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Background/purpose: Myeloma jaw lesions are not uncommon. The study aimed to investigate the status of jaw lesions and medication-related osteonecrosis of jaw (MRONJ) in multiple myeloma (MM) patients.Methods: One hundred and twenty-two consecutive newly-diagnosed MM patients seeking dental care at a hospital of southern Taiwan was examined according to jaw lesions with complete follow-up data.Results: Median age of the patients was 67.8 years, and 88.5% of patients were of DS stage III and 41.0% were of ISS stage III at diagnosis. Median survival was 37.9 months for 43 (35.2%) patients with jaw lesions and 57.4 months for 79 patients without jaw lesions. 1-year, 5-year and >7-year overall survival rates for patients with jaw lesions versus patients without jaw lesions were 94.9%, 67.2%, 56.7% vs 83.7%, 51.8%, 26.8% respectively. Patients with jaw lesions had the worse survival (P = 0.03). Neither age nor stage affected survival. Jaw lesions involved the mandible more often than the maxilla and stopped progressing during remission, but did not repair. Jaw lesions were the first evidence or recurrent sign of MM in six (4.9%) patients. Long-term monthly antiresorptive therapy changed the radiographic patterns of jawbones and induced MRONJ developing in 16.7% (8/48) of patients. Five (62.5%) MRONJ sites spontaneously occurred without local risk factors.Conclusion: Nearly one-third of MM patients develop osteolytic jaw lesions that seem to be associated with poorer survival. Jaw lesion is an independent prognostic predictor of survival in myeloma. Antiresorptive drugs at less frequent dosing regimen are crucial to minimize spontaneous MRONJ. [ABSTRACT FROM AUTHOR]

A baseline study was undertaken on polycyclic aromatic hydrocarbons (PAHs) in phytoplankton. Plankton samples from six stations (duplicates) in Kaohsiung Harbor (KH), Taiwan along with a phytoplankton control sample afar from the harbor, were collected. We applied size-fractionation to isolate phytoplankton (55–120 μm), followed by sedimentation and centrifugation to remove abiogenic particulates. The phytoplankton was freeze-dried, extracted with acetone: n -hexane (1:1, v/v), and analyzed using GC–MS. ΣPAHs in phytoplankton ranged between 5204 and 28,903 ng/g dry weight (mean: 12,150 ng/g). The ΣPAHs in KH were >7 times than the control site (C1: 3972 ng/g). Cluster analysis showed spatial gradients (northern < southern KH). Accumulated PAHs in phytoplankton were from petrogenic (fishing ports and ships) and pyrogenic (river outflows), dominated by lower-ring PAHs, likely due to their higher bioavailability in the dissolved phase. We present a practical phytoplankton isolation technique for more accurate phytoplankton PAH concentrations with insights into their distribution and sources. [Display omitted] • First report on PAHs in size-fractionated marine harbor phytoplankton • Use of simple pre-treatment to isolate and study PAHs in phytoplankton • PAHs accumulated in phytoplankton are from pyrogenic and petrogenic sources. • Fishing ports and rivers are major PAH sources in phytoplankton from study area. [ABSTRACT FROM AUTHOR]

One of the most concerning emerging pollutants is microplastics (MPs), which can infiltrate soft tissues of organisms by ingestion, adhesion, and fusing and may even become embedded in biominerals. However, very little evidence is available about MPs in biominerals found in the wild. This study detected the abundance and characteristics of MPs in the shells of farmed oysters (Crassostrea angulata) off the coast of Taiwan and discussed the distribution, accumulation, and diversity in the oyster shells. The results showed that MPs were ubiquitous in oyster shells, with an average abundance of 0.70 ± 0.40 MPs/g. MPs abundance was significantly (p < 0.01) higher in small oyster shells (shell length < 6.5 cm, weight 5–10 g) and inorganic (CaCO 3) fraction (HCl digestion) than in large oyster shells (>6.5 cm, 10–25 g) and an organic fraction (H 2 O 2 digestion), respectively. However, there was no significant difference in MPs abundance between the top and bottom shells (p > 0.05). MPs with a size <2 mm accounted for 78.5 %, fibrous MPs for 93.7 %, and rayon for 89.5 %. The MPs diversity integrated index (MPDII) in oyster shells was low (0.27), and the small and fibrous MPs seemed more easily embedded in biominerals. The findings confirm the presence of MPs in oyster shells in coastal environments. In addition, oyster shells may contain higher amounts of MPs than soft tissues 4–5 times, which needs to be confirmed. Further revealing the distribution and accumulation of MPs in water/terrestrial biominerals will help to understand the fate of MPs in the environment. • Microplastics are found in the shells of coastal-farmed oysters. • Small size (<2 mm) and fibrous MPs are more likely to embed in oyster shells. • Rayon is the main polymer type, followed by PET, cellophane, and PP. • There is low diversity of MPs in oyster shells. [ABSTRACT FROM AUTHOR]

