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Background/purpose: The purpose of this study was to determine the pathogens and to estimate the incidence of pediatric community-acquired pneumonia (CAP) in Taiwan.Methods: This prospective study was conducted at eight medical centers from November 2010 to September 2013. Children aged 6 weeks to 18 years who met the radiologic criteria for pneumonia were enrolled. To detect classical and atypical bacteria and viruses, blood and pleural fluids were cultured, and respiratory specimens were examined by multiple conventional and molecular methods.Results: At least one potential pathogen was identified in 705 (68.3%) cases of 1032 children enrolled, including bacteria in 420 (40.7%) cases, virus in 180 (17.4%) cases, and mixed viral-bacterial infection in 105 (10.2%) cases. Streptococcus pneumoniae (31.6%) was the most common pathogen, followed by Mycoplasma pneumoniae (22.6%). Adenovirus (5.9%) was the most common virus. RSV was significantly associated with children aged under 2 years, S. pneumoniae in children aged between 2 and 5 years, and M. pneumoniae in children aged >5 years. The annual incidence rate of hospitalization for CAP was highest in children aged 2-5 years (229.7 per 100,000). From 2011 to 2012, significant reduction in hospitalization rates pertained in children under 5 years of age, in pneumonia caused by pneumococcus, adenovirus or co-infections and complicated pneumonia.Conclusion: CAP related pathogens have changed after increased conjugated pneumococcal vaccination rates. This study described the latest incidences and trends of CAP pathogens, which are crucial for prompt delivery of appropriate therapy. [ABSTRACT FROM AUTHOR]

Background/purpose: Rotavirus remains a leading cause of pediatric gastroenteritis-related hospitalization. Surveillance studies have revealed that several major rotaviral genotypes are responsible for most cases of rotavirus gastroenteritis (RVGE). This study aimed to understand the characteristics of acute gastroenteritis (AGE) caused by rotavirus in young children in Taiwan.Methods: Ten hospitals in Taiwan were subjected to prospective hospital-based AGE surveillance during 2014-2017, and children younger than 5 years old who were hospitalized due to AGE were enrolled in the study. Medical and demographic variables were recorded and analyzed, and stool specimens were collected for rotavirus identification and genotyping via real-time RT-PCR. Non-rotavirus AGE age-matched controls were enrolled.Results: Surveillance identified 4747 young children hospitalized with AGE during this study period. The median age of these patients was 2.0 years. Rotavirus was detected in stool samples from 518 patients (10.9%). The prevalent months of RVGE in 2014, 2015, and 2017, wherein the rotavirus positivity rates exceeded 30%. The most common serotypes were G3P[8] (303/518, 58.9%) and G1P[8] (86/518, 16.6%). The percentage of G3P[8] increased from 4.9% in 2014 to 74.3% in 2016 (P < 0.0001), whereas the percentage of G1P[8] decreased from 61.0% in 2014 to 22.5% in 2015 (P < 0.0001). Compared with G3P[8], G1P[8] was associated with a significantly higher C-reactive protein level (P < 0.05).Conclusion: Rotavirus remains a notable pathogenic etiology of childhood AGE and the G3P[8] serotype was dominant in Taiwan. This study highlighted the importance of rotavirus surveillance to ensure protective effectiveness against the circulating strains. [ABSTRACT FROM AUTHOR]

Excessive thiourea(TU) was demonstrated to be harmful to both environmental system and human body, so it is essential to create selective and sensitive sensors to detect TU. Herein, Four iridium(III) complexes, [(fppy) 2 Ir(PD)]PF 6 (Ir-fppy , fppy = 2-(4-fluorophenyl)pyridine), [(fpiq) 2 Ir(PD)]PF 6 (Ir-fpiq , fpiq = 1-(4-fluorophenyl)isoquinoline), [(dfppy) 2 Ir(PD)]PF 6 (Ir-dfppy , dfppy = 2-(3,5-difluorophenyl)pyridine) and [(dfpiq) 2 Ir(PD)]PF 6 (Ir-dfpiq , dfpiq = 1-(3,5-difluorophenyl)isoquinoline) bearing 1,10-phenanthroline-5,6-dione (PD) as ancillary ligands, were designed and synthesized, and employed as efficient chemosensors to identify thiourea. These iridium(III) complexes exhibited emission peaks between 541 nm and 583 nm with PLQY ranging from 0.12 to 0.26 and lifetime in the range of 2.65–2.74 μs. All the four iridium(III) complexes showed significant turn-on response to TU with low limit of detect on the order of 10−8 M. Furthermore, these iridium(III) complexes-based chemosensors exhibited excellent recoveries toward TU in various juice samples including orange, kiwi fruit and lemon juice. Four complexes-composite test strips showed marker color change after adding TU. [Display omitted] • Four novel iridium(III) complexes bearing 1,10-phenanthroline-5,6-dione unit were designed and synthesized. • Four Ir(III) complexes can identify thiourea sensitively in juice samples including orange, kiwi fruit and lemon juice. • Complex-composite test strips can be applied to recognize thiourea by the unaided eye. [ABSTRACT FROM AUTHOR]

