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International audience; Enteroviruses (EV), the major pathogens of hand, foot, and mouth disease (HFMD) and herpangina, affect millions of children each year. Most human enteroviruses cause self-limited infections except polioviruses, enterovirus A71 (EV-A71), enterovirus D68 (EV-D68), and several echoviruses (Echo) and coxsackieviruses (CV). Especially, EV-A71 has repeatedly caused large-scale outbreaks in the Asia-Pacific region since 1997. Some Asian countries have experienced cyclical outbreaks of severe EV-A71 infections and initiated development of EV-A71 vaccines. Five EV-A71 vaccine candidates have been clinically evaluated and three of them were approved for marketing in China. However, none of the China-approved products seek marketing approval in other countries. This situation supports a role for collaboration among Asian countries to facilitate clinical trials and licensure of EV-A71 vaccines. Additionally, enterovirus D68 outbreaks have been reported in the US and Taiwan currently and caused severe complications and deaths. Hence, an Asia-Pacific Network for Enterovirus Surveillance (APNES) has been established to estimate disease burden, understand virus evolution, and facilitate vaccine development through harmonizing laboratory diagnosis and data collection. Founded in 2017, the APNES is comprised of internationally recognized experts in the field of enterovirus in Asian countries working to raise awareness of this potentially fatal and debilitating disease. This article demonstrated the summaries of the first expert meeting, 2017 International Workshop on Enterovirus Surveillance and Vaccine Development, held by APNES in Taipei, Taiwan, March 2017.

The aim of this study was to investigate the influence of rice bran oil consumption on plasma lipids and insulin resistance in patients with type 2 diabetes. Thirty-five patients with type 2 diabetes were randomly assigned to a placebo group or a rice bran oil group. The placebo group consumed 250 mL soybean oil-modified milk (18 g soybean oil) daily for 5 weeks, and the rice bran oil group consumed 250 mL rice bran oil modified milk (18 g rice bran oil) daily for 5 weeks. At week 0 and week 5, anthropometric measurements, hematology tests, and an oral-glucose-tolerance test were conducted. The results showed that the homeostasis model assessment index of insulin resistance, the area under the curve for postprandial serum insulin, and serum low-density-lipoprotein cholesterol concentrations increased significantly in the placebo group. In the rice bran oil group, fasting and 2-h postprandial blood glucose concentrations and the area under the curve for postprandial plasma glucose increased significantly; however, total serum cholesterol and low-density-lipoprotein cholesterol concentrations decreased significantly. However, the homeostasis model assessment index of insulin resistance was not significantly different. Consumption of 18 g rice bran oil modified milk daily for 5 weeks significantly decreased total serum cholesterol concentrations and tended to decrease low-density-lipoprotein cholesterol concentrations in patients with type 2 diabetes. However, no significant influence on insulin resistance was observed.

Background/Purpose Cardiovascular disease accounts for more than 50% of deaths among patients with end-stage renal disease, and numerous factors have been proposed that may contribute to this increased risk of death. Coronary artery calcification has been recognized as one of the important risk factors for cardiovascular disease in patients undergoing dialysis. The aim of this study was to compare the coronary artery calcification score (CACS) in peritoneal dialysis (PD) and hemodialysis (HD) patients, and to assess the effect of dialysis during a 12-month period. Methods Multidetector computed tomography was performed in 33 chronic dialysis patients (15 PD and 18 HD patients; mean age, 54 years) at Months 1, 6, and 12 during the study period. Blood samples were collected from each patient monthly to measure the serum levels of calcium and phosphorus. Results The CACSs were significantly increased at Month 12 versus Month 1 in both PD and HD patients (p Conclusions Our data suggest that the increase in CACS is not different between the PD and HD patients. Furthermore, the decrease in CACS between Months 7 and 12 suggests that there could be a factor other than the level of the calcium–phosphorus product that accounts for the variation in CACS in both groups.

