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Introduction Immune thrombocytopenia (ITP) is an immune-mediated disease; it has been reported to be associated with several diseases. The data on ITP in patients with hepatitis B, tuberculosis, or thyroid diseases are relatively scarce. In addition, these diseases are not rare in Taiwan, together with hepatitis C and Helicobacter pylori which are also related to ITP. Methods and materials We identified 1223 ITP patients and characterized these patients between 2000 and 2013 from the National Health Insurance Research Database. The adult ITP patients were matched with non-ITP patients. Results The overall incidence of ITP was 2.59/100,000 person-years. The frequencies of hepatitis B and C in adult ITP patients were much higher than those indicated in previous studies. The frequencies of non-traumatic intracerebral hemorrhage and gastrointestinal bleeding during hospitalization among ITP patients were low. The diseases associated with increased risks of ITP included hepatitis B (OR = 18.70, 95% CI = 9.71–36.03), hepatitis C (OR = 54.43, 95% CI = 15.94–185.88), hepatitis B and hepatitis C (OR = 7.02, 95% CI = 1.47–33.56), tuberculosis (OR = 5.37, 95% CI = 2.72–10.61), Helicobacter pylori infection (OR = 5.93, 95% CI = 3.16–11.10), hyperthyroidism (OR = 3.43, 95% CI = 2.09–5.64), hypothyroidism (OR = 6.70, 95% CI = 2.35–19.13), and simple and unspecified goiter (OR = 2.68, 95% CI = 1.43–5.03). Conclusions Surveying for the diseases which are frequent and related to increased risks of ITP among patients with newly diagnosed ITP should be considered.

The relationship between infection and Kawasaki disease (KD) remains unclear. Infection has long been considered a key predisposing factor for KD. Bacterial and viral agents may be related to the onset of KD because of superantigen and cytokine production. Various bacterial and viral infections have been reported to be associated with KD, but the actual mechanism remains unknown. The higher association between KD and enterovirus has been well documented by using Taiwan National Health Insurance Research Database. However, no evidence has been obtained that various bacterial and viral infections induce KD. Comprehensive research, including infectious agents, should be conducted to elucidate the pathogenesis of KD.

Mucus production of the respiratory tract is our first defense against microbes and allergens. However, overproduction of the sputum and difficulty with airway clearance could lead to many respiratory tract diseases. Mucoactive agents are medications that either change the properties of the sputum or decrease its production. This article aims to provide an overview of common mucoactive agent.

Background/purpose: To evaluate the relationship between serum-specific immunoglobulin E (IgE) to peanuts/tree nuts and their clinical manifestations in atopic diseases. Method: Serum from people with the classical symptoms of asthma, allergic rhinitis (AR), or atopic dermatitis (AD) was collected for the measurement of serum-specific IgE to peanuts, cashew nuts, Brazil nuts, almonds, and coconuts. Cases with possible sensitization to these nuts (serum specific IgE ≧ 0.35 kU/L) were selected and their clinical relationships with physician-diagnosed asthma, allergic rhinitis, or atopic dermatitis were analyzed. Result: Compared with non-sensitization group, people with peanut/tree nut sensitization have higher prevalence of atopic dermatitis, but no such difference noted in the prevalence of allergic rhinitis. In the situation of asthma, people with sensitization to peanuts and Brazil nuts, but not other nuts, have higher prevalence of asthma than people without sensitization to any nut (p

Background The relationship between hemoglobin and patent ductus arteriosus (PDA) has not been discussed before. The aim of this study was to assess the influence of hemoglobin and perinatal factors on PDA in very low-birthweight (VLBW) infants. Methods Using data from the Premature Baby Foundation of Taiwan (PBFA), the characteristics, perinatal factors, and hemoglobin of VLBW infants with and without PDA and treatment were compared. Results Between January 2008 and December 2010, 89 VLBW infants were admitted to hospital. The overall survival rate was 87.6%. Twelve infants were excluded. Compared to those without PDA, the 34 infants with PDA received oral indomethacin or surgery, had smaller mean gestational age (GA; 27.93 ± 1.818 weeks, P = 0.000003), lower mean birthweight (BW; 1031 ± 259 g, P = 0.0001), significantly lower Apgar score at 5 min, more severe respiratory distress syndrome (RDS; grade 3 or 4), greater use of surfactants, and lower mean hemoglobin (P = 0.018) after birth than those without PDA. Compared to those with indomethacin, the seven infants with surgery had lower mean GA (26.43 ± 1.718 weeks, P = 0.011), significantly lower Apgar scores at 1 min, but higher platelet count (P = 0.002) after birth, and more red blood cell transfusions (P = 0.039). Conclusions Smaller GA, lower BW, lower Apgar score at 5 min, more severe RDS, greater use of surfactants, and lower hemoglobin after birth place VLBW infants at greater risk of PDA. Proper prenatal care, and prevention of premature labor and delivery may be the most important preventative factors. The appropriate hemoglobin level for PDA closure requires further investigation.