People with a chronic psychiatric disorder (CPD) have low employment rates worldwide. This multicenter retrospective cohort study examined the employment outcomes of an innovative in-house vocational training program for people with CPD in Taiwan and explored which program parameters significantly predicted outcomes. Data were retrieved from the records of 323 participants who completed the training program. Satisfactory employment rates were found at 1 (52.9%), 3 (60.4%), and 6 (65.6%) mo posttraining, and 38.7% of participants demonstrated high employment sustainability (employed throughout the first 6 mo posttraining). Three program parameters significantly predicted employment outcomes: (1) occupational therapists' pursuit of additional training or short-term apprenticeship pertinent to clients' job interests, (2) posttraining vocational counseling provided by community-based occupational therapists, and (3) the duration of 6 mo posttraining to allow clients to prepare for competitive employment. Occupational therapist--led in-house vocational training is a promising alternative to traditional vocational training for people with CPD. [ABSTRACT FROM AUTHOR]

Background/purpose: The incidence of multiple myeloma in Asia has risen in the past 30 years. Lenalidomide, an IMiD immunomodulatory agent, has improved the overall survival in patients with relapsed/refractory multiple myeloma (RRMM) when used with dexamethasone versus dexamethasone alone. This observational registry (T-CC-MM-009; NCT01752075) assessed the safety and efficacy of lenalidomide plus dexamethasone in a large Chinese population of patients with RRMM.Methods: This registry followed the first 100 patients treated with lenalidomide plus dexamethasone in Taiwan. Patients were ≥18 years old and had ≥1 prior treatment. The recommended starting dose for the first four 28-day cycles was 25 mg lenalidomide on days 1-21 and 40 mg dexamethasone on days 1-4, 9-12, and 17-20. Thereafter, dexamethasone was given on days 1-4 only. The primary objective was safety; secondary objectives were efficacy, lenalidomide dosage, and reasons for discontinuation.Results: The median duration of treatment was 34.6 weeks, and 75.5% completed ≥3 cycles. Most patients (82.7%) experienced ≥1 treatment-related adverse event; the most commonly reported were neutropenia (23.5%), thrombocytopenia (19.4%), anemia (16.3%), fatigue (16.3%), and hypoesthesia (15.3%). Bleeding events (25.5% of patients) were mostly grade 1/2 (80%). Three patients (3%) had venous thromboembolic events. Two invasive second primary malignancies were reported; however, time to onset was <1 year, suggesting they may not be related to lenalidomide. The overall response rate was 34.7%; median time to disease progression was 20.5 months.Conclusion: These data confirm the safety and efficacy of lenalidomide plus dexamethasone for patients with RRMM in Taiwan. [ABSTRACT FROM AUTHOR]

The accumulation of pollutants in the semi-enclosed waters of ports has long been a concern. This study assessed the pollution status, sources, and toxicity risks of 16 polycyclic aromatic hydrocarbons (PAHs) in surface sediments of 7 major ports in Taiwan. Total PAHs concentrations in sediments ranged between 8.4 and 572.5 ng/g dw, with an average of 112.4 ± 136.5 ng/g dw. The 3- and 4-ring PAHs (63 %) were the major constituents of PAHs in the sediments. Diagnostic ratios and positive matrix factorization analyses indicated that PAHs in sediments were mainly contributed by biomass combustion (45.0 %), coal combustion (31.5 %), and vehicle emissions and related fossil fuels (23.5 %). The results of ecological risk assessment showed a low–medium risk of PAHs in the sediments outside the port, whereas most of the sediments within the port presented a medium–high risk. An assessment of the possible human health risks indicated that PAHs were present at acceptable levels. [Display omitted] • Significant accumulation of PAHs in sediments of commercial ports in Taiwan. • Biomass and coal combustion are the main sources of PAHs in sediments. • Coal-fired power plants near ports are a source of PAHs in sediments. • TEQ of PAHs in the port sediments may pose moderate–high ecological risk. [ABSTRACT FROM AUTHOR]

