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INTRODUCTION: The study aimed to compare the efficacies and safety of 14-day hybrid therapy, 14-day high-dose dual therapy, and10-day bismuth quadruple therapy in the first-line treatment ofHelicobacterpylori infections. METHODS: In this multicenter, open-label, randomized trial, we recruited adult H. pylori-infected patients from 9 centers in Taiwan. Subjects were randomly assigned (1:1:1) to 14-day hybrid therapy, 14-day high-dose dual therapy, or 10-day bismuth quadruple therapy. Eradication status was determined by the 13C-urea breath test. The primary outcome was the eradication rate of H. pylori assessed in the intention-to-treat population. RESULTS: Between August 1, 2018, and December 2021, 918 patients were randomly assigned in this study. The intention-to-treat eradication rates were 91.5% (280/306; 95% confidence interval [CI] 88.4%-94.6%) for 14-day hybrid therapy, 83.3% (255/306; 95% CI 87.8%-95.0%) for 14-day high-dose dual therapy, and 90.2% (276/306; 95% CI 87.8%-95.0%) for 10-day bismuth quadruple therapy. Both hybrid therapy (difference 8.2%; 95% CI 4.5%-11.9%; P = 0.002) and bismuth quadruple therapy (difference 6.9%; 95% CI 1.6%-12.2%; P = 0.012) were superior to high-dose dual therapy and were similar to one another. The frequency of adverse events was 27% (81/303) with 14-day hybrid therapy, 13% (40/305) with 14-day high-dose dual therapy, and 32% (96/303) with 10-day bismuth quadruple therapy. Patients receiving high-dose dual therapy had the fewest adverse events (both P < 0.001). INTRODUCTION: The study aimed to compare the efficacies and safety of 14-day hybrid therapy, 14-day high-dose dual therapy, and10-day bismuth quadruple therapy in the first-line treatment ofHelicobacterpylori infections. METHODS: In this multicenter, open-label, randomized trial, we recruited adult H. pylori-infected patients from 9 centers in Taiwan. Subjects were randomly assigned (1:1:1) to 14-day hybrid therapy, 14-day high-dose dual therapy, or 10-day bismuth quadruple therapy. Eradication status was determined by the 13C-urea breath test. The primary outcome was the eradication rate of H. pylori assessed in the intention-to-treat population. RESULTS: Between August 1, 2018, and December 2021, 918 patients were randomly assigned in this study. The intention-to-treat eradication rates were 91.5% (280/306; 95% confidence interval [CI] 88.4%-94.6%) for 14-day hybrid therapy, 83.3% (255/306; 95% CI 87.8%-95.0%) for 14-day high-dose dual therapy, and 90.2% (276/306; 95% CI 87.8%-95.0%) for 10-day bismuth quadruple therapy. Both hybrid therapy (difference 8.2%; 95% CI 4.5%-11.9%; P = 0.002) and bismuth quadruple therapy (difference 6.9%; 95% CI 1.6%-12.2%; P = 0.012) were superior to high-dose dual therapy and were similar to one another. The frequency of adverse events was 27% (81/303) with 14-day hybrid therapy, 13% (40/305) with 14-day high-dose dual therapy, and 32% (96/303) with 10-day bismuth quadruple therapy. Patients receiving high-dose dual therapy had the fewest adverse events (both P < 0.001). [ABSTRACT FROM AUTHOR]

Background/Aims Hypopharyngeal multichannel intraluminal impedance-pH (HMII-pH) technology incorporating 2 trans-upper esophageal sphincter impedance channels has been developed to detect pharyngeal reflux. We used the HMII-pH technique to validate the candidate pharyngeal acid reflux (PAR) episodes based on the dual-pH tracings and determined the interobserver reproducibility. Methods We conducted a cross-sectional study in tertiary centers in Taiwan. Ninety patients with suspected laryngopharyngeal reflux and 28 healthy volunteers underwent HMII-pH test when off acid suppressants. Candidate PAR episodes were characterized by pharyngeal pH drops of at least 2 units and reaching a nadir pH of 5 within 30 seconds during esophageal acidification. Two experts manually independently identified candidate PAR episodes based on the dual-pH tracings. By reviewing the HMII-pH tracings, HMII-pH-proven PAR episodes were subsequently confirmed. The consensus reviews of HMII-pH-proven PAR episodes were considered to be the reference standard diagnosis. The interobserver reproducibility was assessed. Results A total of 105 candidate PAR episodes were identified. Among them 84 (80.0%; 95% CI, 71.0-87.0%) were HMII-pH-proven PAR episodes (82 in 16 patients and 2 in 1 healthy subject). Patients tended to have more HMII-pH-proven PAR episodes than healthy controls (median and percentile values [25th, 75th, and 95th percentiles]: 0 [0, 0, 3] vs 0 [0, 0, 0], P = 0.067). The concordance rate in diagnosing HMII-pH-proven PAR episodes between 2 independent observers was 92.2%. Conclusion Our preliminary data showed that 80.0% (71.0-87.0%) of the proposed candidate PAR episodes were HMII-pH-proven PAR episodes, among which the interobserver reproducibility was good. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is a chronic and relapsing disease that can be complicated by abscesses, fistulas, or strictures of the damaged bowel. Endoscopy or imaging studies are required to diagnose and monitor the treatment response or complications of the disease. Due to the low incidence of the disease in Taiwan, the pattern of radiation exposure from medical imaging has not been well studied previously. This retrospective study aimed to evaluate the pattern of radiation exposure in 134 Taiwanese IBD patients (45 CD and 89 UC) diagnosed and followed at Changhua Christian Hospital from January 2010 to December 2020. We reviewed the patient demographic data and radiation-containing image studies performed during the follow-up. The cumulative effective dose (CED) was calculated for each patient. During a median follow-up of 4 years, the median CED was higher for patients with CD (median CED 21.2, IQR 12.1–32.8) compared to patients with UC (median CED 2.1, IQR 0–5.6) (p < 0.001). In addition, the CD patients had a trend of a higher rate of cumulative ≥50 mSv compared with the UC patients (6.7% vs. 1.1%, p = 0.110). In conclusion, our study found a higher radiation exposure among CD patients compared to patients with UC, representing the complicated nature of the disease. Therefore, increasing the use of radiation-free medical imaging such as intestinal ultrasound or magnetic resonance imaging should be advocated in daily practice to decrease the risk of excessive radiation exposure in these patients. [ABSTRACT FROM AUTHOR]

Background: Patient‐centred e‐health (PCEH) focusses on the interaction between patients and physicians. However, only a limited number of studies have focussed on the design of physician–patient value cocreation mechanisms in the PCEH context. Thus, we extend Grönroos' concept of value cocreation to understand how PCEH might improve the quality of care. Objectives: This study proposes a theoretical framework to embody PCEH‐supported value cocreation and presents some empirical validation. We expect that PCEH‐supported value cocreation should comprise capabilities for patient empowerment, intention for information sharing, complementation for checking and verifying information, and interaction for shared understanding. Methods: This study surveyed a small group of patients that have used PCEH, 'My Health Bank' in Taiwan. The questionnaires were delivered to patients in hospitals (n = 167 questionnaires, 98% response rate). Results: Results indicate that certain PCEH‐supported value cocreation mechanisms—capabilities for patient empowerment and interaction for shared understanding—affect the perceived quality of medical care. Limitations: The survey only considered patient perceptions of value cocreation. Conclusion: This study shows the patient perception of value cocreation in patient‐centred e‐Health. Further research needs to validate the framework for health professionals and in other e‐Health record information sharing settings. [ABSTRACT FROM AUTHOR]

Objective: To assess the healthcare utilization, economic burden, and long-term neurological complications and mortality of an adult population with Japanese encephalitis (JE). Methods: This study utilized two nationwide datasets in Taiwan: the Notifiable Disease Dataset of confirmed cases from the Centers for Disease Control to identify JE patients, and the National Health Insurance Research Database to obtain patients' healthcare utilization. Survival analyses were performed to identify prognostic factors associated with the all-cause mortality of patients. Results: This study included 352 adult cases with JE (aged≥20 years). The mean age of JE patients was 45 years. Stroke (event rate: 3.49/100 person-years) was the most common neurological complication, followed by epilepsy/convulsions (3.13/100 person-years), encephalopathy/delirium (2.20/100 person-years), and parkinsonism (1.97/100 person-years). Among the 336 hospitalized patients at JE diagnosis, 58.33% required intensive care. Among 79 patients who died following JE diagnosis, 48.84% of death events occurred within the year of diagnosis. The medical costs increased considerably at JE diagnosis and subsequent-year costs remained significantly higher than the costs before diagnosis (p<0.05). Having a four-dose JE vaccination (i.e., born after 1976) versus no JE vaccination history (i.e., born before 1963) was significantly associated with lower all-cause mortality (hazard ratio: 0.221 [95% confidence interval: 0.067, 0.725]). Comorbid diabetes and incident epilepsy/convulsion events significantly increased the mortality risk by 2.47- and 1.85-fold, respectively (p<0.05). Conclusion: A considerable medical burden associated with JE was observed in affected adults, even in the years following JE diagnosis. Vaccination should be considered to prevent this sporadic, but lethal, viral infection. Author summary: The epidemiology of adulthood Japanese encephalitis (JE) remains limited, and data on the economic burden associated with JE is lacking. This study is the first to comprehensively examine the healthcare burden (i.e., healthcare utilization and costs, neurological complications, all-cause mortality) of an adult population with JE, utilizing a nationwide cohort of JE-infected adults with up to 16 years of follow-up. In the first 6 months following JE diagnosis, a higher rate of neurological disorders was found, compared to the years after the diagnosis, with stroke being the most common neurological complication, followed by epilepsy/convulsions. The healthcare utilization of JE patients was higher in the first 6 months after the diagnosis compared to the years following the diagnosis. Medical costs increased considerably at JE diagnosis and subsequent-year costs after diagnosis remained higher than the cost before diagnosis. Having comorbid diabetes or incident epilepsy/convulsion events was a significant risk factor for mortality of adults with JE. Being born after 1976 in Taiwan, and thus likely receiving a four-dose schedule of vaccination, was associated with reduced mortality. Therefore, special attention is required for JE patients with comorbid diabetes or incident epilepsy/convulsion events, and JE vaccination should be considered to prevent this sporadic but lethal viral infection. [ABSTRACT FROM AUTHOR]