Background The 64-multidetector computed tomography (64-MDCT) has developed into a mature clinical tool to detect coronary artery disease. This 64-MDCT system permits cross-sectional and longitudinal imaging of the coronary arteries with a high spatial and temporal resolution. However, small vessels, side branches and the distal portions of the main coronary arteries are not always optimally visualized. Purpose The aim of this study was to evaluate the effect of nitroglycerin (NTG) on lumen diameters and the number of visualized side branches of the coronary arteries on 64-MDCT. We also assessed whether NTG would affect the quality of the images of the coronary arteries obtained by 64-MDCT. Methods Sixty-seven patients were randomized and divided into two groups: Group C (31 patients, no sublingual NTG) and Group N (36 patients, sublingual NTG given before the scan). We measured the lumen diameter of the coronary artery and visibility of the side branches by using the 64-MDCT system and also evaluated the image quality by using the scores. Results The cardiac 64-MDCT images of these patients showed that the average diameters of the proximal segments in the right coronary artery, left main artery, left anterior descending coronary artery, and left circumflex coronary artery were 4.1 ± 0.7 mm, 3.9 ± 0.6 mm, 3.6 ± 0.7 mm, and 3.4 ± 0.6 mm, respectively, in Group N and 3.0 ± 0.5 mm, 3.1 ± 0.6 mm, 2.8 ± 0.5 mm, and 2.7 ± 0.5 mm, respectively in Group C. In addition, the scores for visibility and image quality for the side branches in Group N were significant higher than for those in Group C. Conclusion Our study indicates that CT coronary angiography using 64-MDCT with NTG administration produces images of diagnostically acceptable quality in all coronary segments. Thus, NTG might be recommended for routine 64-MDCT coronary angiography examinations.

Background High-attenuation oral contrast agents in the form of iodine solutions or barium suspensions have been used traditionally and effectively for abdominal computed tomography (CT) examinations. Apart from the unpleasant taste, there are relatively few disadvantages that may affect interpretation, such as pseudotumor formation due to incomplete mixing of contrast material with the bowel contents and poor mural discrimination. Thus, low-attenuation oral contrast materials are needed. Purpose The aim of this study was to evaluate the efficiency of whole milk as a low-attenuation contrast agent compared with water-soluble contrast medium and water for abdomi-nopelvic CT. Methods A total of 152 patients were randomly assigned to receive whole milk (4%), water or water-soluble contrast medium (Optiral). All CT scans were performed using a 64-multidetector CT scanner with a 0.35-second rotation time. Two radiologists were responsible for reviewing the images to assess bowel wall enhancement and bowel dilation. Results There were no differences in average dilation scores among the three groups for duodenum and jejunum. The average dilation score in the milk group was higher than that in the water-soluble contrast medium group in the antrum, and there was no difference between water and milk. For the ileum, there were no differences in the average dilation scores in the milk and water-soluble contrast medium groups, and milk produced better dilation compared with water. Bowel enhancement in the water and milk groups was stronger than that in the water-soluble contrast medium group. The major side effects of milk were nausea and flatulence. Conclusion We concluded that abdominopelvic multidetector CT with whole milk provides better bowel dilation and wall visualization compared with high-attenuation contrast medium. Whole milk and water have potential as good oral contrast materials for bowel discrimination. However, whole milk should be considered as an alternative to water in cases of disease suspected in the pelvis.

Gamma-oryzanol is a component of rice bran oil (RBO) with purported health benefits. This study evaluated the effects of gamma-oryzanol on insulin resistance and lipid metabolism in Wistar rats with type 2 diabetes (T2DM). The rats were divided into three groups and consumed one of the following diets for 5 weeks: 15 % soybean oil (control group); 15 % palm oil (PO); and 15 % PO with the addition of 5.25 g gamma-oryzanol (POO). The results showed that PO markedly increased plasma low-density-lipoprotein cholesterol, plasma triglycerides, and hepatic triglyceride levels, but did not reduce the area under the curve for glucose and insulin significantly, compared with the control group. Adding gamma-oryzanol to PO improved the negative influence of PO on lipid metabolism in T2DM rats. In addition, gamma-oryzanol tended to increase insulin sensitivity in T2DM rats compared to control and PO groups. Longer-term studies are needed to evaluate these effects further.

