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Abstract Liriomyza trifolii is an economically-significant polyphagous pest that infests plants grown in both field and greenhouse conditions. Unfortunately, the lack of genomic resources has hindered our understanding of its ecological adaptation and invasiveness. To address this, we assembled a chromosome-level genome sequence of L. trifolii using a combination of short Illumina reads, PacBio HiFi long sequencing, and Hi-C scaffolding technology. The genome size was calculated at 122.64 Mb, the scaffold N50 value was 23.84 Mb, and 96.25% of the assembled sequences mapped to five chromosomes. BUSCO analysis showed high completeness with 95.28% gene coverage. A total of 11,883 protein-coding genes were identified along with 20.60 Mb of transposable elements. In summary, the genome of L. trifolii provides a valuable genetic resource for understanding invasive pests and developing effective management strategies.

This research focuses on the classification of Chinese Buddhist scripture catalogs, employing advanced deep learning methods to develop an automatic classification mechanism. Chinese Buddhist scripture catalogs serve as vital tools for organizing and retrieving Buddhist literature, facilitating research in the field. However, with the continuous addition of new texts and the need to adapt to modern academic research requirements, traditional manual classification methods have become time-consuming and less effective. In this study, we aim to address this challenge by harnessing the power of deep learning techniques. Our research not only involves the integration of new literature into existing catalog structures but also explores the reasons behind misclassifications in these catalogs. Additionally, we examine the inherent connections between different categories of scriptures to provide a comprehensive understanding of the catalog structure. Our contributions in this research encompass: 1. Automatic Classification: We pioneer the use of deep learning methods for the classification of Buddhist scripture catalogs, allowing for faster and more accurate categorization of texts. This automated approach significantly enhances the efficiency of catalog management. 2. Error Analysis: We delve into the reasons behind misclassifications in the catalogs, shedding light on common pitfalls and misconceptions in traditional classification methods. 3. Interconnections: We uncover the original interrelationships between different categories of scriptures, offering valuable insights for adjusting and optimizing the catalog structure to align with contemporary research needs. 4. Practical Application: The research findings are adopted by the CBETA research group as a reference tool for the cataloging of new literature in future editions of the Tripitaka, ensuring that the catalog remains up-to-date and relevant. This research is a significant step towards modernizing the management of Chinese Buddhist scripture catalogs, making them more efficient, accurate, and adaptable to the evolving landscape of Buddhist literature. (Article content in Chinese with English extended abstract)

Abstract Background The aim of the study was to investigate whether the expression of CD27−CD38+ in interferon (IFN)-γ+CD4+ T cells stimulated by the specific antigen early secreted antigenic target-6 (ESAT-6)/culture filter protein-10 (CFP-10) could be a potential new therapeutic evaluation indicator for anti-tuberculosis (TB) treatment. Methods Newly diagnosed active pulmonary TB patients, latent TB infection (LTBI) and healthy controls were enrolled from January 2021 to December 2021. PTB patients were treated by standard anti-TB regimen 2HREZ/4HR (2 months of isoniazid (H), rifampin (R), ethambutol (E), and pyrazinamide (Z) followed by 4 months of isoniazid (H) and rifampin (R)). The difference of CD27−CD38+ expression in IFN-γ+CD4+ T cells before treatment, 2 months after treatment, and 6 months after treatment were compared. Results Total 45 PTB patients, 38 LTBI cases and 43 healthy controls were enrolled. The expression of CD27−CD38+ decreased significantly after anti-TB treatment and was comparable with that in LTBI and healthy controls when the 6-month anti-TB treatment course was completed. The decline rate of CD27−CD38+ between 6 months after treatment and baseline was positively correlated with erythrocyte sedimentation rate (r = 0.766, P