Background: To conduct a real-word-study-based cost-effectiveness analysis of a GLP-1 receptor agonist (GLP-1RA) versus insulin among type 2 diabetes patients requiring intensified injection therapy and a systematic review of cost-effectiveness studies of GLP-1RAs versus insulin. Methods: Individual-level analyses incorporating real-world effectiveness and cost data were conducted for a cohort of 1022 propensity-score-matched pairs of GLP-1RA and insulin users from Taiwan's National Health Insurance Research Database, 2007–2016. Study outcomes included the number needed to treat (NNT) to prevent one case of clinical events, healthcare costs, and cost per case of event prevented. Costs were in 2019 US dollars. Analyses were performed from a third-party payer and healthcare sector perspectives. Structured systematic review procedures were conducted to synthesize updated evidence on the cost-effectiveness of GLP-1RAs versus insulin. Results: Over a mean follow-up of 2.3 years, the NNT using a GLP-1RA versus insulin to prevent one case of all-cause mortality and hospitalized hypoglycemia was 57 and 30, respectively. Using GLP-1RAs instead of insulin cost US$54,851 and US$29,115 per case of all-cause mortality and hospitalized hypoglycemia prevented, respectively, from the payer perspective, and saved US$19,391 and US$10,293, respectively, from the healthcare sector perspective. Sensitivity analyses showed that the probability of using GLP-1RAs versus insulin being cost-effective for preventing one case of all-cause mortality or hospitalized hypoglycemia ranged from 60 to 100%. The systematic review revealed a cost-effective profile of using GLP-1RAs versus insulin. Conclusions: Using GLP-1RAs versus insulin for type 2 diabetes patients requiring intensified injection therapy in clinical practice is cost-effective. [ABSTRACT FROM AUTHOR]

Background: To assess the associations of various HbA1c measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variability score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes. Methods: Linked data between National Cheng Kung University Hospital and Taiwan's National Health Insurance Research Database were utilized to identify the study cohort. The primary outcome was the composite MVD events (retinopathy, nephropathy, or neuropathy) occurring during the study follow-up. Cox model analyses were performed to assess the associations between HbA1c measures and MVD risk, with adjustment for patients' baseline HbA1c, demographics, comorbidities/complications, and treatments. Results: In the models without adjustment for baseline HbA1c, all HbA1c variability and mean measures were significantly associated with MVD risk, except HVS. With adjustment for baseline HbA1c, HbA1c-CV had the strongest association with MVD risk. For every unit of increase in HbA1c-CV, the MVD risk significantly increased by 3.42- and 2.81-fold based on the models without and with adjustment for baseline HbA1c, respectively. The associations of HbA1c variability and mean measures with MVD risk in patients with baseline HbA1c < 7.5% (58 mmol/mol) were stronger compared with those in patients with baseline HbA1c ≥ 7.5% (58 mmol/mol). Conclusions: HbA1c variability, especially HbA1c-CV, can supplement conventional baseline HbA1c measure for explaining MVD risk. HbA1c variability may play a greater role in MVD outcomes among patients with relatively optimal baseline glycemic control compared to those with relatively poor baseline glycemic control. [ABSTRACT FROM AUTHOR]

Background: Current evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice. This study aimed to investigate the comparative cardiovascular safety of GLP-1ra in comparisons with dipeptidyl peptidase-4 inhibitor (DPP-4i), sulfonylurea (SU), and insulin in a real-world population with T2D. Methods: Adults with newly-diagnosed T2D were identified from Taiwan's National Health Insurance Research Database in 2003–2014. A prevalent new-user cohort design was adopted to include a broad representation of real-world T2D patients being treated with GLP-1ra. The between-group comparability of baseline patient characteristics was achieved by matching on (1) initiation time of study drugs, (2) prior exposure to glucose-lowering agents, and (3) diabetes severity and complications, comorbidities, and concomitant cardiovascular medications using propensity scores. The primary outcome was a composite of cardiovascular disease (CVD) events and assessed up to the end of 2015. Cox modeling was employed to assess the association between study drugs and outcomes. Results: A total of 3195 GLP-1ra stable users was identified in 2011-2014. 1893, 1829, and 1367 GLP-1ra stable users were 1:1 matched to DPP-4i, SU and insulin users, respectively. Compared to DPP-4i, SU and insulin, the use of GLP-1ra was associated with a lower risk of composite CVD events [hazard ratio (95% confidence interval) 0.73 (0.57–0.96), 0.76 (0.57–1.00), and 0.81 (0.62–1.07), respectively]. Subgroup analyses revealed that GLP-1ra versus DPP-4i yielded a greater cardiovascular benefit in those without established CVD versus those with established CVD. Conclusions: This comparison study extends the supporting evidence for the cardiovascular safety of GLP-1ra to a broad spectrum of real-world T2D patients using GLP-1ra. [ABSTRACT FROM AUTHOR]

This paper applies a demographic characteristics perspective to understand the internal contingencies of the relationship between university-industry collaboration (UIC) motivation (commercialisation, learning, accessing the resources, and teaching) and UIC performance (number of publications, number of patents, commercial products, and number of business cooperation cases). The paper focuses on two aspects of demographic characteristics, age and gender among UIC scholars, and their effect on scholars' UIC motivation as potential enhancements to improve UIC performance. We collected data from 376 scholars with UIC experience in Taiwan, and the proposed hypotheses were empirically tested. Our results extend the literature by showing that specific categories of UIC performance depend on a scholar's specific type of UIC motivation. We also specify the moderating effect of demographic characteristics on the relationship between specific subconstructs of UIC motivation and UIC performance. The study's implications and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Introduction: In Taiwan, six venomous snake species with medical importance have been found; however, long-term epidemiological data of snakebite envenomation (SBE) is lacking. This study aimed to explore the epidemiology of SBE based on the distribution and use of different antivenoms in different parts of Taiwan to facilitate the development of prevention strategies and resource allocation. Methods and results: This retrospective study was conducted using the Taiwan National Health Insurance Research Database from 2002 to 2014. A total of 12,542 patients were treated with antivenoms. The directly standardized cumulative incidence was 3.6 cases per 100,000 individuals based on the 2000 World Standard Population. The incidence of SBEs peaked in the summer (35.9%). The relative risk (RR) of male patients versus female patients was 2.5 (p < 0.0001). The RRs of patients aged 18–64 and ≥65 years versus those aged <18 years were 6.0 (p < 0.0001) and 14.3 (p < 0.0001), respectively. Furthermore, the RR of eastern Taiwan versus northern Taiwan was 6.8 (p < 0.0001). The RR of agricultural workers versus laborers was 5.5 (p < 0.0001). Compared with patients envenomed by Trimeresurus stejnegeri stejnegeri or Protobothrops mucrosquamatus, those envenomed by Naja atra or Bungarus multicinctus multicinctus were more likely to occur in central (adjusted odds ratio [aOR] = 2.6, p < 0.0001) or southern (aOR = 3.2, p < 0.0001) Taiwan, but less frequently among agricultural workers (aOR = 0.6, p < 0.0001). The overall case-fatality rate was 0.11%. Conclusions: Among Asian countries, Taiwan had low incidence and case-fatality rates of SBE. Risk factors included male gender, old age, summer season, being in eastern Taiwan, and being an agricultural worker. Differences of the epidemiological findings between snake species should be focused on when developing strategies for snakebite prevention. Author summary: SBE is a neglected tropical disease of highest priority to be aware of, and its epidemiology varies widely worldwide. This study explored the nationwide and long-term epidemiology of SBE based on the use of snake antivenom in Taiwan, including its incidence, risk factors, complications, and management. This could facilitate the development of preventive strategies and resource allocation. In Taiwan, six medically important venomous snake species were found; however, majority (73.3%) of the envenomation events were associated with T. s. stejnegeri (bamboo pit viper) and P. mucrosquamatus (Taiwan habu) and some (17.1%) with N. atra (Chinese cobra) and B. m. multicinctus (many-banded krait). The risks varied depending on the season, sex, age, geographic region, and occupation. Compared with patients envenomed by crotalines, those envenomed by elapids were more likely to undergo surgery due to serious wound complications caused by N. atra or endotracheal intubation due to respiratory failure caused by B. m. multicinctus. The low case-fatality rate observed might be due to easy access to modern medicine, immediate availability of antivenoms in healthcare facilities, few adverse effects of antivenoms, and prompt surgical intervention. The lack of highly venomous snakes with highly potent venom is a leading factor in low case fatality. [ABSTRACT FROM AUTHOR]