Rotavirus infection has been the leading cause of gastroenteritis among children in Taiwan. Studies have shown that 40% of hospitalization for acute gastroenteritis can be prevented through the use of vaccines, including a live, attenuated monovalent rotavirus vaccine and a pentavalent, human–bovine reassortant rotavirus vaccine. In 2009, the World Health Organization suggested that rotavirus vaccine should be included in all national immunization programs. This review summarizes issues and recommendations discussed during an expert meeting in Taiwan. The recommendations included: (1) rotavirus vaccine should be offered to all healthy infants (including those without contraindications, such as immunodeficiency) at an appropriate age; (2) either monovalent or pentavalent vaccine can be administered concurrently with routine injected vaccines; (3) the administration of rotavirus vaccine must be administered at least 2 weeks prior to oral polio vaccination; (4) the first vaccine dose for infants should be administered between age 6 weeks and age 14 weeks 6 days and the course should be completed by age 8 months 0 day; (5) pentavalent vaccines can be administered at 2 months, 4 months, and 6 months while monovalent vaccines can be taken at 2 months and 4 months; (6) a combined use of monovalent and pentavalent vaccine is justified only when the previous dose is unavailable or unknown; and (7) rotavirus vaccines may be given to premature infants, human immunodeficiency virus infected infants and infants who have received or are going to receive blood products.

Background: Beginning 2007, the intratracheal route of epinephrine to end massive pulmonary hemorrhage (MPH) in very low-birthweight (VLBW) infants was modified at Kaohsiung Veterans General Hospital. The aim of the present study was to assess the change in outcomes for these infants, and to evaluate the risk factors of MPH. Methods: Using the database of the Premature Baby Foundation of Taiwan, the mortality, risk factors and characteristics of VLBW infants with or without MPH were compared between 2000–2006 and 2007–2010. Results: Between January 2000 and December 2010, 399 VLBW infants were admitted to Kaohsiung Veterans General Hospital. Mean birthweight (BW) was 1099.6 ± 272.7 g, and mean gestational age (GA) was 28.7 ± 2.9 weeks. The overall survival rate was 84.2%. Sixteen (4%) had MPH: 11 in the first group (2000–2006; 18.2% survival rate), and five in the second group (2007–2010; 80% survival rate; P= 0.0000002). Infants with MPH had lower mean BW (864.9 ± 301.4 g, P= 0.0004), smaller mean GA (26.1 ± 2.0 weeks, P= 0.0002), significantly lower Apgar scores at 1 and 5 min, higher severity of respiratory distress syndrome (RDS; grades 3 or 4), and greater use of surfactant than infants without MPH. They also had more intraventricular hemorrhage and higher mortality. Conclusions: Smaller GA, lower BW, lower Apgar scores at 1 and 5 min, severe RDS (grades 3 or 4), and use of surfactant place VLBW infants at greater risk of MPH. Proper prenatal care and preventing premature labor and delivery were the most important preventative factors. A quick, deep thrust of intratracheal epinephrine with a catheter may improve survival.

Background/Purpose Infective endocarditis caused by Staphylococcus lugdunensis is a rare disease. Since its first description in 1988, there have only been a few reports of this disease and the causative organism. These publications were primarily case reports and brief case series. We conducted a literature review to identify the nature of the disease and its risk factors. Methods We retrospectively reviewed the cases reported between 1988 and 2008 by searching the relevant literature using the keywords "endocarditis" and " Staphylococcus lugdunensis " in the Medline database. All cases included met the definition of the modified Duke criteria. Results For the period 1988-2008, 67 cases from 27 articles were reviewed. The mean age of individuals was 53.9 years. Left-sided valvular endocarditis represented 52 (82.5%) of cases and native-valve endocarditis was evident in 48 (78.7%) of cases. A large proportion (82%) of 50 S. lugdunensis strains were susceptible to penicillin. Valve replacement operations were performed in 42 (66.7%) patients and the mortality rate was 38.8%. Univariate analysis showed a higher mortality rate in patients aged more than 50 years, those treated before 1995, those treated with antibiotics alone, and those with growth not detected by echocar-diography. Medical treatment alone was the independent risk factor for mortality by multivariate analysis. Conclusion S. lugdunensis endocarditis led to substantial morbidity and mortality. Detailed microbiological identification, echocardiography evaluation, and valve replacement may improve the clinical outcome of individuals with S. lugdunensis endocarditis.