Abstract Climate change is closely monitored and numerous studies reports increasing air temperature and weather extremes across the globe. As a direct consequence of the increase of global temperature, the increased heat stress is becoming a global threat to public health. While most climate change and epidemiological studies focus on air temperature to explain the increasing risks, heat strain can be predicted using comprehensive indices such as Universal Thermal Climate Index (UTCI). The Asia–Pacific region is prone to thermal stress and the high population densities in the region impose high health risk. This study evaluated the air temperature and UTCI trends between 1990 and 2019 and found significant increasing trends for air temperature for the whole region while the increases of UTCI are not as pronounced and mainly found in the northern part of the region. These results indicate that even though air temperature is increasing, the risks of heat stress when assessed using UTCI may be alleviated by other factors. The associations between El Niño Southern Oscillation (ENSO) and heat stress was evaluated on a seasonal level and the strongest regional responses were found during December-January (DJF) and March–May (MAM).

The open burning of sugarcane residue is commonly used as a low-cost and fast method during pre-harvest and post-harvest periods. However, this practice releases various pollutants, including dioxins. This study aims to predict polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs or dioxins) emissions using the grey model (GM (1,1)) and to map the annual flux spatial distribution at the provincial level from 2023 to 2028. An annual emission inventory at the provincial level was developed using the activity rate of dry crop residue from national agencies and literature, following the guidelines set by the United Nations Environment Programme (UNEP). Emission distributions from 2016 to 2022 were then mapped. The average PCDD/F emission values show significant variation among the provinces, averaging 309 pg TEQ/year. Spatially, regions with intensive sugarcane production, such as Lampung and East Java consistently show high emissions, often exceeding 400 pg/m2. Emissions calculated using the UNEP emission factor tend to be higher compared to other factors, due to its generic nature and lack of regional specificity. Emission predictions using GM (1,1) indicate that North Sumatra is expected to experience a steady increase in PCDD/Fs emissions, whereas South Sumatra and Lampung are projected are projected to see a slight decline. This forecast assumes no changes in regional intervention strategies. Most regions in Java Island show a gradual increase in emissions, except for East Java, which is predicted to have a slight decline from 416 pg/year in 2023 to 397 pg/year in 2028. Additionally, regions such as Gorontalo and parts of East Java are projected to remain ‘hotspots’ with consistently high emissions, highlighting the need for targeted interventions. To address emission hotspots, this study emphasizes the need for cleaner agricultural practices, enhanced enforcement of environmental regulations, and the integration of advanced monitoring technologies to mitigate the environmental and health impacts of PCDD/F emissions in Indonesia. Future studies should consider developing monthly emissions profiles to better account for local agricultural practices and seasonal conditions. The emission data generated in this study, which include both spatial and temporal distributions, are valuable for air quality modeling studies and can help assess the impact of current and future emissions on ambient air quality.

Abstract In the Asia–Pacific region (APR), extreme precipitation is one of the most critical climate stressors, affecting 60% of the population and adding pressure to governance, economic, environmental, and public health challenges. In this study, we analyzed extreme precipitation spatiotemporal trends in APR using 11 different indices and revealed the dominant factors governing precipitation amount by attributing its variability to precipitation frequency and intensity. We further investigated how these extreme precipitation indices are influenced by El Niño-Southern Oscillation (ENSO) at a seasonal scale. The analysis covered 465 ERA5 (the fifth-generation atmospheric reanalysis of the European Center for Medium-Range Weather Forecasts) study locations over eight countries and regions during 1990–2019. Results revealed a general decrease indicated by the extreme precipitation indices (e.g., the annual total amount of wet-day precipitation, average intensity of wet-day precipitation), particularly in central-eastern China, Bangladesh, eastern India, Peninsular Malaysia and Indonesia. We observed that the seasonal variability of the amount of wet-day precipitation in most locations in China and India are dominated by precipitation intensity in June–August (JJA), and by precipitation frequency in December–February (DJF). Locations in Malaysia and Indonesia are mostly dominated by precipitation intensity in March–May (MAM) and DJF. During ENSO positive phase, significant negative anomalies in seasonal precipitation indices (amount of wet-day precipitation, number of wet days and intensity of wet-day precipitation) were observed in Indonesia, while opposite results were observed for ENSO negative phase. These findings revealing patterns and drivers for extreme precipitation in APR may inform climate change adaptation and disaster risk reduction strategies in the study region.

