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Twenty-seven (0.51%) USA300 isolates were identified from a pool of 5308 meticillin-resistant Staphylococcus aureus (MRSA) isolates collected in Taiwan between 1995 and October 2015, including 12 infecting isolates from 10 patients. The first two isolates were identified in 2005, and 23 isolates have been collected since 2010. Phylogenetic analysis revealed that all the local isolates were closely related to those in North America, and there was a clade consisting of 13 local isolates from 10 patients. MRSA USA300 existed in Taiwan in 2005 or earlier, with increasing identification since 2010. Local transmission of USA300 has occurred in Taiwan after importation from North America. [ABSTRACT FROM AUTHOR]

Background The necessity of routine sub-nipple biopsy was uncertain, and the role of preoperative magnetic resonance imaging (MRI) in detecting nipple invasion in patients who have been selected for nipple sparing mastectomy (NSM) has not been adequately evaluated. Methods We retrospectively collected and analyzed the medical and surgical records of 434 patients with primary operable breast cancer who met the criteria for NSM and underwent breast surgery during the period January 2011 to December 2015. Patients were stratified into three risk groups (low, intermediate, and high) according to tumor size and tumor-to-nipple distance. Results Among the 434 patients in this study, 29 (6.7%) had occult invasion of the nipple-areola complex (NAC). Sub-nipple biopsy had a sensitivity of 84.6%, a specificity of 100%, a false negative rate of 1.2%, a false positive rate of 0%, and an overall accuracy rate of 98.8% in confirming NAC invasion. The NAC invasion rate was 0% in the low-risk group, 5.1% in the intermediate-risk group, and 19.7% in the high-risk group (P < 0.01). The overall NPV of preoperative MRI for predicting NAC invasion was 94.8%. Cost analysis revealed that the cost of NSM with sub-nipple biopsy was significantly higher than that of NSM alone, with a mean difference in cost of USD 238.5 (P < 0.01). Conclusion The high negative predictive value of MRI for NAC invasion is useful for selection of patients receiving NSM. Sub-nipple biopsy is a reliable procedure to detect occult NAC invasion, however, routine use is not cost-effect for low risk patients. [ABSTRACT FROM AUTHOR]

Not only is Asia the most populous region in the world, but inappropriate therapy, including self-medication with over-the-counter antimicrobial agents, is a common response to infectious diseases. The high antibiotic selective pressure among the overcrowded inhabitants creates an environment that is suitable for the rapid development and efficient spread of numerous multidrug-resistant pathogens. Indeed, Asia is among the regions with the highest prevalence rates of healthcare-associated methicillin-resistant Staphylococcus aureus ( HA- MRSA) and community-associated methicillin-resistant S. aureus ( CA- MRSA) in the world. Most hospitals in Asia are endemic for multidrug-resistant methicillin-resistant S. aureus ( MRSA), with an estimated proportion from 28% (in Hong Kong and Indonesia) to >70% (in Korea) among all clinical S. aureus isolates in the early 2010s. Isolates with reduced susceptibility or a high level of resistance to glycopeptides have also been increasingly identified in the past few years. In contrast, the proportion of MRSA among community-associated S. aureus infections in Asian countries varies markedly, from <5% to >35%. Two pandemic HA- MRSA clones, namely multilocus sequence type ( ST) 239 and ST5, are disseminated internationally in Asia, whereas the molecular epidemiology of CA- MRSA in Asia is characterized by clonal heterogeneity, similar to that in Europe. In this review, the epidemiology of S. aureus in both healthcare facilities and communities in Asia is addressed, with an emphasis on the prevalence, clonal structure and antibiotic resistant profiles of the MRSA strains. The novel MRSA strains from livestock animals have been considered to constitute a public health threat in western countries. The emerging livestock-associated MRSA strains in Asia are also included in this review. [ABSTRACT FROM AUTHOR]