As a member of orthomyxoviridae family, influenza viruses are enveloped viruses containing eight RNA segments. The main antigenic determinants of influenza A and B viruses are two surface glycoproteins, the hemagglutinin (H) and the neuraminidase (N). A genetic reassortment between influenza A viruses from different animal hosts may lead to an antigenic shift and thereby increase the risk of a potential pandemic. H1N1 and H3N2 subtypes of influenza A have been circulating all over the world as seasonal influenza since the last H3N2 pandemic in 1968.1 In April 2009, the Centers for Disease Control and Prevention of the United States identified two cases of human infection with the H1N1 novel influenza virus. The greatest initial burden of critical illness and deaths occurred in Mexico between March and June 2009. The virus is a triple-reassortant containing gene segments from swine influenza virus, human influenza virus, and avian influenza virus. Genes for hemagglutinin and neuraminidase come from swine influenza virus.2 On June 11th, 2009, the World Health Organization raised the level of influenza A (H1N1) pandemic alert from phase 5 to 6, as sustained communitylevel transmission of the virus is taking place in more than one region of the world. Recommendations for the Management of Children With H1N1 Novel Influenza Infection

Studies about primary spontaneous pneumothorax (PSP) in pediatric patients are not as many as in adult patients since the incidence of PSP is lower in children than in adults. There are evidence-based guidelines for the management of PSP in adults, whereas, in children, the approach of PSP is mainly extrapolated from the adult guideline. In this article, aspects of incidence rate, epidemiology, and pathophysiology, diagnosis, management, and recurrence rate about pediatric PSP are discussed.

Nontuberculous mycobacterium (NTM) is one of the well-known causes of cervicofacial lymphadenopathy in children under 5 years of age. Children often present with a painless cervical mass that fails to respond to conventional antibiotics. They are often referred under the suspicion of a neoplasm or bacterial adenitis rather than NTM cervical lymphadenitis. The lack of systemic symptoms, modest or negative purified protein derivative test and absence of exposure to active tuberculosis are characteristics of NTM lymphadenitis. The diagnosis usually requires the isolation of pathogen or pathologic proof. Complete excision is the choice of treatment by the majority of authors in the literature. This not only enables rapid diagnosis but ensures the lowest recurrence rate. Medical management is sometimes successful when complete resection is impossible or refused. To our knowledge, the incidence of NTM cervical lymphadenitis in children is increasing throughout the world. However, such reports of children in Taiwan is lacking. Clinicians should suspect a possible nontuberculous mycobacterial infection when a cervical lump is found in a child.

We examined the epidemiological profile of rotavirus infection among children hospitalized for diarrhea in Taiwan, to assess the burden of this disease. From 1 April 2001 through 31 March 2003, children

A clustering analysis method using the number of commonly exposed groups identified as a clustering criterion for a group of peptide structures generated from an in vacuo molecular dynamics simulation is presented. The number of commonly exposed groups is identified as the number of atoms of the same type which appear on vertices of groups of three dimensional convex hulls computed for groups of structures sampled and collected as blocks. Blocks of structures of high structural similarity are classified as clusters if their corresponding number of commonly exposed groups identified are larger than a preset criterion. Linkages between blocks are provided with the generation of blocks consisting of overlapping structures. However, the linkage can be eliminated by employing a minimal distance criterion for each block generated. The feasibility of this proposed clustering method is tested through a comparison of results obtained from a conventional and a hierarchical clustering method. Since change in fine st...

Background Infective endocarditis (IE) due to Pseudomonas aeruginosa is rare and accounts for only about 3% of all patients with this disease. Most infections are associated with the use of intravenous drugs. Patients with P. aeruginosa -related IE who do not use intravenous drugs are extremely rare. We carried out a review of the literature to identify the nature and risk factors of this disease. Methods Patients with IE reported between 1993 and 2013 were reviewed by searching the Medline database using the keywords "endocarditis" and " Pseudomonas aeruginosa ". All of the patients included met the definition of the modified Duke criteria. Results Twenty-seven patients in 22 reports were reviewed. IE associated with health care accounted for 20 patients (74%). The mean age of the patients was 53.4 years and there was a predominance of men (81.5%). Native valve endocarditis was seen in 20 (74.1%) patients. Surgery for infection control was performed in 15 (55.6%) patients and the mortality rate in patients who underwent surgery was 33.3% (five patients). A relapse of IE after adequate treatment was seen in nine (33.3%) patients. The mortality rate in all 27 patients was 28.6% (2/7) for those with community-acquired IE and 40% (8/20) for those with IE associated with health care. Univariate analysis showed a higher mortality rate in patients aged >60 years and in those whose source of endocarditis was related to a prosthetic device. Conclusion P. aeruginosa endocarditis has substantial morbidity and mortality. It is characterized by easy relapse and is highly associated with prosthetic devices.