The aim of this study was to determine the effects of rice bran oil (RBO) on lipid metabolism and insulin resistance in rats with streptozotocin/nicotinamide-induced type 2 diabetes mellitus (T2DM). Rats were divided into two groups: the control group (15% soybean oil, contains 0 g gamma-oryzanol and 0 g gamma-tocotrienol/150 g oil for 5 weeks) and the RBO group (15% RBO, contains 5.25 g gamma-oryzanol and 0.9 g gamma-tocotrienol/150 g oil for 5 weeks). Compared with the control group, the RBO group had a lower plasma nonesterified fatty acid concentration, ratio of total to high-density-lipoprotein cholesterol, hepatic cholesterol concentration, and area under the curve for insulin. The RBO group had a higher high-density-lipoprotein cholesterol concentration and greater excretion of fecal neutral sterols and bile acid than did the control group. RBO may improve lipid abnormalities, reduce the atherogenic index, and suppress the hyperinsulinemic response in rats with streptozotocin/nicotinamide-induced T2DM. In addition, RBO can lead to increased fecal neutral sterol and bile acid excretion.

Reported herein is the case of a 35-year-old multipara woman diagnosed (on sonography) with total placenta previa that had ruptured through the myometrium of the uterus, invading the wall of the urinary bladder. In the 32nd week of gestation the patient underwent an emergency cesarean section due to profuse vaginal bleeding. Due to possible intraoperative massive bleeding during removal of the placenta it was decided to preserve the uterus and placenta temporarily. The patient underwent superselective trans-uterine embolization through the bilateral anterior branches of the hypogastric arteries, using gelfoam cubes and coils. Two days later cesarean hysterectomy was performed, and the placenta was successfully removed from the invaded urinary bladder. The whole procedure went smoothly and the estimated blood loss was only 1300 mL.

Development and refinement of multidetector computed tomography (MDCT) has brought the potential to replace conventional coronary angiography with a noninvasive technique that has comparable spatial and temporal resolution with a single breath-hold. Although clinical use of MDCT has largely been confined to evaluation of atherosclerotic coronary artery burden and coronary artery anomalies, it can be applied to diagnosis of other problems concerning the thoracic vasculature. We present the case of a middle-aged man who presented with recent-onset exertional angina: 64-detector CT was used as an alternative to cardiac catheterization and identified the underlying anatomic anomaly, a rare coronary-to-bronchial-artery communication. Clinicians should be aware that the newest generation of MDCT equipment may allow many patients to forego diagnostic cardiac catheterization without compromise in quality of care.

The extent to which sample dilution factor (DF) affects total antioxidant capacity (TAC) values is poorly understood. Thus, we examined the impact of DF on the ORAC, FRAP, DPPH, and total phenols (TP) assays using pomegranate juice (PJ), grape juice (GJ), selected flavonoids, ascorbic acid, and ellagic acid. For ORAC, GJ was comparable to PJ at DF 750, but at DF 2000, the ORAC value of GJ was 40% more than PJ. Increasing DF increased GJ and PJ, DPPH, TP, and FRAP values 11% and 14%, respectively. Increased test concentrations of quercetin and catechin resulted in 51% and 126% greater ORAC values, but decreased naringenin by 68%. Flavonoids, but not ellagic acid or ascorbic acid, may contribute to the dilution effect on the variation of final TAC values. Thus, reporting TAC or TP using a single DF may introduce uncertainty about the confidence of TAC assay values, especially when comparing different juices. These results underscore the importance of using compatible test standards for reporting TAC values. Practical Application: Total antioxidant capacity (TAC) values such as the ORAC assay are increasingly used for comparison of polyphenol-rich foods and beverages. Choice of standards and test concentrations, even within the linear range of standards, may introduce variation probably due to synergy/antagonism between antioxidant and thereby, confound final TAC values. Thus, test concentration or dilution factors of samples should be considered in the design of TAC assays and interpretation of their results.

