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Purpose Hyperuricemia has been increasingly prevalent and linked to future cardio-metabolic risks in adolescent population. The study aims to explore the relationship between anthropometric indices and hyperuricemia among adolescent athletes. Methods This was a cross-sectional study of 387 student athletes (218 males and 169 females; mean age, 17.4 ± 1.3 years) in Northern Taiwan in 2013–2015. We exhibited the prevalence of hyperuricemia among this population, and tested the association of serum uric acid levels with different anthropometric parameters in males and females respectively. Results A total of 59 (27.1%) male and 37 (21.8%) female adolescent athletes had hyperuricemia. Both in male and female adolescents, several obesity-related anthropometric parameters were significantly higher in hyperuricemia groups than in non-hyperuricemia groups. The odds of having hyperuricemia significantly increased with increasing BMI, BMI z-score, waist circumference and waist-to-height ratio in logistic regression analysis. There was a U-shaped association between uric acid level and body fat percentage (BF%) in both genders. Subjects whose BF% in lowest-body-fat-percentage quintile (quintile 1) and highest-body-fat-percentage quintile (quintile 5) had higher mean serum uric acid level than subjects whose BF% in the middle three quintiles. In both genders, the odds ratio (OR) of having hyperuricemia in subjects whose BF% in quintile 1 remained significantly higher than the OR in the middle three quintiles (the reference) after adjusting for age and BMI z-score. Conclusions In addition to the positive association between obesity and hyperuricemia, there is a U shape association between BF% and prevalence of hyperuricemia among adolescent athletes of both genders.

Background Household transmission is responsible for the subsequent outbreak of community-acquired COVID-19. The aim of this study was to elucidate the household transmission mode and to further estimate effective and basic reproductive number with and without non-pharmaceutical interventions (NPIs). Materials and Methods A total of 26 households with 39 family contacts between January, 2020 and February, 2021 in Taiwan were enrolled for analysis. The Becker’s chain binomial model was used to analyze the probabilities of being infected and escaped from SARS-COV-2 before and after January 1st, 2021, which were further converted to estimating basic reproductive numbers in the absence of NPIs. The likelihood of leading to the subsequent community-acquired outbreak given NPIs was further assessed. Results The secondary attack rate was 46.2%. Given the saturated Greenwood mode selected as the best fitted model, the probability of infected and escaped from COVID-19 within household was estimated as 44.4% (95% CI: 5.0%-53.7%) and 55.7% (95% CI: 46.3%-65.0%), respectively. In the second period of early 2021, the infected probability was increased to 58.3% (95% CI: 12.7%-90.0%)) and the escape probability was lowered to 41.7% (95% CI: 0.0%-86.9%)). The corresponding basic reproductive numbers (R0) increased from 4.29 in the first period to 6.73 in the second period without NPIs. However, none of subsequent community-acquired outbreak was noted in Taiwan given very effective NPIs in both periods. Conclusions The proposed method and results are useful for designing household-specific containment measures and NPIs to stamp out a large-scale community-acquired outbreak as demonstrated in Taiwan.

Background/purpose: Hepatic encephalopathy (HE), a major neuropsychiatric complication in advanced liver disease, is associated with poor prognosis. Sarcopenia, characterized by a decline in muscle mass, strength, and physical performance, is prevalent in liver cirrhosis. This study aims to explore whether sarcopenia is associated with HE in cirrhotic patients. Methods: PubMed and EMBASE were searched for relevant cohort and case-control studies investigating the association between sarcopenia and HE up to July 2018. Data of patients' characteristics, definition of low muscle mass, and protocols of grading/diagnosing HE were retrieved. The primary outcome was estimated by a pooled odds ratio (OR) and its 95% confidence interval (CI), using a random effect model. Results: The meta-analysis enrolled 6 studies, comprising 1795 patients. Sarcopenia was positively associated with the presence of HE (OR 2.74 with a 95% CI, 1.87 to 4.01). The association was less likely to be influenced by differences in research designs, focused study outcomes, muscle mass measurements, and protocols of grading/diagnosing HE. There was lack of evidence supporting higher serum ammonia levels in patients with sarcopenia. Conclusion: In patients with liver cirrhosis, there is a significant association between sarcopenia and HE. A greater number of prospective studies are necessary to clarify whether the association remains even after adjusting relevant confounders and to suggest effective prevention of HE in patients with coexisting sarcopenia. Keywords: Liver, Malnutrition, Skeletal muscle, Neurology, Ammonia

Background Locking plate fixation appears to be a standard treatment for proximal humeral fracture. Different locking plate designs might result in different radiographic and functional outcomes. The original version of the Proximal Humeral Internal Locking System (PHILOS; DePuy Synthes, Warsaw, IN, USA) occupied the largest volume of the humeral head by screw distribution, whereas the Zimmer Periarticular Locking Plate (ZPLP) system (Zimmer Biomet, Warsaw, IN, USA) occupied the smallest. Methods We enrolled 50 patients undergoing ZPLP treatment and 50 undergoing PHILOS treatment. Results The postoperative amount of impaction was significantly higher using the ZPLP System than using the PHILOS. Subgroup analysis showed that medial calcar support was another critical factor that affected surgical outcomes, especially when using the ZPLP System. Conclusion The amount of postoperative impaction was significantly higher when the ZPLP was used compared with the PHILOS locking plate. Medial calcar support is another critical factor that affects surgical outcomes. However, no significant differences in functional outcomes (Constant-Murley score) between the ZPLP System and the PHILOS were noted at the 12-month follow-up.