We report on a 7-year-old immunocompetent boy initially presenting with right-sided frontal cephalalgia, painful ophthalmoplegia, and ptosis for 1 month. Initial cerebrospinal fluid analysis produced normal results. Magnetic resonance imaging revealed an inflammatory pseudotumor of the right cavernous sinus after intravenous gadolinium administration, indicating a rare idiopathic inflammatory disorder of the cavernous sinus, i.e., Tolosa-Hunt syndrome. Ptosis and cephalalgia resolved after steroid treatment, although right-sided ophthalmoplegia remained. Breakthrough headache, associated with signs of meningeal irritation, developed 6 weeks later. Follow-up contrast-enhanced computed tomography revealed no enhancing cavernous soft tissue mass. A further lumbar puncture disclosed central nervous system infection with Staphylococcus saprophyticus. After 6 weeks of vancomycin, the headache resolved completely, and neuroimaging produced normal results. A diagnosis of Tolosa-Hunt syndrome should be rendered cautiously, because the etiology may involve a rare but not “idiopathic” infection. Moreover, if clinical signs are not fully responsive to steroid treatment, the underlying problems should receive careful investigation. [ABSTRACT FROM AUTHOR]

Background/purpose: Community-acquired pneumonia (CAP) is one of the most common diseases during childhood, and its features vary between countries. Death from CAP is rare in industrialized countries, but it is the leading cause of mortality in developing countries. The purpose of this study was to determine the epidemiology and morbidity of pneumococcal CAP (PCAP) in children hospitalized with pneumonia in Taiwan.Methods: We retrospectively screened the medical records of 12,914 children hospitalized with pneumonia at four hospitals in Taiwan from 2000 to 2005. This included a suspected PCAP group (2350 patients) and a group with likely/definite pneumococcal pneumonia (PP group, 901 patients).Results: From 2000, the frequency of suspected PCAP increased gradually every year, and peaked in 2003 (22.14%); while the proportion of likely/definite PP was highest in 2004 (9.75%). The likely/definite PP group accounted for 6.98% of the hospitalized pneumonia patients from 2000 to 2005. Of children hospitalized with pneumonia, 17.9% of the suspected PCAP group and 21.3% of the PP group were admitted to the intensive care unit (ICU). Twenty-three patients died (14 in the PCAP and 9 in the PP groups) and nine (5 in the PCAP and 4 in the PP groups) were discharged with sequelae.Conclusion: Our results indicate that children hospitalized with PCAP are common in Taiwan. About 20% of these children need ICU admissions, and some still have a poor outcome. Effective immunization programs with pneumococcal conjugate vaccine are needed for disease control and prevention. [ABSTRACT FROM AUTHOR]

A maternal high-fat (HF) diet sensitizes offspring to the adverse effects of postnatal HF intake and can lead to metabolic dysregulation. Resveratrol, a natural polyphenolic compound found in grapes and red wine, could help to relieve metabolic syndrome dysregulation. Since the gut microbiota is known to be closely related to metabolic homeostasis, this study aimed to investigate the impact of a combination of maternal and postweaning HF diets on the gut microbiota and whether resveratrol could relieve the gut dysbiosis associated with metabolic dysregulation. Sprague-Dawley dams were sustained on either a chow or HF diet before mating, during pregnancy and during lactation. Their offspring were randomly fed chow or a HF diet after weaning. Four experimental groups were generated: CC (maternal/postnatal chow diet), HC (maternal HF/postnatal chow diet), CH (maternal chow/postnatal high-fat diet) and HH (maternal/postnatal HF diet). A fifth group consisted of HH with resveratrol treatment. We found that both maternal and postnatal HF exposure has a distinct effect on the gut microbiota metagenome of offspring. Maternal HF diet exposure decreased plasma acetate, propionate and butyrate level, while postnatal HF diet exposure decreased plasma acetate level in adult life. The metabolic dysregulation programed by the maternal and postnatal HF diets was related to the relevant gut microbiota. Resveratrol treatment ameliorated the altered plasma propionate level related to maternal HF and postnatal HF diet treatment. Resveratrol treatment also improved most of the altered metabolic dysregulation and related dysbiosis programmed by maternal and postnatal HF diet exposure. [ABSTRACT FROM AUTHOR]