Summary: Background: Human enterovirus 71 (HEV71) infections are a significant public health threat in the Asia–Pacific region and occasionally cause severe neurological complications and even death in children. Although good hand hygiene is important for controlling infection, relevant data regarding the efficacy of widely used hand disinfectants against HEV71 are still lacking. Aim: To investigate the virucidal activity of alcohols and alcohol-based hand disinfectants against HEV71. Methods: A common alcohol-based hand disinfectant (0.5% chlorhexidine gluconate + 70% isopropanol) as well as different concentrations of isopropanol and ethanol were tested for virucidal activity against HEV71 using the suspension and the fingerpad tests. Findings: In suspension tests, 85% and 95% ethanol achieved a mean log10 reduction factor in HEV71 titre of >3 and nearly 6, respectively, within 10 min. By contrast, 70% and 75% ethanol and any concentration of isopropanol (70–95%) produced a factor of <1 in this test after the same exposure time. In fingerpad tests, only 95% ethanol showed a mean log10 reduction factor of >4, while both 75% ethanol and a chlorhexidine gluconate-containing formula were ineffective against HEV71 with a mean log10 reduction factor of <1 after a 30 s exposure time. Conclusions: Widely used alcohol-based hand disinfectants based on 70% ethanol or isopropanol have poor effectiveness against HEV71. Ninety-five percent ethanol is the most effective concentration, but still cannot fully inactivate HEV71 and may be impractical for use in many instances. Hand hygiene with alcohol-based hand disinfectants alone is not recommended for preventing HEV71 transmission. [ABSTRACT FROM AUTHOR]

Abstract: Background: Surgical excision of papillary breast lesions with atypia diagnosed using core needle biopsy (CNB) has been accepted; however, the management of benign papillary lesions (without atypia) has been controversial. The purpose of this study was to evaluate the surgical outcome of nonmalignant papillary lesions diagnosed by ultrasound-guided 14-gauge CNB, and to establish clear guidelines on management of these lesions. Methods: We retrospectively identified 268 nonmalignant papillary breast lesions, including 203 benign lesions and 65 atypical lesions, diagnosed by CNB and subsequently surgically excised in 250 women at our institution between July 2004 and October 2010. For each lesion, medical records and radiologic and pathologic reports were reviewed and coded. We compared the histological upgrade among the collected variables. Results: On histological examination after surgical excision, 15.4% atypical papillary lesions and 5.9% benign lesions were upgraded to malignant, and 20.2% benign lesions were upgraded to atypical. Atypia (P = 0.015) was significantly associated with malignant upgrade at excision. No clinical or radiologic variable was helpful in predicting the possibility of histological upgrade of CNB-diagnosed nonmalignant papillary lesions. Conclusions: Nonmalignant papillary lesions diagnosed with CNB showed an unacceptable pathological upgrade rate after excision. Therefore, surgical excision should be performed for all papillary lesions of the breast for definitive diagnosis. [Copyright &y& Elsevier]

Abstract: Aims: The purpose of the study was to explore factors predictive of breast cancer as diagnosed by excision biopsy in cases with a diagnosis of atypical ductal hyperplasia (ADH) on ultrasound-guided core needle biopsy (CNB). Patients and methods: We carried out diagnosis of breast lesions by ultrasound-guided CNB in a single hospital in Taiwan from November 2003 to October 2009. Patients who were diagnosed with ADH and subsequently underwent excision biopsy were included in this study (n = 124). Results: Fifty-six of the 124 patients who were included (45.2%) had cancer, and the remaining 68 had benign lesions. By multivariate analysis of all clinical characteristics and on the basis of the imaging features in these cases, older patient age (≥50 y/o, OR: 3.910, p = 0.005), larger tumour size (≥15 mm, OR: 3.398, p = 0.013), and the presence of architectural distortion by mammography (OR: 10.7, p = 0.036) were found likely to be associated with breast cancer. Conclusions: Open biopsy is necessary in patients who were diagnosed with ADH on CNB. Older patients (≥50 y/o), with a larger tumour size (≥15 mm) and an abnormal mammography are especially likely to have breast cancer. [Copyright &y& Elsevier]

Abstract: Background: The Acute Physiology and Chronic Health Evaluation II classification system has been extensively used for predicting the patient mortality in various diseases. However, its utilisation on the pyogenic liver abscess has not yet been well studied. Aims: The purpose of this study was to validate this system on this high death rate disease. Patients: A retrospective study was conducted to assess 314 patients with pyogenic liver abscesses admitted to tertiary medical centre in past 12 years. Methods: The outcome measurement was the in-hospital mortality. A multiple logistic regression model was used to assess the association between mortality and Acute Physiology and Chronic Health Evaluation II score while controlling for the potential confounding factors. Results: The overall in-hospital mortality was 8.3%. The mean Acute Physiology and Chronic Health Evaluation II score of the expired patients was higher (P <0.0001). The mortality rate increased rapidly when Acute Physiology and Chronic Health Evaluation II score ≥15. After controlling for the potential confounding factors, patient with high admission Acute Physiology and Chronic Health Evaluation II score ≥15 had a higher chance of in-hospital mortality (P <0.01). In addition, the primary liver cancer history is also a risk factor (P =0.03). Conclusions: The Acute Physiology and Chronic Health Evaluation II score and the primary liver cancer history predict the in-hospital mortality of the pyogenic liver abscess patient. [Copyright &y& Elsevier]