Objective We investigated the anti-obesity effect and underlying action mechanism of INDUS810 isolated from Trigonella foenum-graecum L. (Fabaceae), an annual herb commonly known as fenugreek and reported to have hypocholesterolemic, antidiabetic, anticancer and gastroprotective properties. Methods For obese animal study, 4-week old mice were fed with normal diet or high-fat diet together with or without intraperitoneal injection of INDUS810 (200 mg/kg) twice per week for 15 weeks. 3T3-L1 cells were used to study action mechanism of INDUS810 in adipocyte differentiation and lipid metabolism. Results We found that INDUS810 can reduce high-fat diet-induced weight increase in epididymal white adipose tissue, interscapular brown adipose tissue and liver, as well as serum levels of total cholesterol and low-density lipoprotein cholesterol. Moreover, the insulin sensitivity was significantly improved in INDUS810-treated obese mice. In 3T3-L1 adipocytes, we found that INDUS810 could inhibit lipid accumulation at either differentiating or mature stages, and increase lipolysis activity in mature adipocytes. Additionally, INDUS810 has no effects on cell viability nor the expressions of adipocyte differentiation markers like fatty acid synthase, peroxisome proliferator-activated receptor γ and CCAAT/enhancer-binding protein α. In contrast, INDUS810 can increase protein levels of peroxisome proliferator-activated receptor α, peroxisome-proliferator-activated receptor-γ co-activator 1β, sirtuin 1 and sirtuin 3. Of note, INDUS810 can activate adenosine monophosphate-activated protein kinase, which leads to the reduction of lipid contents in adipocytes. Conclusion Our in vitro and in vivo studies suggest that INDUS810 is a potential anti-obesity agent, and this action depends on activate adenosine monophosphate-activated protein kinase activation.

This study aimed to evaluate the effects of lorcaserin on body weight, cardiovascular risk factors, and safety in obese patients in Taiwan.In this double-blind, randomised controlled trial, 171 obese adults were assigned to receive lorcaserin at a dose of 10mg, or placebo, twice a day for 24weeks. Diet and exercise counselling were given to all patients through the treatment period. Primary outcomes were proportion of patients achieving at least 5% and 10% reduction in body weight and mean change in body weight. Safety and tolerability endpoints such as Beck Depression Inventory-II, blood biochemistry, vital signs, and electrocardiogram were monitored.More patients receiving lorcaserin lost at least 5% body weight than receiving placebo (52.4% and 28.1%, P=0.001) with an average weight reduction of 5.8kg (95% CI: -6.91, -4.70) in lorcaserin group and those of 3.6kg (95% CI: -4.95, -2.33) in placebo group (P0.05). The most common adverse effect with greater incidence in the lorcaserin group was self-limited dizziness. Serious adverse effect were rare and was reported by slightly more patients taking placebo than lorcaserin.In this multicentre, double-blinded placebo-controlled trial, lorcaserin was effective and well-tolerable in Asia group.

To overcome serious clinical problems caused by large bone defects, various approaches to bone regeneration have been researched, including tissue engineering, biomaterials, stem cells and drug screening. Previously, we developed a free-standing biodegradable polymer nanosheet composed of poly(L-lactic acid) (PLLA) using a simple fabrication process consisting of spin-coating and peeling techniques. Here, we loaded recombinant human bone morphogenetic protein-2 (rhBMP-2) between two 60-nm-thick PLLA nanosheets, and investigated these sandwich-type nanosheets in bone regeneration applications. The PLLA nanosheets displayed constant and sustained release of the loaded rhBMP-2 for over 2 months in vitro . Moreover, we implanted the sandwich-type nanosheets with or without rhBMP-2 into critical-sized defects in mouse calvariae. Bone regeneration was evident 4 weeks after implantation, and the size and robustness of the regenerated bone had increased by 8 weeks after implantation in mice implanted with the rhBMP-2-loaded nanosheets, whereas no significant bone formation occurred over a period of 20 weeks in mice implanted with blank nanosheets. The PLLA nanosheets loaded with rhBMP-2 may be useful in bone regenerative medicine; furthermore, the sandwich-type PLLA nanosheet structure may potentially be applied as a potent prolonged sustained-release carrier of other molecules or drugs. Statements of Significance Here we describe sandwich-type poly( L -lactic acid) (PLLA) nanosheets loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2) as a novel method for bone regeneration. Biodegradable 60-nm-thick PLLA nanosheets display strong adhesion without any adhesive agent. The sandwich-type PLLA nanosheets displayed constant and sustained release of the loaded rhBMP-2 for over 2 months in vitro . The nanosheets with rhBMP-2 markedly enhanced bone regeneration when they were implanted into critical-sized defects in mouse calvariae. In addition to their application for bone regeneration, PLLA nanosheets may be useful for various purposes in combination with various drugs or molecules, because they displays excellent capacity as a sustained-release carrier.

Background The Russel-Taylor type 2B fractures compromised the trochanteric region and medial buttress of proximal femur. This fracture pattern limits the choice of implants and raises the risk of adverse outcomes. We aimed to (i) determine the outcome of Russel-Taylor type 2B fractures treated using reverse less invasive stabilization system plates (LISS-DF) and to (ii) learn what factors affected outcomes after osteosynthesis with reverse LISS plates. Design A retrospective study Setting The study was conducted at a Level III trauma center in Taiwan. Methods Twenty-five consecutive patients presenting with a Russel-Taylor type 2B fracture were enrolled. All cases were treated with reverse LISS plates. A Modified Radiographic Union Scale for Femur (RUSF), Radiographic parameters, functional scores, and complications were assessed. Results Union occurred in 21 cases at an average of 18.8 weeks. The average immediate postoperative neck-shaft angle was 130° (range: 122–135°) compared with 139° (range: 135–141°, p = 0.05) on the contralateral side. Two cases had complications of proximal screws cutting out and two cases had broken implants. Finally, all 4 cases required repeated surgeries (16%). Malunion occurred in 4 patients and early mechanical failure (proximal screws cut out) occurred in 2. There was a significant difference in the purchase index of the proximal screws between cases with redisplacement and those without (26.4 mm and 98.6 mm, p = 0.01). Conclusions The use of reverse LISS plate appeared to be an alternative procedure for the specific pattern in the present study. We recommend using this reverse locking plate to treat unstable proximal femoral fractures with meticulous techniques of placing plates. Adequate purchase of the proximal locking screws might decrease the risks of complications.