The aim of this study was to evaluate the glycemic index and peak incremental indices of six popular fruits in Taiwan, comparing healthy subjects (n = 20) and patients with Type 2 diabetes (n = 17). The six kinds of fruits tested were grapes, Asian pears, guavas, golden kiwifruit, lychees and bananas. Glycemic index values were tested according to the standard glycemic index testing protocol. The glycemic index and peak incremental indices were calculated according to published formulas. In Type 2 diabetes subjects, the glycemic index values of grapes, Asian pears, guavas, golden kiwifruit, lychees and bananas were 49.0 ± 4.5, 25.9 ± 2.9, 32.8 ± 5.2, 47.0 ± 6.5, 60.0 ± 8.0 and 41.3 ± 3.5. In healthy subjects, the glycemic index values were 49.1 ± 7.3, 18.0 ± 5.4, 31.1 ± 5.1, 47.3 ± 12.1, 47.9 ± 6.8 and 35.1 ± 5.6. There was no significant difference in glycemic index values between healthy and Type 2 diabetes subjects. There was also no significant difference in PII when comparing healthy subjects and subjects with Type 2 diabetes. In conclusion, glycemic index and peak incremental indices in healthy subjects can be approximately the same for Type 2 diabetes.

Computed tomography (CT)-guided transthoracic needle biopsy is reliable and has become popular for diagnosing pulmonary lesions. Pneumothorax is the most common complication of transthoracic needle biopsy. The aim of this study was to report our preliminary experience with a three-step needle withdrawal technique for CT-guided lung-biopsy, with emphasis on reduction of the pneumothorax rate.A total of 146 patients (85 men and 61 women; mean age, 66.1 years; age range 19-91 years) with a pulmonary lesion underwent single slice CT-guided lung biopsy. We used a 17-gauge coaxial needle for guidance and a 18- gauge cutting needle to perform the biopsy. We used a three-step method to withdraw the needle. Images were reviewed to assess the patients' posture and the size, location, and depth of the tumor. Any pneumothorax or chest tube usage was noted.Pneumothorax occurred in 23 (15.8%) patients, two of whom underwent chest-tube insertion. All 23 patients with a lesion deeper than 4 cm deep hada pneumothorax. In all patients with pneumothorax, lesions were smaller than 2 cm.Our modified CT-guided lung biopsy method with a three-step needle withdrawal technique appears effective with a relatively low pneumothorax rate. Predictors of pneumothorax in our study were a lesion deeper than 4 cm and a lesion smaller than 2 cm.

Background/Aim: While it has been demonstrated that rice bran might lower the cholesterol level in hypercholesterolemic individuals, its effects on the levels of adiponectin and glycated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus remain unknown. Methods: Twenty-eight volunteers with type 2 diabetes were randomly divided into 2 groups, one of which received a dietary supplement of 20 g of stabilized rice bran and the other placebo once daily for 12 weeks. Parameters such as the level of HbA1c, glucose, insulin, homeostasis model assessment for estimation of relative insulin resistance, high-density and low-density lipoprotein (LDL) cholesterol and adiponectin were evaluated. Results: At the end of the study period, postprandial glucose and the area under the glucose curve of the rice bran group were significantly lower than baseline levels by 14.4 and 15.7%, respectively. Compared to baseline, the HbA1c values in the rice bran group were also significantly lower. Serum total cholesterol and LDL cholesterol concentrations in the rice bran group were 9.2 and 13.7% lower, respectively, than in the placebo group. The plasma free fatty acid and adiponectin concentrations were 20% lower and 40% higher in the rice bran group compared to the placebo group. Conclusions: This study demonstrated that stabilized rice bran can lower the level of HbA1c and blood lipids and increase blood adiponectin concentrations in type 2 diabetic subjects. In light of this, we conclude that stabilized rice bran may represent an important functional nutrient to ameliorate lipid and glycemic anomalies in type 2 diabetic subjects.