Fenestrations of the vertebral artery are mostly found at the upper cervical or intracranial segments. We present a rare case of vertebral artery fenestration at the lower cervical (C4–C6) segment, which showed a double-lumen appearance on ultrasonography. Computed tomographic angiography (CTA) and rotational angiography of the vertebral artery with three-dimensional (3D) reconstruction proved the diagnosis and nicely demonstrated the anatomic relationship between two limbs of the fenestrated artery. The embryonic mechanism and possible causes of rareness of this condition are discussed. [Copyright &y& Elsevier]

Abstract: The electronic structures of five polycrystalline YNi2− x Co x B2C (x =0, 0.05, 0.1, 0.15, and 0.2) borocarbide superconductors were studied by photoemission and photoabsorption spectroscopy. The resonant photoemission spectroscopy around the Ni 2p3/2 absorption edge is used to study the 6-eV valence-band satellite of Ni. The Ni and Co K-edge X-ray absorption near edge spectra for these intermetallic compounds are compared with those of Ni and Co powder and foil, respectively. [Copyright &y& Elsevier]

Abstract: 1,3-Di-alkyl-2-(arylazo)imidazolium iodide () has been used to prepare iodocuprate(I) and iodoargentate(I) complexes. The structural confirmation has been carried out by single crystal X-ray diffraction study in representative cases. Iodo bridged anion, [Cu2(μ-I)2I2]2−, serves as charge support to dialkylazoimidazolium ion (). Silver(I) compound is a trimeric iodo-bridged [Ag3I5]2− that forms 1D chain while imidazolium ion, , is penetrating into the network. Electrostatic interaction between organic cation and inorganic anion and supramolecular interactions viz. hydrogen bonding, D–H–π, π–π interactions contribute to the crystal packing. [Copyright &y& Elsevier]

From August 2004 to July 2005, 210 clinical methicillin-resistant Staphylococcus aureus (MRSA) isolates were collected prospectively from 173 children admitted to Chang Gung Children’s Hospital in Taiwan. A comparative molecular analysis of the 111 community-associated (CA) isolates from 102 children and the 99 healthcare-associated (HA) isolates from 71 children was conducted. In comparison to the HA isolates (31%), the CA isolates (90%) were more likely to have been isolated from pus (p <5 × 10−8). For each patient with MRSA infection, only the first isolate was selected for molecular analysis. The molecular characteristics differed significantly between the CA and the HA isolates (p <5 × 10−8). The clone characterized as sequence type (ST)59/pulsotype  D (similar to USA1000)/staphylococcal chromosomal cassette (SCC) mec VT/Panton–Valentine leukocidin (PVL)-positive accounted for 69% of the CA isolates, and another clone, characterized as ST239/pulsotype  A (Hungary clone)/SCC mec III/PVL-negative, accounted for 45% of the 71 HA isolates. The CA clone of ST59 also accounted for 20% of the HA isolates, including 47% of the 17 community-onset isolates. It was concluded that the molecular characteristics of clinical MRSA isolates from children differed significantly between the CA and the HA isolates in northern Taiwan. However, the CA clone of ST59 was also identified in a substantial proportion of HA isolates. [ABSTRACT FROM AUTHOR]

Hybrid fiber laser-arc welding (HLAW) process was applied to a novel hot-rolled Nb-Ti-Mo microalloyed steels of 8 mm thickness. The steel is primarily used to manufacture automotive and construction machinery components, etc. To elucidate the effect of heat input on geometry, microstructure and mechanical properties, different heat inputs (3.90, 5.20 and 7.75 kJ/cm) were used by changing the welding speeds. With increased heat input, the depth/width of penetration was decreased, and the geometry of fusion zone (FZ) changed to “wine cup-like” shape. In regard to the microstructural constituents, the martensite content was decreased, but granular bainite (GB) content was increased. The main microstructural difference was in the FZ cross-section at 7.75 kJ/cm because of the effect of thermal source on the top and bottom. The microstructure of the top part consisted of GB, grain boundary ferrite, and acicular ferrite, while the bottom part was primarily lath martensite. The hardness distribution was similar for different heat inputs. Hardness in FZ, coarse-grained HAZ and mixed-grained HAZ was higher than the base metal (BM), but for the fine-grained HAZ was similar or marginally less than the base metal (BM). Tensile strain was concentrated in the BM such that the fracture occurred in this region. In summary, the geometry, microstructure, and mechanical properties of weld joints were superior at heat input of 5.20 kJ/cm. [ABSTRACT FROM AUTHOR]