Low vitamin D status has been linked to obesity, insulin resistance, and metabolic syndrome. In the present study, we aimed to explore the nature and strength of the relationship between vitamin D and metabolic syndrome among non-diabetic young adults.This was a campus-based cross-sectional study of 355 non-diabetic young adult graduate students (233 males and 132 females; mean age, 23.5 ± 2.4 years) in Northern Taiwan. We measured and tested the association of serum 25-hydroxyvitamin D levels with metabolic syndrome and cardio-metabolic parameters.A total of 24 (6.8%) recruited young adults had metabolic syndrome. There were decreasing trends of body mass index (BMI), Homeostasis Model of Assessment-Insulin Resistance (HOMA-IR) and prevalence of metabolic syndrome across increasing tertiles of vitamin D levels irrespective of age and sex (P for trend0.05). Without adjusting for BMI or HOMA-IR, the odds of having metabolic syndrome decreased across increasing tertiles of vitamin D levels (P for trend 0.021). The odds ratio of having metabolic syndrome was 0.26 (95% confidence interval: 0.08-0.85, P = 0.025) for the highest vs. the lowest tertile of vitamin D levels. However, further adjustments for BMI and HOMA-IR largely removed the inverse association of vitamin D status with metabolic syndrome and its individual components.Among non-diabetic young adults, the potential inverse relationship between vitamin D status and metabolic syndrome may be attributable to the conjunctive effects of individual obesity and insulin resistance.

The current definition of sarcopenic obesity in the elderly does not seem to take the ageing difference of body composition into sufficient consideration. The study accordingly attempted to better define sarcopenia/obesity based on various references, and the impacts of sarcopenia/obesity on elderly physical performance were also examined.2629 elderly subjects (age ≧65) and 998 young adults were recruited for Sarcopenia and Translational Ageing Research in Taiwan (START). For each eligible subject, body composition was measured by bio-impedance analysis and physical performance, including upper and lower extremity function, was examined. The thresholds of sarcopenic obesity were defined as a value at two standard deviations from the gender-specific means of the young population or at the adopted value of our elderly population.Compared to the young adults, the elderly subjects reported a lower appendicular skeletal muscle index (ASMI, kg/m(2)) and a significantly higher fat percentage (%). From three different criteria, thresholds of obesity or sarcopenia were 31.41%, 30.16%, 30.64% (fat percentage) or 6.76kg/m(2), 7.36kg/m(2), 7.09kg/m(2) (ASMI) for men and 39.17%, 41.43%, 43.25% or 5.28kg/m(2), 5.74kg/m(2), 5.70kg/m(2) for women. The elderly subjects were classified into four groups. With covariates adjusted, the "sarcopenia only," "obesity only," and "sarcopenic obesity" elderly subjects were worse than their normal counterparts in physical performance (all p0.05 except for the handgrip strength compared in groups 1 and 3).Sarcopenic obesity seems to exert a synergistic impact on elderly physical performance. Body composition should be an essential part in geriatric assessment and elderly care.

Elderly persons with low muscle mass (LMM) or sarcopenia are prone to frailty and functional decline. This study aimed to investigate the relationship between serum selenium level and skeletal muscle mass in community-dwelling elderly.Cross-sectional observational study.A total of 327 elderly Taipei citizens (mean age 71.5 ± 4.7 years) were recruited from the community.Skeletal muscle mass was measured by bioelectrical impedance analysis. LMM was defined by low skeletal muscle index (SMI: muscle mass (kg)/[height (m)](2)). All participants were further divided into quartiles by serum selenium level and the risk for LMM among these quartiles was examined using multivariate logistic regression analyses. Estimated serum selenium levels for the LMM group vs the normal group and estimated SMI in the quartiles of serum selenium were computed by least square method in linear regression models.The estimated mean (±standard deviation) of serum selenium level was significantly lower in the LMM group compared with the normal group after adjusting for confounders (1.01 ± 0.03 μmol/L vs 1.14 ± 0.02 μmol/L, P.001). After adjusting for age, sex, lifestyle, and physical and metabolic factors, the odds ratios (95% confidence interval, P value) of LMM in the bottom, second, and third selenium quartile groups were 4.62 (95% CI 2.11-10.10, P.001), 2.30 (95% CI 1.05-5.03, P.05) and 1.51 (95% CI 0.66-3.46, P = .327), respectively, compared with the top quartile group of serum selenium level. The least square mean of SMI increased with the quartiles of serum selenium (P.001).This is the first study to demonstrate that low serum selenium is independently associated with low muscle mass in the elderly. The causality and underlying mechanism between selenium and low muscle mass or sarcopenia warrant further research.

Obesity has become an important health issue in Taiwan due to its increasing prevalence among population and the patients are getting younger. In this research, we build a health care information system, named the Pauian Health, for people who were on diet and to control their weight, or others to keep in shape. The Pauian Health is designed based on model–view–controller (MVC) pattern with a proposed architecture framework and has been successfully implemented in Pauian Archiland Company. The architecture centralizes the functions of accessing databases, user identification, and the validation of inherited clinical knowledge in a single component. Under this architecture, the system ensures its scalability, extensibility, data consistency, and the ability of cross-platform. This architecture has also been implemented in different devices and platforms, including iPhone, iPad and website. The architecture also supports unstable network environment, which uses Token as session identifier and user validation. The proposed framework has the potential in duplicating the service for different targeted users or deployed as a cloud service, which is fully capable in extending the service in the future.