Four cationic Ir(III) complexes in the form of [Ir(C^N) 2 (N^N)]PF 6 (C^N = 2-(thiophen-2-yl)pyridine or 2-(benzo[ b ]thiophen-2-yl)pyridine, N^N = 4,4′-dibromo-2,2′-bipyridine or 5,5′-dibromo-2,2′-bipyridine) were synthesized based on electron-withdrawing groups (-Br) on neutral ligands. The introduction of electron-withdrawing groups on neutral ligands can turn the photoluminescence spectra of Ir(III) complexes towards the red region and stabilize both the LUMO and HOMO energy levels. • Four cationic Ir(III) complexes with electron-withdrawing groups were synthesized. • The cationic Ir(III) complexes exhibit strong red phosphorescence. • The property tuning is dependent on the substituent nature of neutral ligands. Four cationic iridium(III) complexes Ir1 – Ir4 with the general form of [Ir(C^N) 2 (N^N)]PF 6 (where C^N = 2-(thiophen-2-yl)pyridine or 2-(benzo[ b ]thiophen-2-yl)pyridine, N^N = 4,4′-dibromo-2,2′-bipyridine or 5,5′-dibromo-2,2′-bipyridine) have been synthesized and characterized. X-ray diffraction analysis of complexes Ir1 – Ir4 indicate the coordination of the iridium atoms are distorted octahedral geometry. All complexes exhibit strong red phosphorescence (λ em = 599–633 nm) with quantum efficiencies of 0.16–0.37 in oxygen-free dichloromethane solution at room temperature. The introduction of electron-withdrawing groups on neutral ligands was found to be useful in red-shifting the emission maxima of the complexes compared to that of the complexes with electron-donating substituents on neutral ligands. Electrochemical study shows a quasireversible, metal-centered oxidation with potentials at 0.76–0.90 V (vs. Ag+/Ag). Density functional theory (DFT) calculation shows that the LUMOs are mainly localized on the neutral ligands and the electron-withdrawing groups on neutral ligands can stabilize both the LUMO and HOMO though the former is affected to a much more appreciable degree than the latter. [ABSTRACT FROM AUTHOR]

Four iridium(III) complexes (L 1) 2 Ir(stpip) (Ir1 , L 1 = 4-(trifluoromethoxy)phenylpyridine), (L 2) 2 Ir(stpip) (Ir2 , L 2 = 2-(4-bromophenyl)pyridine), (L 3) 2 Ir(stpip) (Ir3 , L 3 = 4-(2-pyridinyl)benzaldehyde), and (L 4) 2 Ir(stpip) (Ir4 , L 4 = 6-(4-formylphenyl)nicotinaldehyde) using bis(diphenylphorothioyl)amide (stpip) as ancillary ligands were synthesized and fully characterized. Complexes Ir1 − Ir4 exhibited blue to red emission with peaks ranging from 481 nm to 600 nm, all of which showed high photoluminescence quantum yields of 0.40–0.73. Upon addition of Hg2+ ions to the acetonitrile solutions of Ir1 − Ir4 , all these complexes displayed photoluminescence quenching and blue shift of the emission peaks, showing high selectivity. The detection limit for Hg2+ ions was as low as 10−8 M and that allowed monitoring Hg2+ ions in real water samples. Furthermore, Ir3 and Ir4 containing aldehyde groups showed remarkable specificity and anti-interference ability in the detection of cysteine (Cys). The reaction-type mechanism in sensing Hg2+ ions and Cys using these iridium complexes was studied in detail. [Display omitted] • Four iridium(III) complexes using bis(diphenylphorothioyl)amide as ancillary ligands were synthesized and characterized. • These iridium(III) complexes can be employed as chemosensors for Hg2+ ions and the detection limit was as low as 10−8 M. • The complexes containing aldehyde groups can also detect cysteine with high selectivity. [ABSTRACT FROM AUTHOR]