Background Domestic cats are important companion animals in modern society that live closely with their owners. Mislabeling of pet food can not only harm pets but also cause issues in areas such as religious beliefs and natural resource management. Currently, the cat food market is booming. However, despite the risk that mislabeling poses to cats and humans, few studies have focused on species misrepresentation in cat food products. Methods To address this issue, we used DNA barcoding, a highly effective identification methodology that can be applied to even highly processed products. We targeted a short segment (~85 basepairs) of the mitochondrial 16S rRNA (16S) gene as a barcode and employed Sanger or next generation sequencing (NGS) to inspect 138 canned cat food products in the Taiwanese market. Results We discovered that the majority of mislabeling incidents were related to replacement of tuna with other species. Moreover, our metabarcoding revealed that numerous undeclared ingredients were present in all examined canned products. One product contained CITES Appendix II-listed shortfin mako shark (Isurus oxyrinchus). Overall, we uncovered a mislabeling rate of at least 28.99%. To verify cases of mislabeling, an official standardized list of vernacular names, along with the corresponding scientific species names, as well as a dependable barcoding reference sequence database are necessary.

Background: Dengue fever is a growing concern for public health under future climate variability. This study aims to investigate the dengue fever from 35 cities/counties linked with historical observation and anomaly of weather variables from 4 weather stations in Indonesia. Method: We collected monthly surveillance data of dengue fever in central java, temperature and precipitation from Tegal, Semarang, Tunggul wulung and Sleman weather stations, and flood event from 2009 to 2019. The distributed non-linear model was adopted to evaluate the effect of extremes weather variables and anomalies on the dengue risks. The extreme thresholds were defined at 5th and 99th percentile. Random-effects meta-analysis was applied to estimate weather station-specific pooled relative risk (RR) and 95% confidence intervals (CI) for the studied areas. Result: Dengue prevalence rates were higher in the rainy season (Nov–March) compared to dry season (Apr–Oct). Extreme high temperature was positively associated with dengue fever in Semarang with RR of 4.92 (95 % CI: 1.01, 24.0). Extreme low precipitation was positively associated with dengue fever in Tegal with RR of 9.60 (95 % CI: 2.65, 34.6). The risk of dengue fever in western part of Central Java, especially in the Tunggul wulung, was positively associated with extreme high anomaly of precipitation [RR = 4.05 (95 % CI: 1.86, 13.7). Meanwhile, extreme low anomaly of precipitation was positively associated with the risk of dengue fever with RR of 2.75 (95 % CI: 1.75, 4.32) in Semarang. Conclusion: These findings highlight the importance of considering weather variability in addressing the risks associated with dengue fever in Central Java, Indonesia.

Abstract Background This study investigated associations between climate variables (average temperature and cumulative rainfall), and El Niño Southern Oscillation (ENSO) and dengue-like-illness (DLI) incidence in two provinces (Western and Guadalcanal Provinces) in Solomon Islands (SI). Methods Weekly DLI and meteorological data were obtained from the Ministry of Health and Medical Services SI and the Ministry of Environment, Climate Change, Disaster Management and Meteorology from 2015 to 2018, respectively. We used negative binomial generalized estimating equations to assess the effects of climate variables up to a lag of 2 months and ENSO on DLI incidence in SI. Results We captured an upsurge in DLI trend between August 2016 and April 2017. We found the effects of average temperature on DLI in Guadalcanal Province at lag of one month (IRR: 2.186, 95% CI: 1.094–4.368). Rainfall had minor but consistent effect in all provinces. La Niña associated with increased DLI risks in Guadalcanal Province (IRR: 4.537, 95% CI: 2.042–10.083), whereas El Niño associated with risk reduction ranging from 72.8% to 76.7% in both provinces. Conclusions Owing to the effects of climate variability and ENSO on DLI, defining suitable and sustainable measures to control dengue transmission and enhancing community resilience against climate change in low- and middle-developed countries are important.