Purpose In response to the inconsistent cutoff points for the diagnosis of low muscle mass in elderly, the study endeavored to establish a preferred norm for sarcopenia screening by comparing three muscle indices with physical functional assessment. Methods One thousand healthy adults aged 20–40 were recruited for body composition assessment using bioelectric impedance analysis (BIA, Tanita BC-418, Japan) with segmental measures during annual health examination. Additionally, 308 elderly ambulatory outpatients recruited for comprehensive geriatric assessment were assessed for muscle strength, physical performance, and body composition using the same BIA device. Results With the definition of low muscle mass set at 2 standard deviations below the mean value of appendicular skeletal muscle index (ASMI, appendicular skeletal muscle mass/height 2 ) in the young reference groups, the cutoff points for men and women were 6.76 and 5.28 kg/m 2 , respectively. The ratios of low muscle mass in the elderly subjects read 8.5% for men and 13.5% for women. The cutoff points of the other two muscle indices – total skeletal muscle index (total skeletal muscle mass/height 2 , TSMI), and skeletal muscle index (ASM/total body weight, SMI) – were also calculated and the ratios of low muscle mass appeared to be 25.6% and 69.8%, respectively. Compared to their compartments, the elderly with low muscle mass defined by ASMI were older and demonstrated a higher proportion of physical frailty, lower body mass index, lower muscle strength, and poorer physical performance. Conclusions Compared with TSMI and SMI, ASMI might serve as a preferred index for the diagnosis of low muscle mass.

The association between serum iron status, cardiovascular disease (CVD), and all-cause mortality remains controversial in the elderly. In the present study, we aim to determine the relevance of serum iron level on the incidences of CVD and all-cause mortality in an elderly population.A baseline cohort of 336 participants, aged ≥65 y, was recruited from eight long-term care facilities between 2002 and 2003. The degree of iron deficiency was defined based on the serum iron level (mild: 40 mg/dL ≤serum iron60 mg/dL; severe: serum iron40 mg/dL). Cox proportional hazard regression analyses were adopted to evaluate the relative risks (RRs) of CVD and all-cause death. Taiwan's Department of Health provided the mortality data.There were 210 deaths during a 5-y follow-up period, 62 of which were due to CVD. The prevalence of iron deficiency among the subjects was 50.3%. Age, sex, body mass index, waist circumference, mean arterial pressure, performance status, lifestyle factors, blood glucose, hemoglobin, lipid, albumin, and high sensitivity C-reactive protein levels were adjusted to compare the RRs of the subjects. The RRs (95% confidence interval) of CVD and all-cause mortality among mildly iron-deficient subjects were 1.08 (0.51-2.29) and 1.63 (1.14-2.31), respectively, and 2.77 (1.28-5.99) and 1.96 (1.26-3.04), respectively, among severely iron-deficient subjects. The severity of iron deficiency was positively associated with CVD and all-cause mortality.These results suggest that iron deficiency is independently associated with CVD and all-cause mortality in elderly Taiwanese living in long-term care facilities.

Lean body mass is positively correlated with bone mineral density (BMD). The association between sarcopenia and BMD is less studied. The aim of the study is to investigate the association between sarcopenia and abnormal BMD. A total of 600 community residents aged 40-85 years (mean=63.63 ± 10.12) from Taipei, Taiwan were included. Abnormal and normal BMD groups were categorized by T-score of femoral neck and lumbar spine (L2-L4) measured by dual-energy X-ray absorptiometry. Skeletal muscle mass (SM) index (SMI) was obtained from SM divided by height squared using bioelectrical impedance analysis (BIA) method. Sarcopenia was defined as SMI less than 8.87 kg/m² in men and 6.42 kg/m² in women according to previous Taiwanese sarcopenia study. The association between BMD groups and sarcopenia was examined using binary logistic regression analyses after controlling potential confounders. Subjects with sarcopenia were at higher risk for low BMD (odds ratio (OR) = 1.59, 95% confidence interval (CI)=1.06-2.39 for femoral neck BMD and OR=1.72, 95% CI=1.09-2.72 for lumbar BMD) compared with the nonsarcopenia group. Even in different gender groups with age categorized, sarcopenia was still an important independent factor in female group. The least square (LS) means of BMD of femoral neck and lumbar spine were significantly lower in sarcopenia group. The risk of low BMD increased significantly with sarcopenia.

Hyponatremia is the most common electrolyte abnormality among the elderly living in long-term care facilities. In this study, we investigate the associated factors of hyponatremia, and its association with anemia in the institutionalized elderly in Taiwan. A total of 414 participants aged 65 years and above were recruited from eight long-term care facilities in 2002-2003. Baseline characteristics, medical records, and biomarkers were obtained. Hyponatremia was defined as a serum Na-concentration135 mmol/l. Relationships between hyponatremia and the demographic and laboratory characteristics were tested using multiple logistic and linear regression analyses. The prevalence of hyponatremia and anemia was 14.7% and 56.0%, respectively. Anemia, hypouricemia, and the placement of tubes (including nasogastric tube, tracheostomy tube, and Foley catheter) were significantly associated with hyponatremia after adjustment for potential confounders using multiple logistic regression analysis. The adjusted odds ratios (OR) and 95% confidence interval (95%CI) for these three factors were 3.28 (1.40-7.69), 4.98 (2.18-11.36), 9.15 (3.33-25.12), respectively. Multiple linear regression analyses also showed that serum Na concentration was significantly associated with hemoglobin, uric acid, and number of tubes. In conclusion, it was found that anemia, the placement of tubes, and hypouricemia were associated with hyponatremia in the institutionalized elderly. In those with the above conditions, serum Na concentration should be monitored.