Purpose:To evaluate the effects of hippotherapy on body functions, activities, and participation in children with CP of various functional levels by using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) checklist. Methods:Fourteen children with cerebral palsy (CP) (3–8 years of age) were recruited for a 36-week study composed of baseline, intervention, and withdrawal phases (12 weeks for each phase, ABA design). Hippotherapy was implemented for 30 min once weekly for 12 consecutive weeks during the intervention phase. Body Functions (b) and Activities and Participation (d) components of the ICF-CY checklist were used as outcome measures at the initial interview and at the end of each phase. Results:Over the 12 weeks of hippotherapy, significant improvements in ICF-CY qualifiers were found in neuromusculoskeletal and movement-related functions (b7), mobility (d4) and major life areas (d8) and, in particular, mobility of joint functions (b710), muscle tone functions (b735), involuntary movement reaction functions (b755), involuntary movement functions (b765), and play (d811) (allp< 0.05) when compared with baseline. Conclusion:This study demonstrated the beneficial effects of hippotherapy on body functions, activities, and participation in children with CP.Implications for RehabilitationICF-CY provides a comprehensive overview of functioning and disability and constitutes a universal language for identifying the benefits of hippotherapy in areas of functioning and disability in children with CP.In children with CP, hippotherapy encourages a more complementary approach that extends beyond their impairments and limitations in body functions, activities, and participation.The effect of hippotherapy was distinct from GMFCS levels and the majority of improvements were present in children with GMFCS levels I–III. [ABSTRACT FROM PUBLISHER]

The purpose of this study is to integrate transaction cost theory and the knowledge-based view of the firm to explore why and how a network's hub organisations orchestrate their members to create knowledge in the health services setting. Guided by organisation theory, this study examines a theoretical model at the organisation level, through a qualitative case study of Taiwan's health services sector. In addition to the discovery of a new sub-construct, the findings provide preliminary evidence that, both, transaction cost and knowledge-based factors influence the health services network as per the study's propositions. This study contributes to strategic technology management research by providing a conceptual model to describe and evaluate health services networks' orchestrating process for knowledge creation. The framework also provides a better understanding of, and a practical approach to managing networks to improve knowledge creation. [ABSTRACT FROM AUTHOR]

Antibiotics are commonly used in swine feed to treat and prevent disease, as well as to promote growth. Antibiotics released into the environment via wastewater could accelerate the emergence of antibiotic-resistant bacteria and resistance genes in the surrounding environment. In this study, we quantified the occurrence of sulfonamides, sulfonamide-resistant microorganisms and resistance genes in the wastewater from a swine farm in northern Taiwan and its surrounding natural water bodies and soils. Sulfonamide levels were similar in the receiving downstream and upstream river water. However, the prevalence of sulfonamide-resistant bacteria and resistance genes, as analyzed by cultivation-dependent and -independent molecular approaches, was significantly greater in the downstream compared to the upstream river water samples. Barcoded-pyrosequencing revealed a highly diverse bacterial community structure in each sample. However, the sequence identity of the sulfonamide resistance gene sul1 in the wastewater and downstream environment samples was nearly identical (99-100%). The sul1 gene, which is genetically linked to class 1 integrons, was dominant in the downstream water bodies and soils. In conclusion, the increased prevalence of sulfonamide resistance genes in the wastewater from a swine farm, independent of the persistent presence of sulfonamides, could be a potential source of resistant gene pools in the surrounding environment. [ABSTRACT FROM AUTHOR]

Abstract: In practice, there are various types of eco-innovation. While each type of innovation has its own attributes, determinants, and contribution to business performance, it is not effective to implement eco-innovation programs without a holistic view. This study draws from the resource-based view theory to investigate inter-relationships among three types of eco-innovation (process, product, organizational) and their relative impact on business performance. Using structural equation modeling with 121 samples collected from Taiwan Environmental Management Association, we find that eco-organizational innovation has the strongest effect on business performance. Additionally, eco-process and eco-product innovations partially mediate the effects of eco-organizational innovation, and eco-product innovation mediates eco-process innovations' effects on business performance. Business performance is directly and indirectly affected by eco-organizational, eco-process, and eco-product innovations. The findings suggest that, in order to develop effective eco-innovation programs, managers must understand the interdependence and co-evolutionary relationships between different types of eco-innovation. Overall, this study extends the discussion of innovation to the area of environmental innovation or eco-innovation. [Copyright &y& Elsevier]

Purpose: To evaluate the late effects on the quality of life (QOL) of individual years after protracting low-dose radiation exposure. Materials and methods: We assessed 1,818 subjects using the World Health Organization Questionnaire on Quality of Life - Brief Version (WHOQOL-BREF) in several Health-Related Quality of Life (HRQoL) domains. After adjusting for demographic characteristics and comorbidities, we examined the HRQoL differences at various levels of exposure and ages at disclosure. We also evaluated the potential effect modification by gender. Results: After adjusting for potential confounders, girls aged 12 years or younger at the disclosure of exposure had lower HRQoL scores in physical, psychological, and environmental domains compared to those with later age at disclosure. The differences in the HRQoL scores between different exposure subgroups were not significant in physical, psychological, and social relationship domains, and only appeared in the environmental domain. Conclusions: Being female and less than 12 years of age at disclosure were more significant predictors of HRQoL scores than the levels of radiation exposure among people exposed to protracted low-dose radiation. Further studies are needed to determine the psychological distresses, such as depression and anxiety, and their relationships in this case, especially for the most vulnerable young females. [ABSTRACT FROM AUTHOR]

The present study has identified a new species from the previously monotypic genus Darwiniella Anderson, 1992. Darwiniella angularis sp. n. is similar to D. conjugatum (Darwin, 1854) in external shell morphology and arthropodal characters. Darwiniella conjugatum, however, has a sharper tergal spur and a less obvious adductor plate angle when compared to D. angularis sp. n. Molecular analyses on mitochondrial DNA 12S rDNA and COI regions also support the morphological differences. Sequence divergences in 12S rDNA and COI between D. conjugatum and D. angularis sp. n. are 5% and 13% respectively, which are equivalent to the inter-specific sequence divergences in other barnacles. Both Darwiniella species are common on Cyphastrea Milne-Edwards and Haime, 1848 corals and D. angularis sp. n. is also collected from Astreopora de Blainville, 1830 corals in Taiwan. [ABSTRACT FROM AUTHOR]

Perfluoroalkyl substances (PFASs), as coating materials, possess oil-resistant and waterproof properties. However, their persistency and toxicity have caused concerns. This study developed a method for determining five types of 20 PFASs with ultra-performance liquid chromatography/tandem mass spectrometry, and measured seven categories of 32 commercial samples of oil-resistant food packaging in Taiwan. The assay was validated according to the specification of Taiwan Food and Drug Administration (TFDA). Samples of 100 cm² were cut into pieces and were ultra-sonicated in 20-mL methanol at 50 °C for 45 minutes. The extracts were concentrated to 1 mL for instrumental analysis. Most matrix effect factors and extraction efficiencies of the analytes were 50%e80% and 52%e99%, respectively. Most limits of detection and limits of quantification were between 0.07e11.3 ng/dm² and 0.17e18.3 ng/dm², respectively. Most recoveries ranged from 70% to 117% at three tested levels, and the precisions (%RSD) were lower than 19%. Microwave popcorn paper contained more types and higher levels of PFASs than other packaging, with perfluoroalkyl acids at 8.3e1960 ng/dm² and fluorotelomer alcohols (FTOHs) at 9.7e7188 ng/dm². High concentrations of FTOHs were also observed in one oil-proof paper bag at 454¡2595 ng/dm² and in one French fries paper bag at 22.4e167 ng/dm². [ABSTRACT FROM AUTHOR]