The newly developed 64-multidetector-row computed tomography (MDCT) prompted us to evaluate coronary angiography using this noninvasive method. We reviewed 281 images of MDCT coronary angiography in Taiwanese. The origins of the coronary arteries were identified from the luminal aspect of the aorta. We described them as seen from the aortic sinus looking toward the cardiac ventricle. The sinus facing the left ventricle was designated sinus 1, and that facing the right ventricle was designated sinus 2. Anatomic variants of the coronary artery were divided into five types according to the structure of the left anterior descending artery, right coronary artery, and left circumflex artery. Of the 281 patients, 275 (97.9%) had the type I variant in which the right coronary artery originated from sinus 2. MDCT provides advantages in defining anatomic variation and helps in the planning of clinical therapy or surgery.

Chromium yeast supplementation has been studied for its ability to improve carbohydrate and lipid abnormalities. There have been some earlier literature-reported studies involving chromium supplementation amongst patients suffering diabetes, but the results would appear to be somewhat varied. Forty male Wistar rats (ten weeks old, 300 g in average body mass) were divided into one of four groups, namely (i) controls; (ii) controls treated with chromium yeast; (iii) diabetic controls; and (iv) diabetic rats treated with chromium yeast. In the present investigation, the effect of a four-week oral administration of chromium yeast (600 μg of Cr/kg body mass/day, by gavage) upon the glucose and lipid metabolism in streptozotocin (STZ)-induced diabetic rats was assessed. Supplemental Cr yeast decreased the fasting blood glucose amongst the STZ-diabetic rats. No significant difference was observed in plasma fructosamine levels of rats treated with chromium yeast compared to control rats. Supplemental Cr yeast did decrease the plasma low-density lipoprotein (LDL)-cholesterol level for the STZ-diabetic rats as compared to controls. We noted no significant effect of chromium supplementation upon plasma high-density lipoprotein (HDL)-cholesterol or triglycerides compared to controls. Treatment with chromium yeast significantly increased the blood and urine chromium levels for both the diabetic and normal rats compared to respective control groups. The results of these studies suggest that Cr yeast decreased the fasting blood glucose and LDL-cholesterol levels in STZ-induced diabetic rats. This raises the possibility that Cr yeast supplementation can be considered to improve carbohydrate and lipid metabolism amongst human patients featuring type 2 diabetes mellitus.

AIM: Acute pancreatitis (AP) is a process with variable involvement of regional tissues or organ systems. Multifactorial scales included the Ranson, Acute Physiology and Chronic Health Evaluation (APACHE II) systems and Balthazar computed tomography severity index (CTSI). The purpose of this review study was to assess the accuracy of CTSI, Ranson score, and APACHE II score in course and outcome prediction of AP. METHODS: We reviewed 121 patients who underwent helical CT within 48 h after onset of symptoms of a first episode of AP between 1999 and 2003. Fourteen inappropriate subjects were excluded; we reviewed the 107 contrast-enhanced CT images to calculate the CTSI. We also reviewed their Ranson and APACHE II score. In addition, complications, duration of hospitalization, mortality rate, and other pathology history also were our comparison parameters. RESULTS: We classified 85 patients (79%) as having mild AP (CTSI

Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive method for evaluating the hepatobiliary system. This study investigated the anatomic variants of the biliary tree in Taiwanese using MRCP.170 patients with abdominal or liver diseases underwent diagnostic MRCP over the 29-month study period. We identified the type of biliary tree variants in 130 patients.The imaging findings showed that the most common biliary tree variants were type I and type IIA, which together comprised 70% of all variants. Type I is a triple confluence, which is an anatomy characterized by simultaneous emptying of the right posterior segment duct, right anterior segment duct, and left hepatic duct into the common hepatic duct. Type IIA involves drainage of the right posterior segment duct into the right anterior segment duct to form the right hepatic duct, and then confluence with the left hepatic duct to form the common hepatic duct. There was a mean percentage of 10 to 20% among the 7 types of variants identified.Comparison of these findings with previous investigation indicates that biliary tract structure shows racial and ethnic variation.

The aims of this study were to evaluate the antioxidative effect of a traditional Taiwanese vegetable, Houttugnia cordata Thunb. (H, cordata), by subjecting rodents to oxidized frying oil-induced oxidative stress, and to examine the antimutagenic effects of H. cordata using the Ames test. Forty-eight Sprague-Dawley rats were fed a diet of 0, 2, or 5% H. cordata and 15% fresh oil or oxidized frying oil (OFO) for 28 d. Levels of polyphenol in the feces, plasma, and liver were determined. The LDL lag time, plasma total antioxidant status (TAS), and levels of thiobarbituric acid-reactive substances (TBARS) were used as antioxidative indices, and the protein carbonyl group was used as an oxidative index. The results showed that the polyphenol content decreased in the plasma and increased in the feces when administering OFO, and the apparent absorption of polyphenol also decreased. The polyphenol content in plasma increased when giving H. cordata. There was a higher polyphenol concentration in the water extracts of H. cordata than in the methanol extracts. The OFO-fed groups had higher plasma TBARS and hepatic protein carbonyl group concentrations and shorter LDL lag times than those of the control group. The total TAS was elevated and the LDL lag time was prolonged when fed with H. cordata. In addition, both water and methanol extracts of H. cordata had an antimutagenic effect on benzo(a)pyrene, aflatoxin B1, and OFO, and showed a dose-dependent response using the Ames test. The antimutagenic ability of water extracts was higher than that of the methanol extracts. In conclusion, the polyphenol in H. cordata is easily absorbed and metabolized by rodents. H. cordata showed both antioxidative and antimutagenic properties under OFO feeding-induced oxidative stress.

AIM: To investigate the effect of partial splenic embolization (PSE) on platelet values in liver cirrhosis patients with thrombocytopenia and to determine the effective embolization area for platelet values improvement. METHODS: Blood parameters and liver function indicators were measured on 10 liver cirrhosis patients (6 in Child-Pugh grade A and 4 in grade B) with thrombocytopenia (platelet values < 80 × 103/μL) before embolization. Computed tomography scan was also needed in advance to acquire the splenic baseline. After 2 to 3 d, angiography and splenic embolization were performed. A second computed tomography scan was made to confirm the embolization area after 2 to 3 wk of embolization. The blood parameters of patients were also examined biweekly during the 1 year follow-up period. RESULTS: According to the computed tomography images after partial splenic embolization, we divided all patients into two groups: low (< 30%), and high (≥ 30%) embolization area groups. The platelet values were increased by 3 times compared to baseline levels after 2 wk of embolization in high embolization area group. In addition, there were significant differences in platelet values between low and high embolization area groups. GPT values decreased significantly in all patients after 2 wk of embolization. The improvement in platelet and GPT values still persisted until 1 year after PSE. In addition, 3 of 4 (75%) Child-Pugh grade B patients progressed to grade A after 2 mo of PSE. The complication rate in < 30% and ≥ 30% embolization area groups was 50% and 100%, respectively. CONCLUSION: Partial splenic embolization is an effective method to improve platelet values and GPT values in liver cirrhosis patients with thrombocytopenia and the ≥ 30% embolization area is meaningful for platelet values improvement. The relationship between the complication rate and embolization area needs further studies.