Abstract Recent evidence links dysfunctional lipid metabolism to the pathogenesis of Parkinson’s disease, but the mechanisms are not resolved. Here, we generated a new Drosophila knock-in model of DNAJC6/Auxilin and find that the pathogenic mutation causes synaptic dysfunction, neurological defects and neurodegeneration, as well as specific lipid metabolism alterations. In these mutants, membrane lipids containing long-chain polyunsaturated fatty acids, including phosphatidylinositol lipid species that are key for synaptic vesicle recycling and organelle function, are reduced. Overexpression of another protein mutated in Parkinson’s disease, Synaptojanin-1, known to bind and metabolize specific phosphoinositides, rescues the DNAJC6/Auxilin lipid alterations, the neuronal function defects and neurodegeneration. Our work reveals a functional relation between two proteins mutated in Parkinsonism and implicates deregulated phosphoinositide metabolism in the maintenance of neuronal integrity and neuronal survival.

In this study, we investigated the concentration of airborne influenza virus in daycare centers and influencing factors, such as common cold prevalence, air pollutants, and meteorological factors. A total of 209 air samples were collected from daycare centers in Kaohsiung and the influenza virus was analyzed using real-time quantitative polymerase chain reaction. Air pollutants and metrological factors were measured using real-time monitoring equipment. Winter had the highest positive rates of airborne influenza virus and the highest prevalence of the common cold, followed by summer and autumn. The concentration of CO was significantly positively correlated with airborne influenza virus. Daycare center A, with natural ventilation and air condition systems, had a higher concentration of airborne influenza A virus, airborne fungi, and airborne bacteria, as well as a higher prevalence of the common cold, than daycare center B, with a mechanical ventilation system and air purifiers, while the concentrations of CO2, CO, and UFPs in daycare center A were lower than those in daycare center B. We successfully detected airborne influenza virus in daycare centers, demonstrating that aerosol sampling for influenza can provide novel epidemiological insights and inform the management of influenza in daycare centers.

The goal of this study was to compare model-generated sounds with the process of sound acquisition in humans. The research utilized two dictionaries of the Chaoshan dialect spanning approximately one century. Identical Chinese characters were selected from each dictionary, and their contemporary pronunciations were documented. Subsequently, inconsistencies in pronunciation were manually rectified, following which three machine learning methods were employed to train the pronunciation of words from one dictionary to another. These methods comprised the attention-based sequence-to-sequence method, DirecTL+, and Sequitur. The accuracy of the model was evaluated using five-fold cross-validation, revealing a maximum accuracy of 68%. Additionally, the study investigated how the probability of a sound’s subsequent unit influences the accuracy of the machine learning methods. The attention-based sequence-to-sequence model is not solely influenced by the frequency of input but also by the probability of the subsequent unit.

Background: The need is growing to create medical big data based on the electronic health records collected from different hospitals. Errors for sure occur and how to correct them should be explored. Methods: Electronic health records of 9,197,817 patients and 53,081,148 visits, totaling about 500 million records for 2006–2016, were transmitted from eight hospitals into an integrated database. We randomly selected 10% of patients, accumulated the primary keys for their tabulated data, and compared the key numbers in the transmitted data with those of the raw data. Errors were identified based on statistical testing and clinical reasoning. Results: Data were recorded in 1573 tables. Among these, 58 (3.7%) had different key numbers, with the maximum of 16.34/1000. Statistical differences (P