Background: Ankle sprain is a common sports injury. While the effects of static constraints in stabilizing the ankle joint are relatively well understood, those of dynamic constraints are less clear and require further investigation.Purpose: This study was undertaken to evaluate the dynamic stability of the ankle joint during the landing phase of running and stop-jump maneuvers in athletes with and without chronic ankle instability (CAI).Study Design: Controlled laboratory study.Methods: Fifteen athletes with CAI and 15 age-matched athletes without CAI performed running and stop-jump landing tasks. The dynamic ankle joint stiffness, tibialis anterior (TA)/peroneus longus (PL) and TA/gastrocnemius lateralis (GL) co-contraction indices, ankle joint angle, and root-mean-square (RMS) of the TA, PL, and GL electromyographic signals were measured during each task.Results: During running, the CAI group exhibited a greater ankle inversion angle than the control group in the pre-landing phase (P = .012-.042) and a lower dynamic ankle joint stiffness in the post-landing phase (CAI: 0.109 ± 0.039 N·m/deg; control: 0.150 ± 0.068 N·m/deg; P = .048). In the stop-jump landing task, athletes with CAI had a significantly lower TA/PL co-contraction index during the pre-landing phase (CAI: 49.1 ± 19; control: 64.8 ± 16; P = .009). In addition, the CAI group exhibited a greater ankle inversion (P = .049), a lower peak eversion (P = .04), and a smaller RMS of the PL electromyographic signal in the post-landing phase (CAI: 0.73 ± 0.32; control: 0.51 ± 0.22; P = .04).Conclusion: Athletes with CAI had a relatively inverted ankle, reduced muscle co-contraction, and a lower dynamic stiffness in the ankle joint during the landing phase of sports maneuvers and this may jeopardize the stability of the ankle.Clinical Relevance: Sports training or rehabilitation programs should differentiate between the pre-landing and post-landing phases of sports maneuvers, and should educate athletes to land with an appropriate ankle position and muscle recruitment. [ABSTRACT FROM AUTHOR]

During November 2008-May 2009, an outbreak of 53 measles cases occurred in Taiwan. Of these, 3 cases were sporadic, and the other 50 cases could be grouped into 8 clusters by genetic analysis. We determined 7 H1 genotypes linked to importation and 1 G3 genotype linked to an untraceable source. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate measures of health-related quality of life in a cohort study in Taiwan to assess late health effects of protracted low-dose-rate γ-radiation exposure during 1982 to the mid-1990s. Materials and methods: In 2004, 1,407 cohort subjects were evaluated by a self-measured World Health Organisation - Brief quality of life Questionnaires (WHOQOL-BREF Taiwan version) during an annual medical check-up in a hospital. Results of their health-related quality of life (HRQoL) in physical, psychological, social relationship and environmental domains were compared with an unexposed reference population in the same city. Results: The exposed population was shown to have significantly lower quality of life (QOL) scores in physical, psychological and social relationship domains, but not in the environmental domain compared to the unexposed population. These findings were observed in all age groups with the greatest decrease found among those younger than 25 years old. Female subjects were shown to have larger decrease than male subjects. Conclusions: More than 10 years after being informed of radiation exposure, the exposed populations were observed to have significantly lower perception of HRQoL even though no biomedical effects were apparent. It is recommended that appropriate intervention be carried out in the follow-up of post-event rehabilitation for the radiation exposed. [ABSTRACT FROM AUTHOR]

As habitual heavy alcohol consumption is one of the major causes of cirrhosis in the western world, the majority of studies on the relationship between cirrhosis and stroke have focused on patients with alcohol-related liver diseases. Using a nationwide population-based dataset, this study therefore aimed to examine the risk of stroke among non-alcoholic cirrhosis patients over a 5-year period following their diagnosis with non-alcoholic cirrhosis, as compared with the general population during the same period. We used the 'Longitudinal Health Insurance Database', derived from the Taiwan National Health Insurance program. The study cohort comprised 2336 patients with cirrhosis and the comparison cohort consisted of 11 680 randomly selected subjects. Stratified Cox's proportional hazard regressions were performed to compare the 5-year stroke survival rate for the two cohorts. In the total sample of 14 016 patients, 1187 patients (8.5%) experienced stroke during the 5-year follow-up period: 176 from the study cohort (7.5% of the patients with cirrhosis) and 1011 from the comparison cohort (8.7% of patients without cirrhosis) ( P=0.076). After adjusting for the patients' geographical location, hypertension, diabetes, coronary heart disease, heart failure, atrial fibrillation and hyperlipidaemia, the regression analysis shows that patients with cirrhosis were less likely to experience stroke compared with those without cirrhosis during the 5-year period (hazard ratio=0.59, 95% confidence interval=0.52-0.67, P<0.001). We conclude that patients with non-alcoholic cirrhosis were at a reduced risk for stroke compared with the general population. [ABSTRACT FROM AUTHOR]

Pasteurized milk may contain the liver carcinogen aflatoxin M1 (AFM1) if the cows that produce the milk ingest feed contaminated with aflatoxin B1. In this study, we collected 144 milk samples of three main brands in Taiwan twice a month over a 1-year period and purchased two samples each of eight domestic and imported brands of infant formula at two different times in 2005. Samples underwent solid-phase extraction, cleaning in immunoaffinity columns, and quantification by liquid chromatography-tandem mass spectrometry. We found autumn and winter levels of AFM1 to be higher than those in the spring and the summer. We also found higher concentrations of AFM1 in low-fat milk than in whole-fat milk. We were able detect trace amounts of AFM1 (1.17 to 54.7 ng/liter) in all of our milk samples, but there was only one sample in which level of AFM1 slightly exceeded the regulatory limit of the European Union (50 ng/liter). We were unable to detect AFM1 any of the infant formulae. Using a World Health Organization method of evaluating risk of liver cancer, the group we found to be at greatest risk was 6- to 9-year-old girls (average, 12.2 additional cases per billion); the group with the lowest risk was men of 45 to 64 years of age (average, 3.45 additional cases per billion), the latter consuming less milk than all other groups. Consequently, the risk for liver cancer due to ingestion of milk contaminated with AFM1 was estimated to be low in Taiwan. [ABSTRACT FROM AUTHOR]

Background. Alachlor and butachlor are commonly used herbicides. However, data on acute human poisonings are scarce. We retrospectively analyzed the data of human alachlor/butachlor poisoning in Taiwan. Methods. The study period ran from October 1986 through February 2007. Sixty-three alachlor and 70 butachlor poisoning cases were reported to the Taiwan National Poison Center during the study period. Clinical data were reviewed and analyzed. Results. Most patients intentionally ingested the herbicides. The toxicities of alachlor and butachlor were largely similar. Twenty-eight out of 102 patients with oral exposure were asymptomatic, while the others developed vomiting, central nervous system depression, and other outcomes. Among patients using other exposure pathways, gastrointestinal effects were the main manifestation. Three patients died after manifesting profound hypotension and/or coma following alachlor ingestion. Conclusion. Alachlor and butachlor poisonings are usually of low toxicity. However, severe neurological and cardiovascular outcomes may develop rarely, especially following oral ingestion. Medical management of such poisonings is primarily supportive. [ABSTRACT FROM AUTHOR]

Background: Injury is the leading cause of death in teenagers worldwide. In Taiwan, people in mountainous areas have a 4 to 8 years shorter life span than the general population. Injury among teenagers is likely a major cause. The objective of this study was to investigate the regional differences in the prevalence, the risk factors, and the medical expenditures for injury among Taiwanese teenagers. Method: An equal probability national sample was used. In addition, representative samples from mountainous areas and offshore islands were used. Only those who aged between 12 and 21 years, and signed the consent form permitting us to link their National Health Insurance (NHI) claim data were included in the analysis. Injury-related visits and expenditures in outpatient services were extracted from the NHI data. Logistic regression was used to examine the factors associated with injury. For those who had injury related outpatient visits, mixed model was used to examine the factors associated with medical expenditures accounting for multiple visits by the same individual. Results: The prevalence of nonfatal injury was around 30% of teenagers in Taiwan. It was 10% higher in mountainous areas. Factors associated with injury were those who lived in mountainous areas (adjusted odds ratio [OR]: 1.7; 95%; confidence interval [CI]: 1.3-2.3), males (OR: 1.3; 95%; CI: 1.1-1.6), older teens (18-21 years old), and those with risk behavior were positively associated with injury. These factors were also associated with the number of injury-related outpatient visits. However, teenagers in mountainous areas did not spend more on medical care than those who lived in metropolitan Taiwan. Conclusion: Around 30% of the teenagers were injured in a year, not including the dead. Each of the injured spent at least 851.4NTD (∼27USD) for outpatient visits. The scope of the problem was not trivial. Hazardous environments and high-risk behaviors were the universal causes. In remote areas, lack of medical resources was another possibility. Empowering local people to design prevention programs according to their needs is recommended. [ABSTRACT FROM AUTHOR]

Presents a study which evaluated the experience of a poison control center in Taiwan in managing acute ethylene chlorohydrin poisoning. Methodology; Results of the study; Conclusions.

Provides information on a study that surveyed the existing antidote availability and the anticipated needs in Taiwan. Methodology of the study; Results and discussion on the study.