Purpose This study aims to compare the accuracies of transpedicular screw (TPS) insertion using with computed tomography (CT)-free, CT-based, and intraoperative CT (iCT) with integrated navigation during lumbar spinal surgery. Materials and Methods This study is a retrospective cohort study comparing perioperative data from three patient groups—CT-free navigation (CTF) group, CT-based navigation (CTB) group, andiCT group—who were treated at the Orthopedic Department of Chang Gung Memorial Hospital, Chiayi, Taiwan. Patients who received posterior lumbar TPS insertion with the assistance of computer navigation from January 2002 to June 2011 were included in the study. All demographic and perioperative data were collected from reviews of the medical charts. Postoperative CT images were reviewed to determine screw position. Results This study enrolled 56 patients: 22 patients were enrolled in the CTF group (106 screws), 15 patients in the CTB group (70 screws), and 19 patients in the iCT group (114 screws). The rate of screw insertion without pedicle wall penetration was 89.62% in the CTF group, 98% in the CTB group, and 98% in the iCT group. (p = 0.01) The rate of pedicle wall penetration >2 mm was 5.66%, 0%, and 0% in the CTF, CTB, and iCT groups, respectively. One patient in the CTF group developed a residual neurologic deficit. There were noscrew-related complications in the CTB or iCT groups. Conclusion The use of CT navigation (CT-based and iCT navigations) results in a significantly higher accuracy of screw insertion compared with two-dimensional fluoroscopic navigation for TPS insertion (p = 0.01). Intraoperative CT-integrated navigation provides additional advantages, including simpler registration and the ability to double-check positioning during the operation, andtends to produce less blood loss.

Summary Background Necrotizing fasciitis is a true surgical emergency. This study was undertaken to determine whether clinical indicators could be used to initiate early surgery, and to compare the characteristics observed on initial examination of necrotizing fasciitis in patients who died and those who survived. Methods We retrospectively reviewed the medical records of 143 patients with surgically confirmed necrotizing fasciitis of the extremities over a period of 3.5 years at a tertiary hospital of southwest Taiwan. Differences in mortality, patient characteristics, laboratory findings, and hospital course were compared between patients who died and those who survived, and between patients with Gram-positive infections and those with Gram-negative infections. Results A patient with a fungal infection died. Nine of the 58 patients in the Gram-positive group (15.5%) and 12 of the 60 cases in the Gram-negative group (20%) died. Hence a total of 22 patients died, giving a mortality rate of 15.4%. Hypotension, lower counts of total and segmented leukocytes, higher counts of banded leukocytes, and lower levels of serum albumin were significantly associated with mortality. Monomicrobial infections had a stake of 70.6%, and Vibrio spp were the predominant causative agents (26.6%). Conclusions Hypotensive shock, severe hypoalbuminemia, and increased counts of banded leukocytes can be considered the clinical and laboratory risk indicators to initiate early surgery and to predict mortality for all types of necrotizing fasciitis. The clinical characteristics of Gram-negative infections were more fulminant than those of Gram-positive infections.

Anti-Helicobacter pylori heat shock protein 60 (HpHSP60) antibodies are usually found in H. pylori-infected patients and are known to be associated with the progression of gastric diseases. However, the effects of these antibodies on the functions of HpHSP60 have not been identified. This study aims to investigate the effects of the interaction between anti-HSP60 antibodies and HpHSP60 on inflammatory responses. Anti-HpHSP60 polyclonal sera and monoclonal antibodies (mAbs) were produced to evaluate their effects on HpHSP60-induced IL-8 and TNF-α activity. The results indicated that anti-HpHSP60 polyclonal sera collected from patients infected with H. pylori or from rabbit and mice immunized with HpHSP60 could significantly enhance HpHSP60-mediated IL-8 and TNF-α secretion from monocytic THP-1 cells. Similar effects were also found with anti-HpHSP60 mAbs. Further analysis revealed that this phenomenon was only carried out by anti-HpHSP60 antibody but not by other non-specific mAbs. Moreover, the non-specific mAbs decreased the synergism of HpHSP60 and anti-HpHSP60 mAbs in proinflammatory cytokine induction. Herein, we have examined the role of anti-HpHSP60 antibody in host immune responses for the first time. This study demonstrated that H. pylori HSP60/mAbs could modulate helicobacterial pathogenesis by increasing IL-8 and TNF-α production. The pathogen-specific antibodies may execute potential immune functions rather than recognize or neutralize microbes.

We conducted a multi-center, randomized, laboratory-blinded clinical trial in 185 healthy adults (60 years) and 107 elders (60 years) to examine the immunogenicity and safety of different doses of an inactivated, monovalent, non-adjuvanted, split vaccine against the 2009 pandemic influenza A (H1N1) virus. The 186 adults were assigned to three treatment groups, i.e., one 15 μg hemagglutination (HA) antigen dose, two 15 μg or 30 μg HA doses in 3 weeks apart, and the 107 elders were treated with two 15 μg or 30 μg doses in 3 weeks apart. Prior to the vaccination, 4.8% subjects had hemagglutination-inhibition (HAI) antibody titers of 1:40 or more. By day 21 post-vaccination of one dose of 15 μg HA, the seroprotective rate was 95.1% and 75.5% in subjects60 and65 years of age, respectively; by day 21 post the second 15 μg HA dose, the seroprotective rates were 93.2% and 73.1%, respectively. The seroprotective rates for recipients of 30 μg HA antigen by day 21 were 95.2% for subjects60 years and 81.1% for subjects65 years of age, that was boosted to 98.3% and 80.4%, respectively with a second dose of 30 μg HA antigen. No vaccine-related serious adverse events occurred. The data indicated a single 15 μg HA dose of the vaccine induced a protective immune response in most adults, including the elders60 years of age, and a booster dose at the third week did not render a higher level of antibody response.