Goals: Quantitative Vesikari scales and qualitative severe diarrhea(Vesikari scale Z11) assessments were used to grade the Salmonella-induced and rotavirus-induced gastro enteritis severity. A significantreduction in severe diarrhea (Vesikari score Z11) was used to evaluatethe efficacy of three-combination probiotics (BIO-THREE).Background: Several studies have shown that rotavirus andSalmonella infections are the leading causes of infectious gastro-enteritis. Although probiotics have been effective in some studies,the use of 3-combination formulation probiotics is rare.Study: This single-center, open-label, randomized, controlled trialincluded 159 patients (age range, 3mo to 14y) hospitalized withinfectious gastroenteritis betw een February 2009 and October 2010.Results: Patients were grouped according to the pathogen identified(48, Salmonella; 42, rotavirus; and 69, unknown origin). The totaldiarrhea duration was significantly shorter for children who receivedBIO-THREE (P

The relationship between hemoglobin and patent ductus arteriosus (PDA) has not been discussed before. The aim of this study was to assess the influence of hemoglobin and perinatal factors on PDA in very low-birthweight (VLBW) infants.Using data from the Premature Baby Foundation of Taiwan (PBFA), the characteristics, perinatal factors, and hemoglobin of VLBW infants with and without PDA and treatment were compared.Between January 2008 and December 2010, 89 VLBW infants were admitted to hospital. The overall survival rate was 87.6%. Twelve infants were excluded. Compared to those without PDA, the 34 infants with PDA received oral indomethacin or surgery, had smaller mean gestational age (GA; 27.93 ± 1.818 weeks, P = 0.000003), lower mean birthweight (BW; 1031 ± 259 g, P = 0.0001), significantly lower Apgar score at 5 min, more severe respiratory distress syndrome (RDS; grade 3 or 4), greater use of surfactants, and lower mean hemoglobin (P = 0.018) after birth than those without PDA. Compared to those with indomethacin, the seven infants with surgery had lower mean GA (26.43 ± 1.718 weeks, P = 0.011), significantly lower Apgar scores at 1 min, but higher platelet count (P = 0.002) after birth, and more red blood cell transfusions (P = 0.039).Smaller GA, lower BW, lower Apgar score at 5 min, more severe RDS, greater use of surfactants, and lower hemoglobin after birth place VLBW infants at greater risk of PDA. Proper prenatal care, and prevention of premature labor and delivery may be the most important preventative factors. The appropriate hemoglobin level for PDA closure requires further investigation.

Beginning 2007, the intratracheal route of epinephrine to end massive pulmonary hemorrhage (MPH) in very low-birthweight (VLBW) infants was modified at Kaohsiung Veterans General Hospital. The aim of the present study was to assess the change in outcomes for these infants, and to evaluate the risk factors of MPH.Using the database of the Premature Baby Foundation of Taiwan, the mortality, risk factors and characteristics of VLBW infants with or without MPH were compared between 2000-2006 and 2007-2010.Between January 2000 and December 2010, 399 VLBW infants were admitted to Kaohsiung Veterans General Hospital. Mean birthweight (BW) was 1099.6 ± 272.7 g, and mean gestational age (GA) was 28.7 ± 2.9 weeks. The overall survival rate was 84.2%. Sixteen (4%) had MPH: 11 in the first group (2000-2006; 18.2% survival rate), and five in the second group (2007-2010; 80% survival rate; P= 0.0000002). Infants with MPH had lower mean BW (864.9 ± 301.4 g, P= 0.0004), smaller mean GA (26.1 ± 2.0 weeks, P= 0.0002), significantly lower Apgar scores at 1 and 5 min, higher severity of respiratory distress syndrome (RDS; grades 3 or 4), and greater use of surfactant than infants without MPH. They also had more intraventricular hemorrhage and higher mortality.Smaller GA, lower BW, lower Apgar scores at 1 and 5 min, severe RDS (grades 3 or 4), and use of surfactant place VLBW infants at greater risk of MPH. Proper prenatal care and preventing premature labor and delivery were the most important preventative factors. A quick, deep thrust of intratracheal epinephrine with a catheter may improve survival.

A clustering analysis method using the number of commonly exposed groups identified as a clustering criterion for a group of peptide structures generated from an in vacuo molecular dynamics simulation is presented. The number of commonly exposed groups is identified as the number of atoms of the same type which appear on vertices of groups of three dimensional convex hulls computed for groups of structures sampled and collected as blocks. Blocks of structures of high structural similarity are classified as clusters if their corresponding number of commonly exposed groups identified are larger than a preset criterion. Linkages between blocks are provided with the generation of blocks consisting of overlapping structures. However, the linkage can be eliminated by employing a minimal distance criterion for each block generated. The feasibility of this proposed clustering method is tested through a comparison of results obtained from a conventional and a hierarchical clustering method. Since change in fine st...