Recent studies show that hospitality and services can, if attractively designed, elicit positive responses from guests or customers. Although responses are individual and highly subjective, Fuzzy Quality Function Deployment (FQFD) may provide a competitive advantage to those who are able to read and interpret customers’ responses and needs in terms of hospitality services. This study introduces an integrative framework of Kano's model and FQFD applied to Taiwanese Ban-Doh banquet services. Kano's model with fuzzy sets was used and integrated into the FQFD method to show the relation between service attributes and customer responses. Kano's model categorizes service attributes into three major groups: Must-be, One-dimensional and Attractive. The findings of a case study involving six senior Ban-Doh chefs and 80 guests who attended Ban-Doh banquets are presented. By focusing on the quality of service characteristics that satisfy customers, this study enables service providers and managers to determine the extent to which they can prioritize the improvement of service design in Ban-Doh banquet services to satisfy customer expectations. [ABSTRACT FROM AUTHOR]

Forest thinning is an important method for managing forests, changing forest structure, biological diversity and community. This study examined forest thinning effects on macrofungal diversity and the environmental factors affecting fruiting and community structure. Field surveys were conducted from 2006 to 2010 in 35-year-old Cryptomeria japonica plantations in central Taiwan. Thinning was completed in October 2007 and included control, 25% thinning, and 50% thinning treatments. Each treatment had four replications. Forest thinning and time affected macrofungal species richness observed but not abundance. Thinning influenced macrofungal community compositions; however, the difference between the two thinning intensities was not significant. The macrofungal community showed significant differences between communities of eastern and northern aspect. A redundancy analysis indicated that macrofungal communities in the C. japonica plantations were significantly affected by relative humidity, light, canopy cover, soil water content, soil temperature, soil pH value and soil texture. The fruiting of a dominant coral fungal species, Scytinopogon sp., was affected by thinning and light. The fruiting bodies of this species decreased in the 25% thinning plots and disappeared in 50% thinning plots in the first two years post-thinning, but were recorded in the third year post-thinning. After thinning, macrofungal species richness observed decreased, the community changed, and changes were associated with environmental conditions. Forest thinning decreased observable macrofungal diversity and changed the community structure, and these changes were associated with environmental variation after thinning. [ABSTRACT FROM AUTHOR]

Japan established the medical system in Taiwan during its 50 years of occupation, which evolved into the present National Taiwan University Hospital system. This paper summarizes the biographies of 97 Japanese leaders in various medical disciplines during the Japanese occupation of Taiwan. These leaders were among the elite of Japan, with superior intellectual, social and economic status, who helped to establish the important attributes of medical professionals in Taiwan, such as a good academic background, heritage, and research skills. [ABSTRACT FROM AUTHOR]

Abstract: Chemical engineering Professors in Taiwan commonly deliver lectures in mixed Chinese and English words accompanied with numbers. To the authors’ best knowledge, no studies have explored how the brain of the same individual processes reading of numbers, Chinese words and English words. This work investigated brain activity by applying functional magnetic resonance imaging (fMRI) for selected University students. The activation patterns in brains revealed distinct behavior, which can be roughly divided into two categories. The Group A subjects focused on language words reading; conversely, showed little interest to numbers with no intention for further comprehension. The Group B subjects paid high attention to numbers, and activate numerous brain areas to interpret the therein hidden meanings. Meanwhile, these subjects largely ignored the Chinese or English words in reading. The two groups of subjects should be subjected to different curriculums in chemical engineering education. [Copyright &y& Elsevier]

Background: The prognosis of in-hospital cardiopulmonary arrest remains very poor. Reports have shown patients often have clinically abnormal events prior to arrest. To improve patient outcome and prevent arrest, detection of the abnormal events with early intervention has been advocated. However, the incidence of these events in Taiwan and their clinical significance remain unclear.Methods: We conducted a prospective observational study with the implementation of the clinical alert system (CAS) in a university-affiliated tertiary referral medical center. Clinically abnormal events were detected using the CAS criteria for acute physiologic deterioration, and reported to experienced physicians for management. Patient and report data were retrieved, collected and analyzed.Results: During the 14-month study period, a total of 2,050 events were detected in 1,640 patients. The estimated incidence of the events was 3.19 per 1,000 bed-days, which occurred in 2.14% of admissions. The most common event was abnormal heart rate (36.5%), followed by desaturation (26.7%), abnormal respiratory rate (24.5%), and abnormal blood pressure (23.1%). The majority of the events were reported in the day time, and nurses contributed most of the reports (66.4%). The 30-day and in-hospital mortality rates were 26.3% and 34%, respectively. Multivariate survival analysis showed that desaturation (relative risk [RR] = 1.715; p < 0.001), abnormal respiratory rate (RR = 1.652; p < 0.001), abnormal blood pressure (RR = 1.460; p = 0.001), coma (RR = 1.918; p < 0.001), and oliguria (RR = 1.424; p = 0.0024) were significantly associated with 30-day mortality. Mortality of patients in the last 2 months was significantly lower than that in the first 2 months (20.5% vs. 35.4%; p < 0.001), which suggests the effectiveness of the CAS.Conclusion: The development of clinically abnormal events is associated with poor outcome, which suggests that early detection and timely management of these events is necessary. Implementation of the CAS may improve the in-hospital outcome of these patients. [ABSTRACT FROM AUTHOR]

