to the downstream alluvial aquifers in the sub-tropical area using baseflow separation and rainfall infiltration methods. The Choushui-Wu River basin, the largest groundwater region in Taiwan was the study area. The high slope mountainous catchment located in the upstream of Choushui-Wu River basin, act as an important conduit in conveying surface and subsurface runoff to the recharge of the downstream alluvial aquifers. Geographic Information Systems (GISs) was applied to facilitate the estimation processes. The estimated MBR using the baseflow separation method was 1.08 × 10 9 m 3 /year of which Wu River and Choushui River basins comprised 0.27 × 10 9 m 3 /year (25.2%) and 0.81 × 10 9 m 3 /year (74.8%), respectively. These results are similar to the previous O 18 isotopic study indicating that 22% and 78% were from the Wu River and Choushui River basins, respectively. Moreover, the estimated amount of lateral flow using C 14 technique from the upstream of Choushui River basin was 0.83 × 10 9 m 3 /year, which is close to the result (0.81 × 10 9 m 3 /year) of this study. For comparison, groundwater recharged by rainfall infiltration in the mountainous catchment was derived from the precipitation, evapotranspiration, land use and soil types of the region. The estimated MBR by the rainfall infiltration method is 1.06 × 10 9 m 3 /year, which is close to 1.08 × 10 9 m 3 /year determined by the baseflow separation method. These results are also similar to the groundwater hydrograph analysis. The proposed methods show simple and efficient computation and do not require complex hydrological modeling and detailed knowledge of soil characteristics. They can reasonably estimate the lateral boundary influx contributing from the MBR and are thus applicable to estimate the MBRs in other sub-tropical regions.

summary Shallow groundwater in the Choushui river alluvial fan of southwestern Taiwan contains high As contents. Arsenic concentrations in most of wells varied spatial–temporally. The purpose of this study is to quantitatively evaluate the hydrological and hydrogeochemical factors that influence As concentration in the shallow groundwater of southwestern Taiwan. Dynamic factor analysis (DFA), a dimension reduction technique that considers the time component for studying multivariate time series, is adopted to obtain underlying common trends of response time series and influences of explanatory variables. The major As-associated hydrological and hydrogeochemical parameters were identified and applied to predict the variation of As concentrations in groundwater. The results showed that As fluctuation in groundwater were governed by the rainfall and river water recharges in both dry and wet seasons. Rapid infiltration of surface water caused a rise in groundwater elevation in the rainy season and created a reductive environment, inducing reductive dissolution of As-bearing Fe (hydr)oxides. Dissolved As concentration was subsequently transported by fast groundwater flow to downstream areas. Moreover, extensive pumping for agricultural and aquacultural demands masked the influences of groundwater elevation on variations of As concentrations and led to critical seawater intrusion. In non-saline wells, Fe reduction and subsequent secondary mineralization between dry and wet seasons was responsible for As mobility. Sulfate reduction in saline wells promoted sulfide precipitation and restrained As mobility in wet season. Collectively, hydrological and hydrogeochemical variables controlled the temporal variation and spatial distribution of As concentration, respectively, in the shallow groundwater of southwestern Taiwan.

This study aims to assess the nitrogen contamination of groundwater in paddy and upland fields. A reactive chemical transport model PHREEQC and a variable saturated groundwater flow and transport model FEMWATER were used to evaluate the vertical transport of nitrogen compound in various soil types of paddy and upland. The shallow groundwater quality monitoring data of 2003, 2006, 2009 in the Choushui river alluvial fan, the major agriculture production area in Taiwan, were applied to support the validity of the numerical simulation findings. Results from PHREEQC and FEMWATER simulations showed that the organic-rich impermeable plow sole layer underneath the muddy layer of rice paddy can effectively reduce NO3 − and N2 to NH4 + and retard the movement of NH4 +. However, in the upland field which has no plow sole layer, the NH4 + can move easily to the shallow aquifer and contaminate the groundwater. The spatiotemporal distribution of NO3 −–N and NH4 +–N in the Choushui river alluvial fan revealed that high nitrate–N contamination areas were located mainly in the upland field of the proximal fan, where the granular unconfined aquifer was vulnerable to surface contaminants. Moreover, the unconfined nature of the aquifer allows the oxidization of NH4 + to NO3 − and accelerates the plume movement. High ammonium–N concentration areas were mostly dispersed in the distal-fan area where upland planting and aquacultural farming were prevailed. The high NH4 +–N found in the northern Choushui river alluvial fan was attributed to the alternative planting of rice and upland crops, and the plow sole layer was broken to maintain the quick drainage upland crop needs.