Data on the clinical characteristics of pediatric tuberculosis (TB) are limited. This retrospective study was performed to evaluate the demographic characteristics and clinical features of pediatric TB.The medical records of children with TB at Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, between 1992 and 2002 were analyzed for demographic and clinical characteristics, and treatment regimens.103 children aged 0 to 14 years with probable or confirmed TB were enrolled. Ninety patients (87.4%) had pulmonary tuberculosis (PTB) and 13 (12.6%) had extrapulmonary tuberculosis (EPTB). The mean +/- standard deviation age of children with PTB and with EPTB was 6.0 +/- 4.2 years and 4.5 +/- 5.4 years, respectively. Household contact was the route of infection for 44.4% of patients with PTB and 7.7% of patients with EPTB. TB in children aged 0 to 4 years most commonly involved the lung (53.3%) or the extrapulmonary region (69.2%). Common symptoms of PTB were cough (81.1%) and fever (33.3%). The most frequent sites of pediatric EPTB were bone (n = 4) and cervical lymph nodes (n = 4). Tuberculin skin test (TST;or=10 mm) was positive in 69.6% of children with PTB (55/79) and 37.5% of children with EPTB (3/8). Children with PTB had a lower positive acidfast bacilli rate (40.0%) and Mycobacterium tuberculosis culture (27.8%). Eighty percent of patients infected through household contact had a positive TST.Prolonged cough, household TB contact, and positive TST were characteristic factors for children with PTB in southern Taiwan. Young age was associated with high morbidity.

Kikuchi-Fujimoto disease is a benign and self-limited disorder. The common clinical features are fever and cervical lymphadenitis. A 9-year-old girl with fever and cervical lymphadenitis was admitted because of persistent symptoms. A cervical lymph node biopsy showed the characteristic features of Kikuchi-Fujimoto disease. Herein, we will discuss the clinical features, diagnosis, and treatment of Kikuchi-Fujimoto disease and highlight the dramatic response when a patient was treated with hydroxychloroquine.

To determine the frequency, risk factors, associated pathogens, and outcomes of ventilator-associated pneumonia (VAP) after pediatric cardiac surgery.This was a retrospective review of the medical records of patients younger than 18 years with congenital heart disease (CHD) who underwent cardiac surgery from January 2005 to December 2007. Patients were categorized into 2 groups: with and without VAP.Of 100 patients, 13% acquired VAP. Most patients (85%) who developed VAP were infants younger than 1 year. Patients with complex CHD were more likely to develop VAP than patients with simple CHD (chi(2) = 7.69; p0.03). Two independent and modifiable risk factors were identified: prolonged use of mechanical ventilation (adjusted odds ratio [AOR], 15.196; 95% confidence interval [CI], 2.158-107.2) and prolonged use of a central venous catheter (AOR, 7.342; 95% CI, 1.054-51.140). The cardiopulmonary bypass time and duration of chest tube drainage were not risk factors. The development of VAP increased pediatric intensive care unit duration of stay (p0.006), duration of hospital stay (p0.001), and mortality rate (p0.001). Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were the most common pathogens isolated from endotracheal aspirate.VAP is common after congenital heart surgery. Physicians must pay special attention to infants with complex CHD because they are at high risk for the development of VAP after congenital heart surgery. Shortening the duration of mechanical ventilation and central venous catheter placement are critical factors for reducing the risk for VAP.

The aim of this retrospective study was to test the connection between acute M. pneumoniae infection and the exacerbation of asthma. The clinical characteristics of Mycoplasma infection seen during emergent visits in asthmatic children were reviewed.We examined the cases of 316 asthma exacerbation patients aged from two to fourteen-years-old. They were divided into two groups according to their asthma history. One hundred and eighty-eight cases had evidence of a history of asthma (group 1) and 128 had only had their first asthma attack (group 2). The control group (group 3) was made up of 151 asthmatic children who had no acute exacerbation during the previous six months. In all three groups, we looked whether those children had acute M. pneumoniae infection or not. Acute M. pneumoniae infection was defined by positive results in serologic testing, with specific immunoglobulin M (IgM) antibody or with aor = fourfold increase in IgG titer by the third week in the same children.In group 1, acute M. pneumionae infection was found in 42 (23%) of the 188 children. In group 2, acute M. pneumoniae infection was proven in 57 (45%) of the 128 children. In the control group, 10 (7%) of the 151 children had M. pneumoniae infection. Twenty-three (54%) asthmatic children that presented with fever as the chief complaint were infected with M. pneumoniae, compared with 18 (12%) children without infection (p = 0.014). Twenty-nine (50%) children having their first asthma attack with fever were infected with M. pneumoniae, compared with 22 (32%) without infection (p = 0.009). In group 1, 17 (41%) children with M. pneumoniae infections and 28 (19%) children without M. pneumoniae infections presented with rale breathing sounds of the physical examination (p = 0.027). In group 2, 26 (46%) children with M. pneumoniae infections and 17 (24%) children without M. pneumoniae infections presented with rale breathing sounds (p = 0.019).We found that M. pneumoniae may play a role in asthmatic exacerbation among children, especially in those experiencing their first asthma attack. Moreover, among children with acute M. pneumoniae infection, the number was significantly increased of children having fever as the chief complaint and rales in auscultations compared with those without M. pneumoniae infection.