We conducted a multi-center, randomized and laboratory-blinded clinical trial with subgroup analyses, involving adults aged greater than 60 years old (range 61-86 years old), to investigate the immunogenicity and the potential factors affecting the immune response of a monovalent, unadjuvanted, inactivated, split-virus vaccine. A total of 107 subjects were randomized to receive 15 and 30 microg of hemagglutinin antigen in a 1:1 ratio. The immunogenicity was detected through hemagglutination inhibition (HAI) test of serum obtained before and 3 weeks after vaccination. By 3 weeks after vaccination, HAI titer >or=1:40 was observed in 75.5% and 81.1% of participants receiving 15 and 30 microg of hemagglutinin antigen, respectively. Positive seroconversion was observed in 71.7% and 81.1% of recipients of the 15 and the 30 microg, respectively. The GMTs increased by a factor of 10.7 and 17.4 in the groups of 15 and 30 microg, respectively. This study indicated that one dose of 15 microg hemagglutinin antigen without adjuvant induced protective immune response in the majority of elderly. Multivariate logistic regression analyses showed that gender, age and diabetes were statistically significant factors affecting the seroprotection rate (p=0.04, 0.01 and 0.01, respectively) and seroconversion rate (p=0.01, 0.01 and 0.01, respectively).

Active layers of i-In 0.13 Ga 0.87 N p-i-n photovoltaics (PVs) with a single antireflection layer (SARL) and a multi-antireflection layer (MARL), respectively, were fabricated. Reflectance simulation results show that the PVs with a SARL or a MARL have performance superior to those without an antireflection layer (ARL). In particular, the surface reflectance of PVs with a MARL was reduced to 6% at wavelengths between 330 and 500 nm. The ARL reduced the reflectance and recombination current, as well as boosting shunt resistance without increasing series resistance. Compared with PVs without an ARL, the open-circuit voltage and fill factor of PVs with a MARL increased by 100% and 54.5%, respectively. The ideal factor was improved by 19.4% and 31.9% in devices with a SARL (SiO 2 ) and a MARL (Ta 2 O 5 /SiO 2 ), respectively.

Improvement in nutritional status using two different care models was assessed in 374 elderly people (mean +/- S.D. age = 78.8+/-7.2 years) living in eight long-term care facilities in middle Taiwan. The subjects were divided into two groups using randomized block design; a hospital-based multidisciplinary team was responsible for the care of the intervention group, and the control group received usual care for 6 months. A structured questionnaire, anthropometric measurements, and biomedical markers were checked for each subject before and after the intervention. No significant differences were observed in age, height, weight, body mass index, hemoglobin, and albumin between the intervention (n = 125) and control (n = 249) groups at baseline. After 6 months of intervention, 83 subjects in the intervention group and 182 subjects in the control group had completed the study. The change in albumin level was greater in the intervention group (1.58 g/l) than in the control group (0.15 g/l, p < 0.05). The prevalence of hypoalbuminemia (albumin < 35 g/l) decreased from 69.2% to 52.9% in the intervention group and from 70.3% to 67.0% in the control group. In conclusion, a hospital-based multidisciplinary care effectively improved the nutritional status of elderly patients living in long-term care facilities in middle Taiwan.

Adipose tissue is now accepted by the scientific and medical community to be a genuine endocrine organ, in addition to its classical role as an energy store. Adiponectin is one of the many adipocytokines that are secreted almost exclusively by adipose tissue. Alteration in blood adiponectin concentrations has been linked to many human diseases in numerous cross-sectional and prospective studies. In this review, we describe briefly the biological effects of adiponectin as revealed by basic scientific investigations. We also summarize the principles of blood adiponectin assays. Overall, lower blood adiponectin concentration is found in subjects with obesity, type 2 diabetes mellitus, dyslipidemia, and hypertension. These medical conditions are components of the metabolic syndrome and major risk factors for accelerated atherosclerosis. Plasma adiponectin levels are also expected to be lower in subjects with cardiovascular diseases, such as coronary artery disease, ischemic stroke and peripheral artery disease. Congestive heart failure (CHF) and cardiac arrhythmia are common end points in cardiovascular diseases. Surprisingly, higher blood adiponectin levels are frequently reported to predict mortality associated with CHF. Few human data regarding adiponectin and cardiac arrhythmia are available. Higher blood adiponectin level has been documented only in atrial fibrillation. We also summarize data on the role of the high molecular weight (HMW) iso-forms of adiponectin and the effects of clinical treatment on the levels of total or HMW adiponectin. Whether adiponectin is a risk marker or a risk factor for the diseases reviewed in this article, and in many other human diseases, and their detailed pathogenic links awaits further investigation.

BACKGROUND Betel nut chewing is related to several kinds of cancer, metabolic syndrome, and type 2 diabetes. Whether it is associated with a greater risk of cardiovascular disease (CVD) and all-cause mortality, however, remains unclear. OBJECTIVE We aimed to investigate the association between betel nut chewing and CVD and all-cause mortality. DESIGN A baseline cohort of 56,116 male participants > or = 20 y old were recruited from 4 nationwide health screening centers in Taiwan in 1998 and 1999. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs) of CVD and all-cause mortality for betel nut chewers during an 8-y follow-up period. RESULTS There were 1549 deaths during the follow-up period, 309 of which were due to CVD. After adjustment for age, body mass index, diabetes, hypertension, lipids, smoking, alcohol consumption, physical activity, income, and education level, the RRs (95% CI) of CVD and all-cause mortality among the former betel nut chewers were 1.56 (1.02, 2.38) and 1.40 (1.17, 1.68), respectively, and those among current chewers were 2.02 (1.31, 3.13) and 1.40 (1.16, 1.70), respectively, compared with persons who had never chewed betel quid. Current and former betel nut chewers had a higher risk of CVD mortality (RR: 2.10; P < 0.05) than did current and former smokers. Greater frequency of betel nut chewing was associated with greater CVD and all-cause mortality. CONCLUSIONS Betel nut chewing was independently associated with a greater risk of CVD and all-cause mortality in Taiwanese men. Regular screening for betel nut chewing history may help prevent excess deaths in the future. An anti-betel nut chewing program is urgently warranted for current chewers.