Summary In the light of the redox characteristics of groundwater in the arsenic-affected multi-layers aquifers in the Choushui River alluvial fan, an investigation on major redox-sensitive species were carried out to explore their spatial patterns, the controlling factors and the redox zonations. Factor analysis was applied to 16 hydrochemical parameters of 152 groundwater samples. Five factors including seawater salinization, arsenic pollutant, nitrate contamination, alkaline and Fe, Mn accounted for 86.4% of the total variance identified. Among them, arsenic pollutant, nitrate contamination and Fe, Mn were redox-sensitive factors. Arsenic pollutant factor has strong loading on As and TOC, moderate loading on NH 4 + and low loading on Alkalinity and Fe. These hydrochemical parameters closely relate to the reductive dissolution processes of arsenic release to groundwater. Discriminant Analysis was adopted to delineate three redox zones (oxidative, transitional and reductive zones) in 4-layers aquifers and yielded 90.4% correctness on groundwater quality data. The spatial distributions of As and NH 4 + were similar but showed a reverse pattern with NO 3 - . Arsenic and NH 4 + were mainly distributed in the reductive zone whereas NO 3 - was majorly distributed in the oxidative zone suggesting the denitrification is partially responsible to the reductive dissolution of As in the groundwater.

Residents of the Pingtung Plain, Taiwan, use groundwater for drinking. However, monitoring results showed that a considerable portion of groundwater has an As concentration higher than the safe drinking water regulation of 10 μg/L. Considering residents of the Pingtung Plain continue to use groundwater for drinking, this study attempted to evaluate the exposure and health risk from drinking groundwater. The health risk from drinking groundwater was evaluated based on the hazard quotient (HQ) and target risk (TR) established by the US Environmental Protection Agency. The results showed that the 95th percentile of HQ exceeded 1 and TR was above the safe value of threshold value of 10-6. To illustrate significant variability of the drinking water consumption rate and body weight of each individual, health risk assessments were also performed using a spectrum of daily water intake rate and body weight to reasonably and conservatively assess the exposure and health risk for the specific subgroups of population of the Pingtung Plain. The assessment results showed that 0.01-7.50 % of the population's HQ levels are higher than 1 and as much as 77.7-93.3 % of the population being in high cancer risk category and having a TR value >10-6. The TR estimation results implied that groundwater use for drinking purpose places people at risk of As exposure. The government must make great efforts to provide safe drinking water for residents of the Pingtung Plain.

Hereditary angioedema (HAE) due to C1 inhibitor deficiency (C1-INH) is a rare complement immunodeficiency disease. It is an autosomal dominant condition with an estimated prevalence of approximately 1:50,000 to 100,000 in Western countries and 1: 1,000,000 in Taiwan. HAE can be categorized into three different types. Type I HAE results from low antigenic and functional levels of C1INH. Type II HAE is associated with a normal C1-INH protein level but impaired function. Type III HAE has been described in women only and presents normal C1-INH levels and function. In Taiwan, all of the reported cases were type I HAE. In this report,wedescribe thefirst caseof type II HAE inTaiwan. A 37-year-old man visited Mackay Memorial Hospital, Taipei, becauseof recurrent abdominal painwith syncope for 2 months. He suffered from spontaneous lip, limbs, and perineum eruption with nonpitting edema since 2009, but there was no identified trigger. The skin lesion onset was about three to five times a year and the usual duration was 3e4 days, afterwhich the symptoms resolved spontaneously. Severe abdominal pain with syncope occurred in July 2014. Physical examination showed periumbilical tenderness with muscle guarding noted but no rebounding pain. Abdominal computed tomography showed edematous of the duodenum