Aim: To assess the relationship between acarbose and hepatotoxicity, cardiovascular disease (CVD), and mortality among type 2 diabetes (T2D) patients with end-stage renal disease (ESRD).Methods: 32,531 T2D patients with ESRD were identified from Taiwan's National Health Insurance Research Database in 2000~∼2012 and followed up until 2013. 19.3% of subjects were newly initiated with acarbose during the follow-up. The use of acarbose was quantified as the numbers of the 30-day drug's supplies and dosages (measured by defined daily doses; DDDs), respectively. Time-varying Cox models were applied to evaluate the association of acarbose use with hepatic, cardiovascular and mortality outcomes, with adjustment for patients' demographics, comorbidities, diabetes severity, and co-medications.Results: For each 30-day supply increase in acarbose exposure, the risks of hepatic injury, composite CVD events, and all-cause mortality were significantly lowered by 9% (95% confidence interval: 6-12%), 7% (6-7%) and 7% (7-8%), respectively, while for each 30-day DDD increase in acarbose exposure, the risks for three aforementioned outcomes were significantly reduced by 45% (33-54%), 33% (29-36%) and 35% (32-39%), respectively. In subgroup analyses, the favorable study outcomes of acarbose use were more apparent among patients with more severe diabetes, a longer diabetes duration, or absence of established CVD at baseline.Conclusion: Acarbose used in real-world T2D patients with ESRD may have hepatic and cardiovascular safety. [ABSTRACT FROM AUTHOR]

Focuses on the statistics of poisoning cases reported through telephone calls to the Taiwan National Poison Center from 1985 to 1993. Age and gender demographics of poisoning cases; Types of poisonings; Substances reported as the cause of poisonings; Percentage of cases involving suicide attempts.

This practitioner note is to combine transaction cost theory and the knowledge-based view of the firm to investigate why and how the hub company in a network coordinates its members to co-create value in the steel industry. A theoretical model was proposed. A qualitative case study based on original survey data in the context of Taiwan's steel industry. The analyses are based on different types of data: (1) direct observations, (2) semi-structured interviews, and (3) archived material. First, participant observation was employed since to analyze the organizational behavior and cooperation patterns among the members of the steel collaborative network. Second, we interviewed several managers, researchers, and scholars and kept records of all our data, and developed a list of codes to analyze the interviews' transcripts by using the constructs obtained by the primary theoretical framework. After coding, pattern-matching techniques and explanation building techniques were used for analyzing data across informers and matching the information in the theoretical framework. Pattern-matching technique can classify open-ended comments into generalized classifications and evaluate the prompted comments regarding a proposition. We compared the different cases by examining new classifications and responses. The explanation building facilitated a preliminary assessment of the presumed set of causal link to improve the tentative theoretical framework and help develop preliminary propositions. Except one new construct emerging, the findings suggest preliminary evidence that the network's value co-creation practices in steel collaborative network influenced by transaction cost factors and knowledge-based factors as theory argued. Two propositions are induced from the qualitative data. Proposition 1: The level of transaction cost factors perceived by ERC members is positively related to the degree of implementation of network's value co-creation practices in Taiwan's steel industry. Proposition 2: The level of knowledge-based factors perceived by ERC members positively related to the degree of implementation of network's value co-creation practices in Taiwan's steel industry. Theoretical implications contribute to strategic technology management research by providing a conceptual model for describing and assessing a steel collaborative network's implementing process for value co-creation by using a case approach. Researchers have begun exploring inter-organizational knowledge creation in the steel industry and provided significant support to the prominence of new steel product-services knowledge. However, only a few studies focused on why and how the value of new steel product-services knowledge is co-generated within a steel collaborative network, and empirical evidence is lacking. Hence, it is important to develop a value co-creation model for steel collaborative networks to identify the determinants and procedure of value co-creation by integrating the knowledge-based view of the firm and transaction cost theory. This approach may help clarify the motivations of various strategic network value co-creation activities in the steel industry, especially the integration of complementing logics of transaction cost theory and knowledge-based view. Moreover, this practitioner note used qualitative research to contextualize the value co-creation network, and, thus, helps extend value co-creation theories with respect to the steel industry, which have been criticized for their unclear management mechanisms. Results also contribute to the findings of Marcos-Cuevas et al. (2016) and add appropriating as a sub-construct of the network's value co-creation practices. Regarding business marketing implications, the proposed theoretical framework has several implications for marketing managers in companies operating within steel collaborative networks. Understanding the strategic model of network's value co-creation practices may assist a hub steel company's administrators to adopt effective marketing strategies for co-generating innovative value and identifying both knowledge-based factors and transaction cost factors that may impede the co-creation of value in the network context. Hence, this framework contributes to a better understanding of how networks can be managed to improve value co-creation practices and also provides a practical way of managing value co-creating networks. Rather than managing a discrete set of alliances, steel network members need to collaborate to implement linking, materializing, institutionalizing, and appropriating to minimize the unintentional outflow of assets to possible challengers. This approach would also support the effective transfer of knowledge-based resources for value co-creation within their network. Although growing attention in practices of value co-creation, an over-emphasizing on traditional supplier-customer co-operation has limited our thinking of where and how network-level value co-creation can initiate and how it is implemented. In Taiwan's steel industrial context, the model proposes an implementation process of value-co-creation by Steel Collaborative Network-ERC that comprise of steel suppliers, universities, research institutes, and customers. It demonstrates the impact of the steel collaborative network's value co-creation determinants on its value co-creation practice and the way steel collaborative networks co-create their value. Steel Collaborative Network's value co-creation practices are relied on both the transaction cost factors and knowledge-based factors in Taiwan's steel industry. [ABSTRACT FROM AUTHOR]

Aims: This study assessed the cost‐effectiveness of long‐acting insulin analogues (LAIAs) vs intermediate/long‐acting human insulin (ILAHI) for patients with type 1 diabetes (T1D) in real‐world clinical practice. Methods: Individual‐level analyses were conducted within a longitudinal population‐based cohort of 540 propensity score‐matched T1D patients (LAIAs, n = 270; ILAHI, n = 270) with over 10 years of follow‐up using Taiwan's National Health Insurance Research Database, 2004–2013, from third‐party payer and healthcare sector perspectives. The study outcomes included the number needed to treat (NNT) to prevent one case of clinical events (eg, hypoglycaemia, diabetes‐related complications), medical costs, and cost per case of events prevented. Cost estimates are presented in 2013 British pounds (GBP, £). Results: The NNTs using LAIAs vs ILAHI to avoid one case of hypoglycaemia requiring medical assistance, outpatient hypoglycaemia and any diabetes‐related complications were 12, 9 and 10 for mean follow‐up periods of 5.84, 6.02 and 3.62 years, respectively. From third‐party payer and healthcare sector perspectives, using LAIAs instead of ILAHI saved GBP6924‐GBP7116 per case of hypoglycaemia requiring medical assistance prevented, GBP5346‐GBP5508 per case of outpatient hypoglycaemia prevented, and GBP3570‐GBP3680 per case of any diabetes‐related complications prevented. Sensitivity analyses considering sampling uncertainty showed that using LAIAs over ILAHI yields at least a 76% probability of cost‐saving for avoiding one case of hypoglycaemia requiring medical assistance, outpatient hypoglycaemia or any diabetes‐related complications. Conclusions: This real‐world evidence reveals that compared with ILAHI, the greater pharmaceutical costs associated with LAIAs for patients with T1D could be substantially offset by savings from averted hypoglycaemia or diabetes‐related complications. [ABSTRACT FROM AUTHOR]

The families of Hymenoptera causing commonly poisonous animal stings in Taiwan include Apoidea (bee) and Vespidae (wasp). This study aimed to investigate the epidemiologic, clinical characteristics, and outcomes of the severity of envenomation following wasp or bee stings in Taiwan. We conducted a retrospective study by identifying all wasp and bee sting-related envenomation reported to the Taiwan National Poison Control Center between January 2001 and November 2021. Data were reviewed and abstracted by two independent reviewers. We then used ordinal logistic regression analysis to find potential predictors of severe wasp and bee sting-related envenomation. In Taiwan, bee or wasp stings mainly occur in late summer and autumn. A total of 611 patients were reported to the Taiwan National Poison Control Center with 7.5% resulting in severe or fatal envenomation. Four-hundred and forty-one patients were eligible for the final analysis of the predictors of severity. Logistic regression analysis showed that a greater number of stings, being stung by wasps, older age, and stings over the body were significant predictors for greater severity. The systemic effects following wasp and bee sting included anaphylactic reaction, prolongation of activated partial thromboplastin time, rhabdomyolysis, acute kidney injury, and elevated liver enzymes. Wasps generally inflicted more severe envenomation than bees. Only 7.5% of patients had severe or fatal outcomes. Patients with older age, multiple stings, and/or multiple sites of stings were more likely to have severe outcomes. [ABSTRACT FROM AUTHOR]