Two rotavirus vaccines (RV1 and RV5) are available on the private market in Taiwan, not included in national immunization program. Scanty reports evaluated the rotavirus vaccine effectiveness (VE) in Asian countries. From February 2014-July 2017, we conducted a prospective case-control study in ten hospitals in Taiwan. Case-patients included children aged 8–59 months, and hospitalized with laboratory-confirmed rotavirus acute gastroenteritis (AGE). For each case patient, up to four controls, rotavirus-negative AGE or non-AGE illnesses, respectively, were matched by gender, age and enrolled date. Vaccination history was confirmed through vaccination card or hospital record. VE was calculated as (1 − odds ratio of vaccination) × 100%. Totally 4248 AGE patients and 2242 non-AGE controls were enrolled. A total of 330 case-patients with rotavirus AGE, 1226 rotavirus-negative AGE controls and 1122 non-AGE controls were included for analysis. Unvaccinated rate was 85.15% for rotavirus-positive cases, 42.9% for rotavirus-negative controls, and 34.31% for non-AGE controls. VE of two-dose RV1 was 84.9% (95% confidence interval [CI]:77.7%, 90.1%) for rotavirus-negative AGE and 88.9% (95% CI: 83.4%, 92.8%) for non-AGE controls, while VE of three-dose RV5 was 92.5% (95% CI: 85.1%, 96.7%) and 96.4% (95% CI: 91.9%, 98.6%), respectively. For respective vaccine, VEs were not significantly different in term of rotavirus genotypes. VEs of both vaccines declined <80% in children aged three years by combined controls. Both vaccines provided excellent and sustained protection against rotavirus AGE hospitalization in children in Taiwan, but the effectiveness declined slightly in children aged three years. [ABSTRACT FROM AUTHOR]

Background Enteroviruses are seasonally prevalent each year in Southeast Asia. Elevated C-reactive protein (CRP) levels have been noted in minor populations of patients, and antibiotics may be prescribed under the impression of a suspected bacterial infection. This prescription might be inappropriate, resulting in further bacterial resistance and medical expense. The aim of this study was to delineate how effective antibiotics are for children suffering from enterovirus infection complicated with a high CRP level. Methods The medical records of children hospitalized between January 2008 and December 2012 with herpangina or hand, foot and mouth disease were reviewed retrospectively. The children enrolled were divided into three groups, A, B, and C, by CRP level, which were <40, 40-80, and ≥80mg/l, respectively. A case-control study of group C divided into subgroups according to the prescription of antibiotics for at least 24h during the admission was conducted for further analysis. Results A total 3566 cases were identified; 214 were in group C and 71.0% of them received a prescription for antibiotics. There was a linear trend between a relatively higher CRP level and a higher proportion of antibiotics prescribed in the three groups (p=0.001). In the case-control study, there were no significant differences in age, sex, mean CRP, or febrile days. However, a relatively longer stay of hospitalization was recorded in the subgroup with an antibiotic prescription (p=0.020). Conclusions The present study indicated that antibiotics might not be beneficial in treating these patients, even those with a high CRP level. Clinicians should be more prudent in antibiotic use when no obvious evidence of bacterial infection is found. [ABSTRACT FROM AUTHOR]

Mycoplasma pneumoniae is currently the most commonly detected bacterial cause of childhood community-acquired pneumonia in several countries. Of note, clonal expansion of macrolide-resistant ST3 occurred in Japan and South Korea. An alarming surge in macrolide resistance complicates the treatment of pneumonia. We aimed to evaluate the clinical manifestation and clonal relatedness of M. pneumoniae circulating among children in Taiwan. We prospectively enrolled 626 children with radiologically confirmed pneumonia between 2017 and 2019. An M. pneumoniae infection was suspected on clinical grounds, and tested by real-time PCR and oropharyngeal swab cultures. We used multilocus sequence typing and whole-genome sequencing to characterize the genetic features of M. pneumoniae. A total of 226 children with M. pneumoniae pneumonia were enrolled. Macrolide resistance was found in 77% (174/226) of patients. Multi-locus sequence typing revealed that ST3 (n = 93) and its single-locus variant ST17 (n = 84) were the predominant clones among macrolide-resistant strains. ST17 presented clinical characteristics comparable to its ancestor ST3. On multivariate analysis, macrolide resistance (OR 3.5; 95% CI 1.4–8.5; p 0.007) was independently associated with fever >72 hours after macrolide treatment. By whole-genome sequencing, prediction analysis of recombination sites revealed one recombination site in ST3 and ST17 compared with M29 (a macrolide-sensitive ST3 strain isolated from China in 2005) containing cytadhesin MgpC-like protein, RepMP4 and RepMP5. ST17 had another recombination site containing an adhesin and RepMP2/3. In addition to macrolide resistance, ST3 and its ST17 variant might evolve through recombination between repetitive sequences and non-P1 cytadhesins for persistent circulation in Taiwan. [ABSTRACT FROM AUTHOR]