Hereditary angioedema (HAE) is a rare, autosomal dominant inherited disease which is caused by a genetic deficiency of C1 esterase inhibitor (C1 INH). There have only been a few case reports in Taiwan to date.To describe the clinical features of type I HAE in Taiwanese patients.Three unrelated Taiwanese families with type I HAE are reported, and one case of a family from a review of PubMed was reviewed. Clinical manifestations, diagnostic examinations, management and genetic studies were analyzed.Including this report, 19 patients had low C1 INH and low C4 levels and were diagnosed with type I HAE. Only 11 (57.9%) patients were symptomatic. Recurrent skin swelling and edema over the four extremities or trunk were reported in all symptomatic patients (100%). 45.5% of the patients recalled laryngeal attacks and one patient died from asphyxia. 18.2% of the patients experienced abdominal symptoms. The age at the beginning of clinical symptoms ranged from 5 to 30 years (mean +/- SD: 20.82 +/- 7.88 years). The diagnosis tended to be delayed (range from 1 to 39 years; mean +/- SD: 8.45 +/- 11.04 years). Nine patients had a mutant C1 INH gene, and two patients received long-term prophylaxis with danazol.The prevalence of hereditary angioedema in Taiwan is low. Persons with low levels of C1 INH who were clinically symptomatic accounted for only 57.9% of the cases in our study, which is far lower than previous reports from other countries. Ethnic differences may be the reason for this finding. Further genomic studies are needed to elucidate the genetic penetrance of C1 INH deficiency in Taiwan.

X-linked agammaglobulinemia (XLA, also called Bruton's disease) is is an X-linked recessive disorder characterized by recurrent bacterial infections, usually occurring in the first few years of life. Here, we report the results of a BTK gene mutation screening study that was performed in Taiwanese families with the BTK gene defect to further understand the inheritance patterns of XLA patients in Taiwan and to avoid new cases of XLA within families.In this study, 52 members of 4 unrelated Taiwanese families with the BTK gene defect were enrolled. We studied the immunologic reports of 6 symptomatic living male patients with confirmed BTK gene defects and correlated the findings with their clinical symptoms. The genomic DNA of the subjects was subjected to direct sequencing mutation analysis.We screened 52 members of 4 unrelated Taiwanese families with the BTK gene defect for BTK gene mutation and found that there were 6 symptomatic living patients with a confirmed defect, 7 symptomatic deceased patients highly suspected to have had the defect and 11 asymptomatic female carriers.This is the first report in a series of the thorough screening for the BTK mutation and its carrier status in 4 unrelated Taiwanese families. One pedigree of our study comprises 4 generations. A complete BTK gene mutation study for the patient's family members is strongly suggested.

Scleroderma is a chronic connective tissue disease characterized by hardened or scaly skin and widespread abnormalities of the viscera, which is rare in the pediatric age group.In this study, we retrospectively reviewed 23 pediatric patients suffering systemic (SSc) and localized (LS) scleroderma.Twenty-three patients were enrolled and were diagnosed with SSc or LS from March 1993 to September 2009 in the Department of Pediatrics at Mackay Memorial Hospital in Taipei, Taiwan. These diagnoses were based on the criteria of the American College of Rheumatology and the clinical manifestations of hard skin. Data recorded included sex, age-at-onset, age-at-diagnosis, laboratory data, family history, trauma history, treatment, and outcomes.Three patients suffered SSc and 20 patients had LS, including 16 girls and 7 boys. Mean age-at-onset was 6.55 +/- 3.28 years old. Antinuclear antibodies were positive in 15 patients. Tests for anti-Scl-70 antibodies were positive in 1 patient with SSc. One boy had en coup de sabre combined with a posterior fossa tumor. Twenty-two patients were treated with D-penicillamine. Oral prednisolone and methotrexate were added, if indicated. One girl with LS developed proteinuria after D-penicillamine treatment. All patients with localized disease ultimately documented a softening of their skin lesions.While scleroderma is rare in children, the prognosis of SSc is poor but better than for adults. The prognosis for LS is usually benign, however, the skin may become progressively indurated and it may not only be a skin disease. No progression from LS to SSc was observed in our study.

Arsenic (As) contamination of groundwater, accompanied by critical salinization, occurs in the southwestern coastal area of Taiwan. Statistical analyses and geochemical calculations indicate that a possible source of aqueous arsenic is the reductive dissolution of As-bearing iron oxyhydroxides. There are few reports of the influence of sulfate-sulfide redox cycling on arsenic mobility in brackish groundwater. We evaluated the contribution of sulfate reduction and sulfide re-oxidation on As enrichment using δ(34)S([SO(4)]) and δ(18)O([SO(4)]) sulfur isotopic analyses of groundwater. Fifty-three groundwater samples were divided into groups of high-As content and salinized (Type A), low-As and non-salinized (Type B), and high-As and non-salinized (Type C) groundwaters, based on hydro-geochemical analysis. The relatively high enrichment of (34)S([SO(4)]) and (18)O([SO(4)]) present in Type A, caused by microbial-mediated reduction of sulfate, and high (18)O enrichment factor (e([SO(4)-H(2)O])), suggests that sulfur disproportionation is an important process during the reductive dissolution of As-containing iron oxyhydroxides. Limited co-precipitation of ion-sulfide increased the rate of As liberation under anaerobic conditions. In contrast to this, Type B and Type C groundwater samples showed high δ(18)O([SO(4)]) and low δ(34)S([SO(4)]) values under mildly reducing conditions. Base on (18)O mass balance calculations, the oxide sources of sulfate are from infiltrated atmospheric O(2), caused by additional recharge of dissolved oxygen and sulfide re-oxidation. The anthropogenic influence of extensive pumping also promotes atmospheric oxygen entry into aquifers, altering redox conditions, and increasing the rate of As release into groundwater.