The use of new psychoactive substances (NPSs) has markedly increased worldwide; thus, it is important to monitor NPS-related effects. The Taiwan Emergency Department Drug Abuse Surveillance (TEDAS) project aims to assess the patterns of recreational drug use in patients presenting to emergency departments (EDs) across the country. Here, we report the preliminary results of this project. This observational study included the collection and analysis of urine samples and assessment of the clinical presentation of patients from 79 EDs across Taiwan. Clinical features were recorded through a questionnaire filled by attending doctors or nurses who collected urine samples for clinical diagnosis. Urine samples were analyzed for 110 drugs and metabolites using electrospray ionization liquid chromatography-tandem mass spectrometry (LC-MS/MS). Between February and November 2019, a total of 2649 patients were enrolled for urine drug analysis. A total of 675 cases older than 12 years (males, n = 480) had NPS or other illicit drugs detected in their urine samples. Overall, 1271 counts of drugs, among which 717 (56.4%) were NPS. At least one NPS was detected in 340 patients (50.4%), and 292 cases were positive for multiple drugs. The most frequently detected drug was methamphetamine/amphetamine, followed by synthetic cathinones, ketamine and its two analogs, and opioids. The most common drug combination was cathinones plus ketamine and/or its analogs (n = 56). Younger patients (OR = 3.3, p≤.0001) and women (OR = 1.5, p =.01) were more likely to have NPS detected in their urine samples. NPS-positive cases frequently experienced chest pain (OR = 2.6, p =.03), tachycardia (OR = 2.6, p =.0002), and suicide attempt/non-suicidal self-harm (OR = 1.8, p =.004), whereas depressed consciousness (OR = 0.5, p =.001) was less frequent among NPS-positive cases than among other illicit drug-positive cases. The TEDAS project provides a nationwide epidemiological profile of recreational drug use in Taiwan. More than half of the recreational drugs were NPSs, which were comprehensively detected using LC-MS/MS. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the short- and long-term use of medication for psychological distress after the diagnosis of cancer.Methods: Longitudinal data from the Taiwan National Health Insurance database were used to follow 35,137 cancer patients for 2.5 years after being diagnosed in 2006 and 2007.Results: Among those patients who survived for at least 180 days, 20.9 % had used psychotropic medications; sedatives were the most frequently prescribed (14.3 %), followed by antidepressants (5.5 %), anxiolytics (3.6 %), and antipsychotics (2.7 %). Lung cancer, prostate cancer, and oral cancer showed a significant association with the regular use of medication in the first 180 days. Among patients who survived for at least 2.5 years, 4.8 % still used psychotropic medication on a regular basis. Lung cancer and prostate cancer were associated with such prolonged use.Conclusions: This longitudinal study found that the type of cancer was significantly associated with the use of psychotropic drugs after the diagnosis was made. It provided information about the trajectory of that use and found that a small number of patients were still using those medications after 2.5 years. [ABSTRACT FROM AUTHOR]

This study aimed to assess the impact of diabetic retinopathy (DR) severity on the incidence of major adverse cardiac events (MACE) and end-stage renal disease (ESRD) in T1D patients. Patients diagnosed with T1D between 1999 and 2013 were identified from patient-level data of Taiwan's National Health Insurance Research database. A total of 1135 patients were included and classified into mild DR (n = 454), severe DR (n = 227), or non-DR (n = 454) by using propensity score matching. Multi-state model analyses, an extension of competing risk models with adjustment for transition-specific covariates for prediction of subsequent MACE and ESRD, were performed. MACE and ESRD risks were significantly higher in the severe DR patients; a 2.97-fold (1.73, 5.07) and 12.29-fold (6.50, 23.23) increase in the MACE risk among the severe DR patients compared to the mild DR and DR-free patients, respectively; and, a 5.91-fold (3.50, 9.99) and 82.31-fold (29.07, 233.04) greater ESRD risk of severe DR patients than that of the mild DR and DR-free groups, respectively (p < 0.001). Severity of DR was significantly associated with the late diabetes-related vascular events (i.e., MACE, ESRD) among T1D patients. [ABSTRACT FROM AUTHOR]

Background: To assess the effect of sodium glucose cotransporter-2 inhibitors (SGLT-2is) for type 2 diabetes on kidney outcomes stratified by patient baseline estimated glomerular filtration rate (eGFR) levels (i.e., eGFR ≤ 60, 60 < eGFR ≤ 90, and eGFR > 90 mL/min/1.73 m2). Methods: Patients from three large healthcare delivery systems in Taiwan who had initiated SGLT-2is or other glucose-lowering drugs (oGLDs) between May 2016 and December 2017 were included. Main outcomes were the times to 30%, 40%, and 50% eGFR reduction after treatment initiation. One-to-one propensity score matching in the overall study cohort and in each eGFR subgroup between SGLT-2i and oGLD users was applied to ensure between-group comparability in baseline characteristics. Results: There were 13,666 matched pairs of SGLT-2is and oGLD users in the overall cohort. While a sustained eGFR decline was revealed in oGLD-treated patients (mean values [standard errors] from 85.61 [0.43] to 82.49 [0.44] mL/min/1.73 m2 during the 12 months after treatment initiation), the mean eGFR values of SGLT-2i users decreased in the first 3 months (85.68 [0.37] to 79.71 [0.41] mL/min/1.73 m2) but then improved and sustained until the end of follow-up. There were 2300, 5705, and 5509 matched SGLT-2i and oGLD users in the eGFR ≤ 60, 60 < eGFR ≤ 90, and eGFR > 90 subgroups, respectively. Using SGLT-2is versus oGLDs was significantly associated with slower eGFR declines; hazard ratios (HRs) were 0.51 (95% CI 0.37–0.69), 0.51 (0.37–0.70), and 0.47 (0.31–0.71) for 40% eGFR reduction in the eGFR ≤ 60, 60 < eGFR ≤ 90, and eGFR > 90 subgroups, respectively. The renoprotective effect of SGLT-2is versus oGLDs was confirmed in the outcomes of 30% and 50% eGFR reduction across the three eGFR subgroups. Conclusions: This study supports the renoprotective benefit of real-world SGLT-2i use irrespective of patient baseline kidney function. [ABSTRACT FROM AUTHOR]

To assess real-world effectiveness of hyperbaric oxygen therapy (HBOT) on delayed neuropsychiatric sequelae (DNS) after carbon monoxide (CO) poisoning we conducted a retrospective review of patients with CO poisoning admitted to Linkou Chang-Gung Memorial Hospital, Taiwan's largest medical center, during 2009–2015. We included patients developing DNS after CO poisoning and compared improvements in neuropsychiatric function, with and without HBOT, after 12 months post-DNS to understand differences in recovery rates. DNS improvement-associated factors were also evaluated. We used receiver operating characteristic (ROC) curve analysis to assess the role of time elapsed between DNS diagnosis and HBOT initiation in predicting DNS improvement. A total of 62 patients developed DNS, of whom 11 recovered while the rest did not. Possible factors predicting DNS improvement included receiving HBOT post-DNS (72.7% vs 25.5%; P = 0.006), and treatment with more than three HBOT sessions during acute stage CO poisoning (81.8% vs 27.5%; P = 0.003). The relevant area under the ROC curve was 0.789 (95% CI 0.603–0.974), and the best cut-off point was 3 days post-DNS diagnosis, with 87.5% sensitivity and 61.5% specificity. Early HBOT in patients who developed DNS after CO poisoning significantly improved their DNS symptoms, with treatment effects sustained for 1 year after DNS diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: Colorectal cancer (CRC) is a major health problem with high incidence and mortality rates worldwide. The increased incidence of CRC in Taiwan may be associated with environmental contaminants such as polycyclic aromatic hydrocarbons (PAHs), nitrate, and nitrite. Accordingly, in this study, the relationship between these contaminants and CRC was investigated. Methods: Paired plasma and tumor tissues of CRC patients were obtained from the Tissue Bank at Kaohsiung Chang Gung Memorial Hospital. The samples were extracted and analyzed using enzyme-linked immunosorbent assay and gas chromatography-tandem mass spectrometry for detecting the concentrations of nitrate/nitrite and 16 types of PAHs, respectively, at the Super Micro Mass Research & Technology Center, Cheng Shiu University. Results: Nitrite and the 16 types of PAHs were undetectable in the plasma; thus, only nitrate was selected for further investigation. The data indicated that the plasma levels of nitrate were not significantly different between the CRC and control groups. Notably, the average levels of nitrate in tumor tissues were significantly higher than the average plasma levels, but the nitrate levels in paired plasma and tumor tissues did not show a significant correlation. Moreover, no significant difference in the nitrate levels of plasma and tumor tissues was found in patients with different tumor stages. Conclusions: In this pilot study, no significant correlation was found between the nitrate levels in plasma and tumors of CRC patients, which could be caused by the smaller study cohort. However, the result is a potentially valuable reference for further research. [ABSTRACT FROM AUTHOR]

Elevated serum uric acid (UA) is frequently observed in adults with high blood pressure (BP); however, data from adolescents are limited. We examined the association between serum UA and BP in a nationally representative sample of Taiwan adolescents. Some 1384 participants, aged 14–19 years, from the Nutrition and Health Survey in Taiwan 2010–2011 were included for the study. Elevated BP was defined as systolic or diastolic BP ≥120/80 mmHg. The analyses examined the relationship between serum UA and BP using linear regression and odds ratios of having an elevated BP using logistic regression. In this study population, the mean age was 16.0 years, mean serum UA was 5.8 mg/dL, 22.5% were obese (body mass index ≥24 kg/m2) and 9.8% had an elevated BP. Compared to girls, boys are more likely to be obese and to have higher serum UA and BP. After full adjustments, systolic BP, diastolic BP and mean arterial pressure increased 0.45, 0.48 and 0.47 mmHg, respectively, for each 1-mg/dL increase in UA (p = 0.07, 0.03 and 0.02, respectively). The odds of having an elevated BP were 3.4 times higher in subjects of the upper tertile of serum UA than those of the lower tertile (p = 0.02). Adolescents with factors as male, obesity, and UA ≥5.5 mg/dL were prone to have an elevated BP, regardless of age and family history of hypertension. The present study found that serum UA levels are significantly correlated to BP in Taiwanese adolescents. [ABSTRACT FROM AUTHOR]