The Al0.11Ga0.89N-based photodiodes fabricated under different annealing ambient after inductively coupled plasma reactive ion etching process were studied. The dark current and photocurrent with different illuminated wavelengths were characterized. Higher photocurrent for the diode annealing in H2 ambient can be observed and attributed to the defect-assisted photocurrent. This photocurrent shows a strong annealing ambient dependence and causes the shift of cutoff wavelength in the responsivity spectrum. The surface state was characterized by the capacitance analysis with Schottky contact.

Background Oxidative stress increases in patients with end-stage renal disease and exaggerates the related comorbidities. Objective The aim of the study was to evaluate the effects of supplementation with decaffeinated green tea extract (catechins) on hemodialysis-induced reactive oxygen species, atherosclerotic disease risk factors, and proinflammatory cytokines. Design We enrolled 6 healthy subjects and 54 hemodialysis patients for the study. First, the pharmacokinetics of one oral dose of catechins was compared between healthy subjects (n = 6) and hemodialysis patients (n = 10). Second, in the 10 hemodialysis patients, we compared the antioxidant effects of 3 different doses (0, 455, and 910 mg) of oral catechins with that of oral vitamin C (500 mg) during a hemodialysis session. Third, the other 44 hemodialysis patients participated in a 7-mo interventional study, in which 30 patients received placebo throughout and 14 patients received catechins (455 mg/d) from the third to the fifth month. Results After one oral dose, the hemodialysis patients (n = 10) had later peaks and slower decay of plasma catechins than did the healthy subjects. In the 10 hemodialysis patients, catechin supplementation reduced hemodialysis-enhanced plasma hypochlorous acid activity more effectively than did placebo or vitamin C. Between treatments with 455 or 910 mg catechins, no significant difference was found in the reduction of plasma hypochlorous acid activity. Catechins also significantly reduced proinflammatory cytokine expression enhanced by hemodialysis. In the 7-mo interventional study, the 14 patients who received daily supplementation of catechins for 3 mo had less predialysis plasma hydrogen peroxide activity, lower hypochlorous acid activity, and lower phosphatidylcholine hydroperoxide, C-reactive protein, and proinflammatory cytokine concentrations than did the 30 hemodialysis patients who received placebo. Conclusion Catechins reduce hemodialysis-induced production of hydrogen peroxide and hypochlorous acid, atherosclerotic disease risk factors, and proinflammation.

The defects induced by inductively coupled plasma reactive ion etching (ICP-RIE) on a Si-doped gallium nitride (GaN:Si) surface have been analyzed. According to the capacitance analysis, the interfacial states density after the ICP-etching process may be higher than 5.4 × 10 12 eV −1 cm −2 , compared to around 1.5 × 10 11 eV −1 cm −2 of non-ICP-treated samples. After the ICP-etching process, three kinds of interfacial states density are observed and characterized at different annealing parameters. After the annealing process, the ICP-induced defects could be reduced more than one order of magnitude in both N 2 and H 2 ambient. The H 2 ambient shows a better behavior in removing ICP-induced defects at a temperature around 500 °C, and the interfacial states density around 2.2 × 10 11 eV −1 cm −2 can be achieved. At a temperature higher than 600 °C, the N 2 ambient provides a much more stable interfacial states behavior than the H 2 ambient.

Chronic hemodialysis (HD) patients increase erythrocyte susceptibility to hemolysis and impair cell survival. We explored whether electrolyte-reduced water (ERW) could palliate HD-evoked erythrocyte impairment and anemia. Forty-three patients undergoing chronic HD were enrolled and received ERW administration for 6 month. We evaluated oxidative stress in blood and plasma, erythrocyte methemoglobin (metHb)/ferricyanide reductase activity, plasma metHb, and proinflammatory cytokines in the chronic HD patients without treatment (n=15) or with vitamin C (VC)- (n=15), vitamin E (VE)-coated dialyzer (n=15), or ERW treatment (n=15) during an HD course. The patients showed marked increases (15-fold) in blood reactive oxygen species, mostly H(2)O(2), after HD without any treatment. HD resulted in decreased plasma VC, total antioxidant status, and erythrocyte metHb/ferricyanide reductase activity and increased erythrocyte levels of phosphatidylcholine hydroperoxide (PCOOH) and plasma metHb. Antioxidants treatment significantly palliated single HD course-induced oxidative stress, plasma and RBC PCOOH, and plasma metHb levels, and preserved erythrocyte metHb /ferricyanide reductase activity in an order VCERWVE-coated dialyzer. However, ERW had no side effects of oxalate accumulation easily induced by VC. Six-month ERW treatment increased hematocrit and attenuated proinflammatory cytokines profile in the HD patients. In conclusion, ERW treatment administration is effective in palliating HD-evoked oxidative stress, as indicated by lipid peroxidation, hemolysis, and overexpression of proinflammatory cytokines in HD patients.