Background In Taiwan, trivalent oral poliovirus vaccine (tOPV) is in the routine immunization schedule, but its association with illnesses had not been examined. Objectives To investigate clinical presentations and viral characteristics of patients with poliovirus isolates. Study design Clinical data, vaccination records and viral sequences were retrospectively analyzed for patients from whom polioviruses were isolated during 2000–2005. Results OPV-like strains were the only pathogen identified in 208 children who were diagnosed with lower respiratory tract infection (24.5%), acute gastroenteritis (16.8%) or upper respiratory tract infection (10.6%). Timing of poliovirus isolation relative to the tOPV vaccination was unusual in 59 patients, including 6 before any dose and 53 more than 10 weeks after the 3rd or later dose of tOPV. Sequence analyses of the VP1, 2C and 3C/D regions for 19 poliovirus isolates revealed that 4 had previously reported neurovirulence reversions, 1 had intertypic recombination, and 6 had both. No patient had neurological complications, but 3 died of myocarditis, including 2 with recombinant strains and 1 who never received OPV. Conclusion This study describes the isolation of OPV-like strains from patients with a variety of illnesses, raising concerns about their pathogenic potential in an area where tOPV is routinely administered. The detection of genetic variations among OPV-like strains warrants continuing surveillance for these variants in patients with severe illnesses besides neurological complications.

Background/Aims Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and novel therapies are urgently needed. Recently, aberrant expression of Aurora kinases has been reported in various human cancers including HCC. We sought to investigate the potential of a potent and selective Aurora kinase inhibitor, VE-465, for targeted therapy of HCC. Methods Cytotoxicity effects of VE-465 were tested in Huh-7 and HepG2 cell lines. Inhibition of Aurora kinase activity was demonstrated by Western blotting and immunofluorescence staining. Mitotic perturbation was visualized by confocal microscopy. Cell cycle profiles and apoptosis were assessed by flow cytometry. In vivo efficacy was determined in nude mice with human HCC xenografts. Results We demonstrated that VE-465 induced proliferation blockade, histone H3 (Ser10) dephosphorylation, mitotic disturbance, endoreduplication, and apoptosis in Huh-7 and HepG2 cells. We also found that VE-465 suppressed Aurora kinase activity, prevented tumor growth, and induced apoptosis in a Huh-7 xenograft model. Conclusions These findings show that VE-465 has potent anticancer effects in human HCC. Inhibitors of Aurora kinases may deserve further exploration as molecular targeted agents against HCC.

The effects of coumarin on cell viability, cell cycle arrest and induction of apoptosis were investigated in human cervical cancer HeLa cells. Coumarin was cytotoxic with an IC50 of 54.2 microM, induced morphological changes, and caused G0/G1 arrest and apoptosis. The decreasing number of viable cells appeared to be due to induction of cell cycle arrest and apoptotic cell death, since coumarin induced morphologically apoptotic changes and internucleosomal DNA laddering fragmentation and increased the sub-G1 group. Coumarin affected the production of reactive oxygen species and Ca2+ concentration, and dose-dependently induced the depolarization of mitochondrial membrane potential. Also, coumarin treatment gradually decreased the expression of G0/G1-associated proteins which may have led to the G0/G1 arrest, and the anti-apoptotic proteins Bcl-2 and Bcl-xL, and increased the expression of the pro-apoptotic protein Bax. Coumarin decreased the mitochondrial membrane potential and promoted the release of cytochrome c and the activation of caspase-3 before leading to apoptosis. These results provide information on the mechanisms by which coumarin induces cell cycle arrest and apoptosis in human cervical cancer cells (HeLa).

Although Henoch-Schönlein purpura (HSP) is the most common cause of systemic vasculitis in children, long-term and large-scale Taiwanese studies on HSP are rare. We reviewed the records of 107 Taiwanese pediatric patients diagnosed with HSP at our institution between 1991 and 2005.The first clinical manifestations, laboratory findings, and outcome evaluations of the patients were analyzed. Data were grouped according to the presence of fever and upper respiratory tact infection (URI) as a presenting symptom and also by gender. Chi-squared test was used for statistical analysis.The children had a mean age of 6.2 +/- 2.5 years (range, 2 to 13 years), with a male-to-female ratio of 1.0:0.7. Main clinical symptoms included skin rashes (95.3%), gastrointestinal (GI) symptoms (72.0%), joint involvement (46.7%), and kidney involvement (28.0%). The most common first manifestations were skin rashes (56.1%), GI symptoms (35.5%), and joint involvement (12.1%). There was no significant association between first manifestations and fever presence or gender. However, the non-URI patients had a significantly higher incidence of GI problems than the URI group (p=0.01). Fever as a symptom was not associated with elevation of C-reactive protein (p=0.45). Immunoglobulin A levels were within the normal range. No chronic renal failure or end-stage renal disease was detected, and overall the prognosis of patients was good.The categories used did not predict the expression of HSP, with the exception of an association between absence of URI and GI manifestations. Overall, HSP showed a good prognosis.