Abstract: Forecasts can be improved by combining separate forecasts obtained by different methods. The complementary nature of the scenario analysis and technological substitution models means that combining the two can obtain improved forecasts. The former has the strength of dealing with the uncertain future, while the later offers data-based forecasts of quantifiable parameters. This study thus proposes a process for combining the scenario analysis with the technological substitution model for discussing new generation technological developments. The proposed process not only has the strengths of scenario analysis, but also contains features that scenario analysis lacks, including predicting annual developments for future years, considering old technology development, and forecasting substitution of old technologies. This study uses the forecast of the market share of Fiber to the x in Taiwan over the next ten years as an example illustrating the proposed combined forecast process. [Copyright &y& Elsevier]

We used the buried-bag in situ incubation technique to quantify net rates of N mineralization and nitrification in a forest ecosystem in northeastern Taiwan. At the near-ridge top site, NH4+ concentrations in the organic horizon (O horizon; 2–0 cm) ranged from 14.5 to 58.5 mg N kg−1 and NO3− varied from 2.5 to 7.8 mg N kg−1. In the lower part of the watershed, NH4+ concentrations in the O horizon were between 10.3 and 28.8 mg N kg−1 and NO3− varied from 2.6 to 20.1 mg N kg−1. There were slightly lower soil NH4+ concentrations during the summer than other seasons. Using the buried-bag technique, we estimated net mineralization rates to vary between 0.02 and 0.28 mg N kg−1 soil per day and net nitrification rates between 0.02 and 0.26 mg N kg−1 soil per day at the upper site. Rates of both processes were lower during the summer and were positively related to soil moisture content. We speculate that differences in soil texture are likely related to the differing pattern in concentrations of inorganic soil N between the two sites. N mineralization was positively correlated with nitrification rate (r=0.820, P<0.001) and relative nitrification (slope of this relationship) was 0.709, indicating the dominance of nitrate cycling relative to ammonium cycling. Our results show that improved knowledge about rates of fundamental ecosystem nutrient cycling processes in watersheds in Taiwan can contribute to our understanding of regional variation in rates of ecosystem function. [Copyright &y& Elsevier]

Focusing on 27 rare filter-feeding megamouth sharks (Megachasma pelagios) captured as a by-catch of drift gillnet fishery in the Pacific Ocean to the east of Taiwan, this study analyzes the concentrations of 24 elements in their muscle, discusses the bioaccumulation of each element and the correlation between different elements, and assesses the potential health risks of consuming megamouth shark muscle. Among the 24 elements, mean concentrations of Ga, Ag, Li, Bi, Hg, Co, and Cd were relatively low ranging from 10−3 to 10−1 mg/kg, those of Pb, Ba, Mn, Ni, As, Cr, B, Sr, Cu, and Zn ranged from 10−1–101 mg/kg, and those of Fe, Ca, Al, K, Mg, Ti, and Na were relatively high ranging from 101 to 103 mg/kg. The toxic element content index was most significantly correlated with the concentration of Cu. Hence, this study recommends that the concentration of Cu could be used as an indicator of metal accumulation in megamouth shark muscle. The log bioconcentration factor (BCF) ranged from less than 0 to 7.85 in shark muscle. For elements with a concentration of less than 100 μg/L in seawater, the log BCF was inversely proportional to their concentration in seawater. According to the correlation analysis, the accumulation of elements in muscle of megamouth sharks is primarily affected by the concentrations of dissolved elements in seawater, except that the accumulation of Hg, As, Cu, Ti, Al, and Fe appears to be mainly affected by feeding behaviors. The assessment of the health risk of consuming megamouth shark muscle showed that its total hazard index was greater than 1. This suggests that the long-term or high-frequency consumption of megamouth shark muscle may cause health hazards due to the accumulation of trace elements, particularly those with a large contribution of health risk, including As, Hg, and Cu. Image 1 • Reveals the profile of 24 elements in the muscle tissue of Megachasma pelagios. • Cu level may be used as an indicator of metal accumulation in megamouth shark muscle. • Metal in seawater with level <100 μg/L inversely correlated with its log BCF in muscle. • Feeding behavior seems mainly affecting on element bioaccumulation of shark. • Long-term eating megamouth shark muscle may cause adverse risk to human health. [ABSTRACT FROM AUTHOR]