Background: Head-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide. Methods: We conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016–2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every 3 months in the 1-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches. Results: A total of 1512 subjects receiving dulaglutide and 1513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: − 1.06%, p < 0.001; liraglutide: − 0.83%, p < 0.001), with a significant between-group difference (− 0.23%, 95% confidence interval − 0.38 to − 0.08%, p < 0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: − 1.14 kg, − 3.08 U/L and − 2.08 mL/min/1.73 m2, p < 0.01; liraglutide: − 1.64 kg, − 3.65 U/L and − 2.33 mL/min/1.73 m2, p < 0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (− 2.47 mmHg, p < 0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant. Conclusions: In real-world T2D patients, dulaglutide versus liraglutide was associated with better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions. [ABSTRACT FROM AUTHOR]

There is no large-scale population-based study to clarify the association between major adverse cardiovascular events (MACEs) and pre-eclampsia/eclampsia. A population-based Taiwanese cohort study was performed in 1,132,064 parturients from 1999 to 2003 using a dataset linking birth certificates and National Health Insurance hospital discharge data. Sociodemographic factors and obstetric complications were used in multivariate logistic regression models to determine adjusted hazard ratios of pre-eclampsia/eclampsia on risks of MACEs and mortality during pregnancy to at least the third year postpartum. Incidence rates of MACEs and all maternal mortality in women with pre-eclampsia/eclampsia were 16.21 and 40.38 per 100,000 patients per year, respectively. Women with pre-eclampsia/eclampsia had a 13.0-fold higher incidence of myocardial infarction, a 8.3-fold higher incidence of heart failure, a 14.5-fold higher incidence of stroke, a 12.6-fold higher incidence of MACEs, a 7.3-fold higher incidence of MACEs without stroke, a 2.3-fold higher incidence of MACE-related deaths, and a 6.4-fold higher incidence of overall death than women without pre-eclampsia/eclampsia. Kaplan-Meier survival curve discriminated in MACEs, nonstroke MACEs, MACE related death and overall death. In conclusion, women with pre-eclampsia/eclampsia have a significantly higher risk of MACEs, especially myocardial infarction and stroke, during pregnancy and their risk remains significant to ≥36 months postpartum. Our results suggest that women with pre-eclampsia/eclampsia should be closely monitored during pregnancy and for up to ≥3 years postpartum. [ABSTRACT FROM AUTHOR]

The results of many studies indicate that cadmium (Cd) exposure is harmful to humans, with the proximal tubule of the kidney being the main target of Cd accumulation and toxicity. Studies have also shown that Cd has the effect of activating the pathway of epidermal growth factor receptor (EGFR) signaling and cell growth. The EGFR is a family of transmembrane receptors, which are widely expressed in the human kidney. The aim of this study was to investigate the kidney function estimated glomerular filtration rate (eGFR), and its relationship with plasma Cd level and EGFR gene polymorphism. Using data from Academia Sinica Taiwan biobank, 489 subjects aged 30–70 years were analyzed. The demographic characteristics was determined from questionnaires, and biological sampling of urine and blood was determined from physical examination. Kidney function was assessed by the eGFR with CKD-EPI formula. Plasma Cd (ug/L) was measured by inductively coupled plasma mass spectrometry. A total of 97 single-nucleotide polymorphisms (SNPs) were identified in the EGFR on the Taiwan biobank chip, however 4 SNPs did not pass the quality control. Multiple regression analyses were performed to achieve the study aim. The mean (±SD) plasma Cd level of the study subjects was 0.02 (±0.008) ug/L. After adjusting for confounding variables, rs13244925 AA, rs6948867 AA, rs35891645 TT and rs6593214 AA types had higher eGFR (4.89 mL/min/1.73 m2 (p = 0.035), 5.54 mL/min/1.73 m2 (p = 0.03), 4.96 mL/min/1.73 m2 (p = 0.048) and 5.16 mL/min/1.73 m2 (p = 0.048), respectively). Plasma cadmium and rs845555 had an interactive effect on eGFR. In conclusion, EGFR polymorphisms could be modifiers of Cd kidney toxicity, in which rs13244925 AA, rs6948867 AA, rs35891645 TT and rs6593214 AA may be protective, and Cd interacting with rs845555 may affect kidney function. [ABSTRACT FROM AUTHOR]

Pregnant women are considered as one of the most vulnerable groups for iodine deficiency. The Nutrition and Health Survey in Taiwan 2013 revealed that the median urinary iodine concentration (UIC) of non-pregnant women of child-bearing age of 15–44 years was 124 μg/L, which was adequate in general, but insufficient according to pregnancy criteria. The aim of this study was to determine the iodine nutritional status of pregnant women in an urban area of Northern Taiwan. A hospital-based cross-sectional survey was conducted in Taipei Veterans General Hospital. Random spot urine samples were collected from January to October, 2018 and UIC was determined by inductively coupled plasma mass-spectrometry. A food frequency questionnaire was also delivered to the participants. The overall median UIC was 225.3 μg/L (IQR: 109.1–514.2 μg/L) for 257 pregnant women ranging from 21–47 years-old. The distribution of UIC was as follows: 35.4% with UIC <150 μg/L, 17.1% with UIC within 150–249 μg/L, 21.8% with UIC within 250–499 μg/L, and 25.7% with UIC ≥500 μg/L. The use of prenatal multivitamin was very common among the participants: 79.4% (n = 204) took multivitamin either every day or less frequently, with 52.5% (n = 135) taking one pill every day, and only 20.6% (n = 53) never took multivitamin during their pregnancy. Other commonly consumed iodine-containing foods were dairy products and fish. Our results indicate that the iodine status in the studied women is adequate. However, efforts are still needed to avoid iodine deficiency as well as iodine excess. [ABSTRACT FROM AUTHOR]

Abstract Objectives Delayed neuropsychiatric sequelae (DNS) are serious complications of carbon monoxide poisoning; neuropsychiatric disorders can occur within a few days of recovery from acute poisoning. Hyperbaric oxygen therapy (HBOT) has been the main treatment of carbon monoxide (CO) poisoning and was recommended as the treatment choice for CO poisoning by the American Undersea and Hyperbaric Medical Society and the Tenth European Consensus Conference on Hyperbaric Medicine of the European Underwater and Baromedical Society. However, the optimal timing for commencing HBOT in patients with CO poisoning remains unknown. We therefore conducted a retrospective study in an attempt to target the optimal time of HBOT for DNS prevention. Methods A retrospective review of patient files/medical records was conducted on all patients with CO poisoning admitted to the Emergency Department of Linkou Chang-Gung Memorial Hospital, Taiwan between January 1, 2009 and December 31, 2015. A total of 279 patients who received HBOT were eligible for further DNS detection. DNS was defined as the presence of one of the following neurological, cognitive, or psychological sequelae that were documented in the medical record during hospital stay or outpatient clinic follow-up for at least 6 months. A multivariable logistic regression analysis was employed to identify potential determinants of DNS after receiving HBOT for CO poisoning. A receiver operating characteristic (ROC) curve was used to analyse the influence of duration from CO exposure to HBOT on DNS development. Results A Glasgow coma score of <9 (odds ratio [OR], 3.20; 95% confidence interval [CI], 1.19–8.60) and a longer duration from CO exposure to HBOT (OR, 1.06; 95% CI, 1.03–1.09) were associated with a higher risk of DNS. By contrast, the presence of multiple victims from the same incident was associated with a lower risk of DNS. The ROC curve for the duration between CO exposure and HBOT in predicting DNS development demonstrated an area under the curve of 0.638 (95% CI, 0.575–0.698). The optimal cut-off point according to the Youden index was 22.5 h, with a sensitivity of 41.7% and a specificity of 85.9%. We also stratified the duration from CO exposure to HBOT into 5 intervals (< 6 h, 6–11 h, 12–23 h, 24–47 h and ≥ 48 h) and revealed a trend of increasing DNS risk with time. Conclusions We identified several potential predictors of DNS in patients with CO poisoning who received HBOT. Multivariable logistic regressions further revealed that longer duration from CO exposure to HBOT, loss of consciousness, and the presence of multiple victims were independent predictors of DNS development. HBOT should be performed as early as possible and preferably within 22.5 h after CO poisoning. Highlights • Loss of consciousness increases delayed neuropsychiatric sequelae risk • Delayed neuropsychiatric sequelae relate Carbon Monoxide exposure time to therapy • Presence of multiple victims leads lower risk of delayed neuropsychiatric sequelae • < 22.5 h from Carbon Monoxide poisoning to Hyperbaric oxygen therapy is acceptable [ABSTRACT FROM AUTHOR]