IgE-mediated hypersensitivity to buckwheat is common in Korea, Japan, and some other Asian countries. However, buckwheat is not a common allergen in Taiwan. We report a woman with asthma who had anaphylactic shock, generalized urticaria, and an acute exacerbation of asthma five minutes after ingesting buckwheat. The patient underwent skin prick and Pharmacia CAP testing (Uppsala, Sweden) for specific IgE to buckwheat, white sesame and soybean as well as other common allergens in Taiwan including Dermatophagoides pteronyssinus (Dp), D. farinae (Df), cat and dog dander, cockroach, egg white, cow milk and codfish. The patient had a strongly positive skin prick test response to buckwheat and positive reactions to Dp and latex. Specific IgE results were class 6 for buckwheat, class 4 for Dp and Df, and class 2 for dog dander, wheat, sesame and soybean. Results of an open food challenge with white sesame and soybean were negative. Although buckwheat is a rare allergen in Taiwan, it can cause extremely serious reactions and should be considered in patients presenting with anaphylaxis after exposure to buckwheat.

The purpose of this study was to compare the safety and efficacy of cetirizine plus pseudoephedrine (C+P) with loratadine plus pseudoephedrine (L+P) in the treatment of perennial allergic rhinitis. This was a double blind, randomized, parallel trial with an active control. Subjects aged 12 to 70 years with perennial allergic rhinitis for at least 2 years were enrolled and randomized to receive either of the active study medications plus a placebo resembling the other, twice daily for 4 weeks. Nasal total symptom scale (NTSS) including sneezing, rhinorrhea, nasal itching and nasal stuffiness is evaluated by subjects daily and at baseline, 2 weeks, and 4 weeks by the investigator as efficacy measurement. A total of 51 eligible patients were enrolled and 45 patients completed the treatment course. Both groups had significant reductions in NTSS after 4 weeks of treatment as assessed by the subjects, but there was no significant difference between the two groups (mean +/- SD) reduction of 4.25 +/- 2.45 with C+P vs. 3.52 +/- 2.41 with L+P, p = 0.215. As assessed by the investigator, sneezing was significantly better at 2 weeks (-1.13 vs. -0.52, p = 0.028) and nasal congestion at 4 weeks (-1.71 vs. -1.19, p = 0.031) in subjects treated with C+P compared to those treated with L+P. There were 37 treatment-related adverse events (5 in 4 subjects in the C+P group and 32 in 16 subjects in the L+P group). It was concluded that both cetirizine plus pseudoephedrine and loratadine plus pseudoephedrine are efficacious for perennial allergic rhinitis in Taiwanese subjects. Relief of sneezing and nasal congestion may be marginally better with the cetirizine preparation, which also seemed to be slightly better tolerated, although the incidence of side effects did not differ significantly.

In infants and children, enterovirus (EV) infections are very common. In neonates, EV infections may lead to fatal myocarditis, encephalitis, or necrotizing hepatitis. Transplacental viremia before delivery is possible but has only been demonstrated occasionally. The presence or absence of passively acquired maternal antibody specific for the infecting EV serotype plays the most important role in neonatal EV infections. We report a fatal case of congenital coxsackievirus B5 infection, confirmed by culture of the virus from the patient's throat and rectal swab and from his mother's throat. The mother had suffered from fever for 1 week since 9 days before delivery. Fever subsided 2 days before the day of delivery, but absence of fetal movements was noted. The newborn's 4-year-old elder sister also had suffered from fever with upper respiratory symptoms during the same period. Fever occurred in this baby immediately after birth by cesarean section, suggesting the presence of transplacental virus transmission.