Rotavirus infection is the most important cause of diarrheal illness in small children in both developed and developing countries. In addition to causing morbidity and mortality in children, the treatment of rotavirus gastroenteritis is a major economic burden on the health care system and families. The purpose of this study was to estimate the economic burden associated with rotavirus infection in Taiwan. To do this, we combined data on the disease burden of a rotavirus-associated hospital admission with detailed cost data for a sample of 2,600 children with diarrhea who were admitted to the hospital. The annual total social and hospital costs for rotavirus-associated admission calculated from data collected during April 1, 2001 to March 31, 2003 was US $13.3 million and US $10.4 million, respectively. On average, families spent US $294 when their child's admission was associated with rotavirus infection; this cost represents approximately 40% of the monthly salary of an unskilled or service worker. In conclusion, these data emphasize the potential for a safe and effective rotavirus vaccine to reduce the economic burden associated with rotavirus disease.

To evaluate the potential of DNA vaccine against dengue (DEN) infection, we characterize the protective efficacy and immune responses of mice intramuscularly injected with plasmid encoding DEN-2 non-structural protein 1 (NS1). Intravenously challenged by lethal DEN-2, mice vaccinated with NS1-DNA exhibited a delay onset of paralysis, a marked decrease of morbidity, and a significant enhancement of survival. In addition to a moderate increase of NS1-specific antibody titer from immunized mice measured by ELISA, a strong priming effect on anti-NS1 response was also noticed in plasmid NS1-vaccinated mice by radioimmunoprecipitation (RIP) or immunoblot analysis. Interestingly, newborn mice from NS1-DNA-immunized dam showed stronger resistance to viral challenge, as compared to those from vector DNA or PBS-immunized dams, indicating the protective role of NS1-specific antibody. In contrast to humoral immune response, DNA immunization can elicit strong cellular immune responses, including NS1-specific T cell proliferation and cytolytic activity. The NS1-DNA-induced protection can be further augmented by co-injection of plasmid encoding interleukin 12 (IL-12), suggesting an effector role of Th1 immunity against DEN infection. In summary, our results suggest the potential of NS1-DNA vaccine against DEN infection, and indicate both NS1-specific humoral and cellular immune responses contribute to the protection.

Objectives: A major outbreak of enterovirus 71 (EV71) in Taiwan in 1998 caused many severe cases and 78 deaths. Our purpose was to find reliable markers and early indicators of fatal EV71 central nervous system (CNS) infection. Methods: From June 2000 to November 2001, 21 patients with hand foot mouth disease or herpangina with CNS infection were admitted to Kaohsiung Veterans General Hospital. All 21 had culture-confirmed EV71 infection or were EV71 IgM positive. Patients were divided into two groups: group I included the five fatalities at our institution and group II, the 16 surviving patients. Results: Of the 21 infants and children with EV71 infection with CNS involvement, MR imaging studies were completed on 17, and 15 showed hyperintensity in the posterior portions of brain stem. All patients received intravenous immunoglobulin (IVIG) 1 g/day for two days and supportive care. Five patients rapidly deteriorated owing to irreversible hypotension and died. The other 16 patients recovered completely without sequel. In group I patients, the decrease of cardiac ejection function is significant and laboratory findings showed lower platelet count ( P =0.0192). The mean of initial cTnI level for groups I and II was 10.6±11.6 and 0.48±0.55 ng/dl, respectively, higher in group I than in II ( P =0.0019). Conclusion: We hypothesized that like patients with severe burns, those with severe EV-71 CNS meningoencephalitis have varying degrees of non-ischemic cardiac injury, manifesting as leakage of cTnI from myocytes into the circulation. EV-71 CNS meningoencephalitis likely to die with an early myocardial involvement evidenced by reduced ejection fraction and release of cTnI. We conclude that fatal EV71 CNS infection quickly leads to death due to severe encephalopathy associated with cardiomyopathy.

Hyper-IgM syndrome (HIM) is a rare disorder resulting from mutation in the CD40 ligand (CD40L) gene. This defect is associated with normal or elevated serum level of IgM and with low to undetectable levels of serum IgG, IgA, IgE. This case of HIM with CD40L deficiency was proven by flow cytometry but initially presented as interstitial pneumonia. Pneumocystis carinii pneumonia was highly suggested. After intravenous immunoglobulin and trimethoprim-sulfamethoxazole treatment, his lung condition improved. However, peritonitis developed and surgical intervention was performed. Ileum perforation and intestinal lymphoproliferation from a pathologic specimen were noted. Although peritonitis is extremely rare in patients with HIM, this report indicates that peritonitis which results from intestinal lymphoproliferation may be a manifestation of HIM.