Objective. Delayed neuropsychiatric sequelae (DNS) are serious complications of carbon monoxide (CO) poisoning that adversely affect poisoned patients’ quality of life as well as socioeconomic status. This study aimed to determine clinical predictors of DNS in patients with CO poisoning. Methods. This retrospective study included all CO-poisoned patients admitted to the emergency department (ED) of Linkou Chang Gung Memorial Hospital in Taiwan from 1 January 2009 to 31 December 2015. The medical records of all patients with CO poisoning were carefully reviewed, and relevant data were abstracted into a standardised form. Univariate and multivariate logistic regression models were used to identify predictors of DNS after CO poisoning. Receiver operating characteristic (ROC) curve analysis was used to determine the ideal cut-off value for continuous variables that predict the development of DNS. Results. A total of 760 patients with CO poisoning were identified during the study period. Among them, 466 were eligible for the analysis of predictors of DNS. In multivariate analysis, Glasgow Coma Scale <9 (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.21–6.21), transient loss of consciousness (OR, 3.59; 95% CI, 1.31–9.79), longer duration from CO exposure to ED presentation (OR, 1.05; 95% CI, 1.03–1.08), and corrected QT (QTc) prolongation (OR, 2.61; 95% CI, 1.21–5.61) were found to be associated with a higher risk of DNS. The area under the ROC curve (AUC) for QTc interval measured within 6 h after exposure best predicted the development of DNS, with a result of 0.729 (95% CI 0.660–0.791). Moreover, the best cut-off value of the QTc interval was 471 ms, with a sensitivity of 53.3% and a specificity of 85.1%. Conclusions. We identified several potential predictors of DNS following CO poisoning. Among them, QTc prolongation found within 6 h after exposure is a novel predictor of DNS, which may be helpful in the future care of patients with CO poisoning. [ABSTRACT FROM AUTHOR]

This study quantified five perfluorocarboxylic acids (PFCAs) and two perfluorosulfonic acids in cereals, meats, seafood, eggs, pork liver, and milk in Taiwan using ultra-performance liquid chromatography-tandem mass spectrometry and evaluated the dietary exposure of the general population and pregnant women using per capita consumption and a questionnaire, respectively. Perfluorooctanoic acid (PFOA) and PFCAs of 10-12 carbons were found in almost all of the samples in considerable concentrations in rice and pork liver, reaching as high as 283 ng/g (PFOA in pork liver); the levels are two to three orders of magnitude higher than previous reports. Perfluorooctane sulfonate (PFOS), the most frequently mentioned perfluoroalkyl substance, was rarely detected in many food items (detection frequencies <20% in rice, flour, pork, chicken, salmon, squid, eggs, and milk) at <0.4 ng/g, except for beef, pork liver and some seafood (detection frequencies: 100%, GMs: 0.05--3.52 ng/g). Compared to populations in Western countries, people in Taiwan are exposed to much more perfluorohexanoic acid, PFOA, perfluorodecanoic acid, and perfluoroundecanoic acid (11.2, 85.1, 44.2, and 4.45 ng/kg b.w./day, respectively), mainly due to the higher contaminations in food. The exposure of 8.0 μg PFOA/person/day in the 95 percentile of pregnant women was due to their frequent consumption of pork liver. [ABSTRACT FROM AUTHOR]

Background:Naja atra snakebite is uncommon in Taiwan and causes distinct effects on its victims. Although the Taiwan government produces its own specific antivenom, little information on the management of N. atra snakebite is available. Materials and methods: We retrospectively evaluated 183 patients admitted to two medical centers. Of these, 45 were identified as definite cases of N. atra snakebite, 86 as suspected cases, and 52 as clinical cases. Demographic data, symptomatology, and management were compared between these case groups. Results: Symptomatology and management were similar in the three groups. Among the 183 patients, 10 (5.5%) were asymptomatic and nine (4.9%) had transient and partial ptosis or body weakness. The principal effects were local tissue swelling and pain in 173 patients (94.5%), followed by clinically suspected wound infection in 148 (80.9%), skin necrosis in 120 (65.6%), necrotizing soft tissue infection in 77 (42.1%), fever in 59 (32.2%), and gastrointestinal effects in 53 (29%). The median total dose of specific antivenom needed to treat N. atra envenoming was 10 vials. In the envenomed patients, debridement was required in 74 patients (42.8%), fasciotomy/fasciectomy in 46 (26.6%), and finger or toe amputation in seven (4%). The first operation was performed at a median of 3.5 days after the bite. Discussion and conclusions: Based on these typical manifestations, clinical diagnosis of N. atra snakebites may be feasible and practical. In contrast to other snakes of Elapidae family, N. atra bite did not cause serious neurological effects. Early surgical consultation should be obtained because half of the patients underwent surgery due to infectious complications. Acute compartment syndrome was the surgical indication in rare cases; however, overestimation of the incidence may have occurred. This syndrome should be confirmed by serial intracompartmental pressure monitoring instead of only physical examination, and a sufficient dose of antivenom should be given prior to surgical decompression. [ABSTRACT FROM AUTHOR]

Chinese herbal medicines (CHMs) containing aristolochic acid (AA) are associated with chronic kidney disease (CKD), but some prescribed CHMs have been shown to possess renoprotective effects. We conducted a nationwide retrospective cohort study to delineate the role of prescribed CHMs on the CKD progression. Renoprotective CHM (RPCHM) was defined if a CHM contained dong chong xia cao (Cordyceps sinensis (Berk.) Sacc.), da huang (Rheum palmatum L), huang qi (Astragalus membranaceus), dan shen (Salvia miltiorrhiza Bge.), and dong quai (Angelica sinensis (Oliv.) Diels) or belonged to specific mixture herbal formulations (Yishen capsule, Saireito, or Wen Pi Tang). Subjects who had ever used AA-containing CHMs, had cancer or HIV prior to CKD diagnosis, or died within the first month of CKD diagnosis were excluded. A total of 11,625 patients were eligible subjects. The adjusted hazard ratio (aHR) for all-cause mortality was 0.6 (p < 0.001) and 0.6 (p = 0.013) among subjects receiving RPCHMs containing Angelica sinensis and those receiving other RPCHMs, respectively. For CKD-related mortality, the aHR among subjects receiving RPCHMs containing Angelica sinensis was 0.6 (p = 0.025). The use of specific RPCHMs, especially those that contained Angelica sinensis, was associated with a lower risk of mortality among CKD patients. [ABSTRACT FROM AUTHOR]

Based on the holistic perspective of ‘alignment’, evaluating the alignment of human–computer interaction is crucial to ensure effective information system implementation and a positive impact on performance. This study aims to examine the impact of alignment between the nurses' perception of NIS (Nursing Information System) performability and technological capability of NIS achieving success on nurses' satisfaction and nursing care performance through the perspectives of alignment as covariation and alignment as profile deviation. A quantitative method and a cross-section design were used to collect data from 531 registered nurses in Taiwan. The results indicate that the coalignment of nurses' perception of NIS performability and the technological capability of NIS achieving success has a positive impact on nurses' satisfaction with NIS usage. Consequently, nurses' satisfaction will increase with the improved performance of nursing care. The results of this research will help the management of NIS application and development within the context of nursing care. [ABSTRACT FROM AUTHOR]

The article presents a 2015 national prospective cohort study in Taiwan which examined whether screening for the human leukocyte antigen (HLA)-B*58:01 allele before allopurinol treatment is effective in preventing severe cutaneous adverse reactions (SCAR). The study results were compared to the National Health Insurance research database of Taiwan. Based on the results, screening along with alternative drug treatment for carriers is effective in lowering incidence of allopurinol induced SCARs.

Background: Taiwan has the highest incidence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. Chinese herbal medicine (CHM) has been linked to CKD/ESRD in Taiwan. The specific effects and frequency of CHM on the risk of CKD are unknown. Methods: A hospital-based case‐control study was performed from August 2006 through December 2009. The cases were consecutive nephrology outpatients 20years of age or older, with a first-time diagnosis of CKD, and without cancer or pre-existing renal disease. The controls were randomly selected outpatients that did not have CKD and were matched 1:1 to cases for age, gender and date of outpatient visit. Results: Four hundred and twenty-four patients were recruited. Among 212 cases, 23.6% took non-prescribed CHM, compared to 6.6% among the controls (p<0.001). Multivariate analysis showed that illiteracy [odds ratio (OR) 6.3, 95% confidence interval (CI) 2.4–16.6], hypertension (OR 5.4, 95% CI 2.9–9.8) and occasional use of non-prescribed CHM (OR 6.2, 95% CI 1.8–21.6) were positively associated with CKD, whereas regular exercise was inversely associated with CKD (OR 0.5, 95% CI 0.3–0.9). Conclusion: Occasional use of non-prescribed CHM was associated with the risk of CKD in Taiwan. [Copyright &y& Elsevier]