Wiring of patellar fractures is a common treatment. Breakage of the wires is not unusual, but the wire pieces usually remain extra-articular around the knee joint. Intra-articular migration of a wire piece is uncommon; Chen et al. reported one case which was managed by open retrieval. Arthroscopic retrieval would be better for the patient, but searching for a small foreign body in the knee joint is not an easy task, especially as hypertrophic synovial tissue usually envelops the object. For radioopaque substances, an image intensifier enables exact location. We report two cases of intra-articular wire pieces which were successfully removed with simultaneous use of arthroscopy and image intensifier.

Heme oxygenase-1 (HO-1) is the rate-limiting enzyme in heme catabolism, which confers cytoprotection against oxidative injury and provides a vital function in maintaining tissue homeostasis. HMG-CoA reductase inhibitors (statins) possess several anti-inflammatory mechanisms and may be beneficial in the treatment of inflammatory diseases. Our previous study has shown that statins can inhibit iNOS gene expression in murine RAW264.7 macrophages. In this study, we showed that lovastatin, fluvastatin, atorvastatin, simvastatin, mevastatin and pravastatin are able to upregulate the mRNA expression of HO-1 gene. This effect of lovastatin was attenuated by farnesyl pyrophosphate (FPP), geranylgeranyl pyrophosphate (GGPP), a protein kinase G (PKG) inhibitor (KT5823), a soluble guanylyl cyclase inhibitor (ODQ), a p38 MAPK inhibitor (SB203580), and MEK inhibitors (U0126 and PD98059), but not by inhibitors of protein kinase C (PKC), protein kinase A (PKA), c-jun N-terminal kinase (JNK) and Rho kinase. Consistent with this notion, our previous study has reported the ability of statins to activate ERK and p38 MAPK in RAW264.7 macrophages. Here we further found the participation of cyclic guanosine monophosphate (cGMP)/PKG pathway for ERK activation in cells stimulated with statin and the ability of statin to induce AP-1 activity, which is an essential transcription factor in the regulation of HO-1 gene expression. In addition, a Ras inhibitor (manumycin A) treatment also caused a marked induction of HO-1 mRNA followed by a corresponding increase in HO-1 protein; instead, inhibition of Rho activity by toxin B only led to a transient and weak induction of HO-1. The involvement of signal pathways in manumycin A-induced HO-1 gene expression was associated with p38 MAPK, JNK and ERK activation. Taken together, these results demonstrate for the first time that statins might activate PKG to elicit activations of ERK and p38 MAPK pathways and finally induce HO-1 gene expression, which provides a novel anti-inflammatory mechanism in the therapeutic validity.

Reduced hemodialysis-induced oxidative stress in end-stage renal disease patients by electrolyzed reduced water. Background Increased oxidative stress in end-stage renal disease (ESRD) patients may oxidize macromolecules and consequently lead to cardiovascular events during chronic hemodialysis. Electrolyzed reduced water (ERW) with reactive oxygen species (ROS) scavenging ability may have a potential effect on reduction of hemodialysis-induced oxidative stress in ESRD patients. Methods We developed a chemiluminescence emission spectrum and high-performance liquid chromatography analysis to assess the effect of ERW replacement on plasma ROS (H 2 O 2 and HOCl) scavenging activity and oxidized lipid or protein production in ESRD patients undergoing hemodialysis. Oxidized markers, dityrosine, methylguanidine, and phosphatidylcholine hydroperoxide, and inflammatory markers, interleukin 6 (IL-6), and C-reactive protein (CRP) were determined. Results Although hemodialysis efficiently removes dityrosine and creatinine, hemodialysis increased oxidative stress, including phosphatidylcholine hydroperoxide, and methylguanidine. Hemodialysis reduced the plasma ROS scavenging activity, as shown by the augmented reference H 2 O 2 and HOCl counts (RH 2 O 2 and RHOCl, respectively) and decreased antioxidative activity (expressed as total antioxidant status in this study). ERW administration diminished hemodialyis-enhanced RH 2 O 2 and RHOCl, minimized oxidized and inflammatory markers (CRP and IL-6), and partly restored total antioxidant status during 1-month treatment. Conclusion This study demonstrates that hemodialysis with ERW administration may efficiently increase the H 2 O 2 - and HOCl-dependent antioxidant defense and reduce H 2 O 2 - and HOCl-induced oxidative stress.

Although there is no conclusive evidence that manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain (Assendelft et al., 2003; Furlan et al., 2008), clinicians usually use manipulative therapy first because they believe that it relieves pain from musculoskeletal injuries and other causes of pain, reduces stress, enhances relaxation and increases general well being (Cassileth and Vickers, 2004). Manipulative therapy encompasses diverse physical treatments including massage, soft-tissue mobilization, joint manipulation, myofascial release (Gatterman and Hansen, 1994). Massage involves manipulating the patient’s body with pressure, tension, motion or vibration performedmanually or withmechanical aids. It is not entirely risk-free. However, serious adverse events are probably true rarities (Ernst, 2003) but the case of a 51-year-old man with rapidly enlarging thigh swelling after manipulative therapy is reported. To our knowledge, this is the first report of such an unexpected response to manipulative therapy caused by softtissue tumor rupture and secondary chondro-osseous metaplasia.

Higher light output intensity and wider polar radiation pattern of InGaN/GaN multiple quantum well (MQW) light-emitting diodes (LEDs) with a different nanoscale titanium dioxide (TiO2) textured densities film have been observed. The light output power values and external quantum efficiency of the conventional LEDs at an injection current of 20 mA are 6.34 mW and 11.7%, respectively. The light output power values and external quantum efficiency of the nanoscaled TiO2 textured LEDs at an injection current of 20 mA are 7.55 mW and 14%, respectively. The light output intensity and power values of the nanoscaled TiO2 textured LEDs is approximately 65% and 20% higher than that of the conventional LEDs, respectively.