Capnography provides a substitute for monitoring of arterial carbon dioxide tension (PCO2). We performed a prospective study to evaluate a new application of capnography, using quantitative curve analysis in the pediatric ICU. Twenty-five infants and children admitted to the pediatric ICU after cardiovascular surgery for congenital heart diseases were included in the study. Capnographic curves were recorded during 3 phases of mechanical and spontaneous ventilation: phase 1, immediate postoperative period; phase 3, preextubation period; and phase 2, period between phases 1 and 3. Each recording included 17 sec of capnographic tracings from consecutive spontaneous and/or ventilator-driven breaths. Quantitative curve analysis was made to define parameters including peak value of exhaled PCO2 (P), mean rate of rise of PCO2 (R), and area under each capnographic curve (A). Qualitative inspection of the wave contour showed no obvious difference in phase 3 during spontaneous and mechanically assisted ventilator breaths. However, an obvious difference existed between spontaneous and mechanically assisted breaths in phase 2. For each parameter (P, R, and A), there was a significant difference in phases 2 and 3 from spontaneous breaths. However, there was no significant difference in phases 2 and 3 from ventilator-assisted breaths. We further calculated the ratio of parameters of spontaneous breaths (S) and ventilator-assisted breaths (V) in phase 2 and phase 3. The ratio of S/V for P, R, and A showed significant differences between phase 2 and phase 3. We conclude that quantitative analysis of exhaled end-tidal PCO2 curves revealed significant changes of specific parameters during the transition from the ventilator-dependent state to the spontaneously breathing ventilator-independent state. This new approach provides a new way to estimate respiratory status in infants and children receiving ventilator therapy. Through quantitative capnographic curve analysis, if P, R, and A from spontaneous breaths approached those of ventilator-assisted breaths, patients have resumed reasonable pulmonary mechanics, and extubation may then be considered. Pediatr Pulmonol. 2001; 32:453–458. © 2001 Wiley-Liss, Inc.

Background/Purpose Acute respiratory tract infections are a leading cause of morbidity and mortality in children worldwide. Most have a viral etiology, with pneumococcus as an important pathogen. This single-center study compared the use of conventional diagnostic tools and two multiplex polymerase chain reaction (PCR) examinations for determining pathogens in lower respiratory tract infections (LRTIs) among children aged Methods From July to October 2010, 45 patients aged 2 months to 60 months and diagnosed as having LRTIs were enrolled. Their nasopharyngeal aspirates were evaluated through viral culture and two multiplex PCR examinations. The patients' clinical course, symptoms, signs, and laboratory findings were recorded and analyzed. Results Among the 45 patients, 38 (84.4%) had detectable pathogens. Conventional viral and blood cultures had 35.6% positive rate, which increased to 51.1% when the quick antigen tests (Influenza A+B test and respiratory syncytial virus) and urine pneumococcal antigen test were combined. The positive rate further increased to 84.4% when the two multiplex PCR methods were combined. Twelve patients had co-infection, including 10 detected by the multiplex PCR methods. The co-infection rate was 26.7% (12/45). Conclusion Most LRTIs in children have a viral etiology. Multiplex PCR tests are rapid assays that can increase the diagnostic yield rate and detect slow-growing viruses and can detect more pathogens than conventional viral culture to enable, thereby helping clinicians to provide appropriate and timely treatment.

Background Lower respiratory tract infections (LRTIs) play an important role in pediatric diseases; however, there are limited data about LRTIs in Southern Taiwan. This study aimed to investigate the clinical and epidemiological data of LRTIs in this area. Methods Children aged under 5 years who were hospitalized at a medical center in Southern Taiwan with acute LRTIs from July 2010 to October 2010 (summer) and from March 2011 to May 2011 (spring) were prospectively enrolled. Nasopharyngeal aspirates were obtained and sent for viral cultures, multiplex polymerase chain reaction (PCR), and traditional quick tests. The clinical features, laboratory data, and imaging findings were recorded and analyzed. Results A total of 90 children were enrolled, 70 of whom had detectable pathogens. The positive rate of conventional viral and bacterial cultures was 25.6%, which increased to 77.77% after combining with the two multiplex PCR methods. Adenovirus and enterovirus were the most common viral etiologies identified (26.5% of cases) and Streptococcus pneumoniae was the leading bacterial etiology (46.4%). The seasonal trend of viral infections in Southern Taiwan was different from Northern Taiwan. There were no differences in demographic data, severity of disease, or hospital stay between single and mixed infections. A similar result was found between nonpneumococcal and pneumococcal infections. Conclusion Viral infections were the main etiologies of LRTIs in young children. Multiplex PCR methods are rapid assays that can increase the diagnostic yield rate. Mixed infections do not seem to affect the severity of disease. Early detection may aid clinicians in appropriate decision-making and treatment.