This study characterizes the phylogenetic relatedness of non-SARS human coronaviruses (HCoVs) in southern Taiwan by sequencing the nucleocapsid (N), spike (S), and RNA-dependent RNA polymerase (RdRp) genes directly from ten HCoV PCR-positive respiratory samples collected during 2012–2013. In the N, S1, and RdRp phylogeny, HCoV-OC43 in one and three samples was clustered with genotypes F and G, respectively, and HCoV-OC43 in sample YC101/TWN/2013 represented a recombination event between genotypes F and G. Amino acid substitutions in the S1 protein of HCoV-OC43 were also identified. In the N phylogeny, HCoV-HKU1 in one and two samples clustered with genotypes A and B, respectively, and HCoV-229E in two samples was clustered with genogroup 6. The genotypes and genogroup detected here were in line with the prevalent phylogenetic lineages reported outside of Taiwan during the contemporary period. In summary, three species of non-SARS HCoVs with different genotypes cocirculated in the community, with genetic evolution observed in HCoV-OC43.

Ongoing climate variability and change are increasing the burden of diarrhoeal disease worldwide. Meaningful early warning systems with adequate lead times (weeks to months) are needed to guide public health decision–making and enhance community resilience against health threats posed by climate change. Toward this goal, we trained various machine-learning models to predict diarrhoeal disease rates in Nepal (2002–2014), Taiwan (2008–2019), and Vietnam (2000–2015) using temperature, precipitation, previous disease rates, and El Niño Southern Oscillation phases. We also compared the performance of shallow time-series neural network (NN), Random Forest Regressor, artificial nn, gradient boosting regressor, and long short-term memory–based methods for their effectiveness in predicting diarrhoeal disease burden across multiple countries. We evaluated model performance using a test dataset and assessed the accuracy of predicted diarrhoeal disease incidence rates for the last year of available data in each district. Our results suggest that even in the absence of the most recent disease surveillance data, a likely scenario in most low- and middle-income countries, our NN-based early warning system using historical data performs reasonably well. However, future studies are needed to perform prospective evaluations of such early warning systems in real-world settings.

Abstract Background Insomnia is a common sleep disturbance in older adults and is associated with many poor health outcomes. This study aimed to explore factors associated with insomnia in older adult outpatient clinics, and to further analyze the influence of gender on factors associated with insomnia. Methods This cross-sectional study was conducted in the outpatient clinics of a tertiary hospital in Southern Taiwan from July to September 2018. A total of 400 consecutive subjects aged 60 years or older were recruited. Insomnia was defined as a score of ≥6 points on the Athens Insomnia Scale (AIS). Socio-demographics, health behaviors and clinical data were collected by face-to-face interview. Multivariable logistic regression was adopted for statistical analysis of the entire sample and stratified by gender. Results Participants’ mean age was 74.74 ± 8.54 years, and the majority (93%) had more than one chronic disease. The prevalence of insomnia accounted for 30% (120/400) of all subjects, with males 22.9% (46/201) and females 37.2% (74/199). Gender, appetite, exercise, depressive symptoms, and sleep-related conditions such as short sleep duration, sleeping pills usage, medium-high risk of obstructive sleep apnea (OSA) and restless leg syndrome (RLS) were factors associated with insomnia in older adults. Exercise, sleeping pills usage, and RLS were independently associated with insomnia only in men, while appetite and medium-high risk of OSA were associated with insomnia in women only. In addition, after further adjusting for covariates, prevalence of the insomnia-related symptoms such as sleep induction, total sleep duration, sleep quality and sleepiness during the day was significantly higher in females than in males. Conclusions Insomnia symptoms are highly prevalent among older adults, predominantly females. Significant differences are found between genders in factors associated with insomnia and insomnia-related symptoms. Understanding gender differences may help clinicians to modify associated factors when managing older adults with insomnia.