Objectives We studied paediatric patients with human adenovirus (HAdV) infection during the 2011 outbreak in northern Taiwan to define the clinical features of different HAdV genotypes in children. Methods Between January and December 2011, 637 patients <19 years of age exhibited culture-confirmed adenoviral infection in Chang Gung Memorial Hospital, and provided specimens available for genotyping by multiplex real-time PCR. Clinical data were collected retrospectively. Results Excluding five cases with multiple genotypes, 632 cases were included for analysis. Three genotypes were identified, including HAdV-3 (429/632; 67.6%), HAdV-7 (144/632; 22.6%) and HAdV-2 (59/632; 9.8%). Median age was 4.58 years (range 2 months to 18 years), with children infected with HAdV-3 significantly older (82.9% >3 years; p <0.001). Of the 621 inpatients, 98.2% had fevers and all exhibited respiratory symptoms, 75 patients (12.1%) had lower respiratory tract infections, 20 (3.2%) required intensive care (HAdV-2: 1; HAdV-3: 8; and HAdV-7: 11), and three died (all HAdV-7-infected). HAdV-3-infected patients were significantly more likely to have upper respiratory symptoms and a high serum C-reactive protein level >100 mg/L, whereas leucocytosis (white blood cell count >15 000/mm 3 ) was more common in HAdV-2-infected patients (p 0.007). HAdV-7 infections were significantly associated with a longer duration of fever, leucopenia (white blood cell count <5000/mm 3 ), thrombocytopenia (platelet count <150 000/mm 3 ), lower respiratory tract infections, a longer length of hospital stay, and requiring intensive care (all p <0.001). Conclusion Childhood HAdV-2, HAdV-3 and HAdV-7 infections may exhibit different clinical manifestations. Although HAdV-3 was the most prevalent genotype observed during the 2011 Taiwan outbreak, HAdV-7 caused more severe disease characteristics and outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Four bottom-mounted current profilers were deployed across the Taiwan Strait from September 28 to December 14 of 1999 to monitor the current velocity when the northeast monsoon was strong. Results indicate both diurnal and semidiurnal tidal currents were primarily barotropic. The barotropic diurnal tide might be explained by a single Kelvin wave propagating along the Mainland China coast from north to south. However, the barotropic semidiurnal tide manifested as a more complicated form in the Taiwan Strait. The subtidal current generally fluctuated with the northeast winds. When the northeast wind was weak, the along- and cross-strait subtidal current flowed primarily against the wind and toward Taiwan, respectively. As the northeast wind intensified, the along-strait current flowed downwind, brought the cold China coastal water southward, and formed a baroclinic velocity front in the western portion of the Taiwan Strait. The Ekman effect forced the cross-strait current toward Mainland China in the upper water column and toward Taiwan in the lower water column, respectively. The along-strait volume transport, estimated from interpolated current velocity, varied from −5 to 2Sv with a mean value of 0.12±0.33Sv. Similar transport was also estimated from the sea level difference across the Taiwan Strait. Although the local wind played a dominant role for the fluctuations of current velocity and transport in the Taiwan Strait, it could be not the only important factor. The current or transport directed frequently against the wind could be related to the northward current, which was consistently observed in the Penghu Channel. [Copyright &y& Elsevier]

Aim: To elucidate the cause of cerebral hypoperfusion on the stent placement side after carotid artery stent placement (CAS) measured by pseudocontinuous arterial spin labelling (PCASL) perfusion imaging.Materials and Methods: Consecutive patients with symptomatic internal carotid artery stenosis receiving CAS were included in the study. Cerebral blood flow (CBF) was measured by PCASL perfusion imaging at 3 T magnetic resonance imaging (MRI) the day before and 3 days after the procedure. Changes in cerebral haemodynamics after CAS were assessed.Results: Twenty-two patients were included; 17 patients had increased or stationary CBF after CAS and five patients had significantly reduced CBF on the stenting side after CAS whereas CBF increased on the contralateral side. High stent position was noticed in the five patients. After labelling plane adjustment to avoid labelling on the stent, no more cerebral hypoperfusion was noticed.Conclusion: When using PCASL perfusion imaging to monitor post-stenting CBF, the stent may cause an artefact that leads to a low CBF in the territory of the stented vessel. Routinely adding a fast T2 star gradient-echo echo-planar-imaging covering the upper neck region before PCASL perfusion imaging to identify the stent position and avoid the stent-related artefact is recommended. [ABSTRACT FROM AUTHOR]