OBJECTIVES Diarrheal disease continues to be a significant cause of morbidity and mortality. We investigated how anomalies in monthly average temperature, precipitation, and surface water storage (SWS) impacted bacterial, and viral diarrhea morbidity in Taiwan between 2004 and 2015. METHODS A multivariate analysis using negative binomial generalized estimating equations was employed to quantify age-specific and cause-specific cases of diarrhea associated with anomalies in temperature, precipitation, and SWS. RESULTS Temperature anomalies were associated with an elevated rate of all-cause infectious diarrhea at a lag of 2 months, with the highest risk observed in the under-5 age group (incidence rate ratio [IRR], 1.03, 95% confidence interval [CI], 1.01 to 1.07). Anomalies in SWS were associated with increased viral diarrhea rates, with the highest risk observed in the under-5 age group at a 2-month lag (IRR, 1.27; 95% CI, 1.14 to 1.42) and a lesser effect at a 1-month lag (IRR, 1.18; 95% CI, 1.06 to 1.31). Furthermore, cause-specific diarrheal diseases were significantly affected by extreme weather events in Taiwan. Both extremely cold and hot conditions were associated with an increased risk of all-cause infectious diarrhea regardless of age, with IRRs ranging from 1.03 (95% CI, 1.02 to 1.12) to 1.18 (95% CI, 1.16 to 1.40). CONCLUSIONS The risk of all-cause infectious diarrhea was significantly associated with average temperature anomalies in the population aged under 5 years. Viral diarrhea was significantly associated with anomalies in SWS. Therefore, we recommend strategic planning and early warning systems as major solutions to improve resilience against climate change.

Maintenance of an acid-base balance is essential for normal physiological processes in vertebrates. Freshwater fishes live in an aquatic environment with variable pH, and their buffering capacity for acid-base balance in body fluids is weak. Thus, after acid exposure, fishes secrete excess acid to prevent internal acidosis. Acid-secreting ionocytes present in the adult gills and embryonic skin are primarily responsible for acid secretion, and H+-ATPase and Na+/H+ exchanger 3 (NHE3) are the two main transporters responsible for apical acid secretion. Vitamin D is a well-known hormone involved in the maintenance of Ca2+ homeostasis and is suggested to be involved in acid-base regulation by modulating the activity and/or mRNA expression of NHE3 in mammalian models. It remains unclear whether vitamin D is involved in acid secretion in fishes. The aim of the present study was to use zebrafish as a model to determine whether vitamin D and its receptors influence acid secretion. Our results indicated that the levels of 1α, 25-dihydroxyvitamin D3 (1α,25(OH)2D3), the bioactive vitamin D, were significantly increased in 3 days post-fertilization zebrafish larvae after exposure to acidic freshwater (AFW, pH 4.0). Exogenous 1α,25(OH)2D3 (20 μg/L) incubation substantially enhanced the mRNA expression of acid-secreting transporters and acid secretion at the skin of the entire body and each H+-ATPase-rich cell (HRC), a type of acid-secreting ionocyte. Furthermore, the expression of vitamin D receptors (VDRs) was identified in HRCs of zebrafish. When both VDRa and VDRb were knocked down, acid secretion and the mRNA expression of acid-secreting transporters were significantly decreased. Moreover, double knockdown of VDRa/b prevented the increase in acid secretion induced by AFW and 1α,25(OH)2D3 treatment. This study is the first to indicate that vitamin D is involved in acid secretion in fish.

Abstract The vagal nervous system is central to the physiological responses and systemic diseases of the liver. We evaluated the subsequent risk of liver and intrahepatic cancer (HCC/ICC) in non-H. pylori (HP)-infected perforated peptic ulcer (PPU) patients with and without vagotomy. Hospitalized PPU patients who underwent simple closure or truncal vagotomy/pyloroplasty (TVP) in the National Health Insurance Research Database from 2000 to 2008 were enrolled. The exclusion criteria included: (1) Multiple surgeries for PPU were received at the same admission; (2) Any cancer history; (3) Previous peptic ulcer-associated surgery; (4) HP infection history; (5) Viral hepatitis infection history; (6) Follow-up duration

Abstract Short-term adverse health effects of constituents of fine particles with aerodynamic diameters less than or equal to 2.5 μm (PM2.5) have been revealed. This study aimed to evaluate the real-time health outcome of ambulance services in association with ambient temperature and mass concentrations of total PM2.5 level and constituents in Kaohsiung City, an industrialized city with the worst air quality in Taiwan. Cumulative 6-day (lag0-5) relative risk (RR) and 95% confidence interval (CI) of daily ambulance services records of respiratory distress, coma and unconsciousness, chest pain, headaches/dizziness/vertigo/fainting/syncope, lying at public, and out-of-hospital cardiac arrest (OHCA) in association with ambient temperature and mass concentrations of total PM2.5 level and constituents (nitrate, sulfate, organic carbon (OC), and elemental carbon (EC)) from 2006 to 2010 were evaluated using a distributed lag non-linear model with quasi-Poisson function. Ambulance services of chest pain and OHCA were significantly associated with extreme high (30.8 °C) and low (18.2 °C) temperatures, with cumulative 6-day RRs ranging from 1.37 to 1.67 at the reference temperature of 24–25 °C. Daily total PM2.5 level had significant effects on ambulance services of lying at public and respiratory distress. After adjusting the cumulative 6-day effects of temperature and total PM2.5 level, RRs of ambulance services of lying at public associated with constituents at 90th percentile versus 25th percentile were 1.35 (95% CI: 1.08, 1.68) for sulfate and 1.20 (95% CI: 1.02, 1.41) for EC, while RR was 1.31 (95% CI: 1.09–1.58) for ambulance services of headache/dizziness/vertigo/fainting/syncope in association with OC at 90th percentile versus 25th percentile. Cause-specific ambulance services had various significant association with daily temperature, total PM2.5 level, and concentrations of constituents. Elemental carbon may have stronger associations with increased ambulance services than other constituents.

Introduction: Reservoir management problems are increasing, and tools are needed to categorize and predict their eutrophication status in order to provide technical support for the government’s decision to protect drinking water resource. Thus, this study aims to predict and classify the tendency of eutrophication level in Chengchinghu Reservoir, Kaohsiung City, Taiwan as one of major water sources for industrial and domestical needs by supplying 109,170,00 m3 for Southern Taiwan. Method: The CTSI (Carlson’s Trophic States Index, which calculated from Chl-a, TP, and transparency) datasets in winter (December-February), spring (March-May), summer (June-August), and fall (September-November) from 2000 to 2017 was collected from Taiwan Environmental Protection Administration (EPA). This study used the Classification and Regresiion Tree (CART) model provides the explicit categorical rules for Chengchinghu Reservoir. Results and Discussion: The CART results for Chengchinghu Reservoir showed the good performance of prediction since the accuracy of the CART training process value reached 61.89%. According to the CART results, the eutrophic state condition is most probably occur in Chengchinghu Reservoir when the TP concentration is greater than 22.86 mg/L or Chl-a concentration is greater than 5.2 μg/L or SD is less than 1.1 m. Conclusion: The CART result may helps the local governments to understand the pollution conditions in Chengchinghu Reservoir and take responsibility for reservoir water management and conservation. Therefore, they could make policies to treat and manage water pollution sources in Chengchinghu Reservoir.

The dynamic regulation of ions and amino acids in the gills and mantle of the Asian hard clam, Meretrix lusoria, following the exposure to a hyperosmotic environment was hitherto unclear. The present study revealed that the osmolality as well as the Na+ and Cl– concentrations in the hemolymph were significantly increased 3 h after transferring the clams from an environment with the salinity of their natural habitat (brackish water; BW; 20‰) to one with hyperosmotic salinity (seawater; 35‰). In addition, we found that the specific activities of Na+/K+-ATPase, a key enzyme that plays a significant role in cell osmoregulation, in the gills and mantle of clams were significantly increased at 72 and 12 h post-transfer, respectively, during acclimation to hyperosmotic salinity. Similarly, the contents of free amino acids (FAAs) such as taurine, alanine, and glycine were significantly elevated during hyperosmotic salinity acclimation. Previous research indicates that taurine is the most abundant FAA in the gills and mantles of Asian hard clams and that the taurine transporter (TAUT) plays an important role in taurine accumulation. The present study showed that TAUT mRNA and protein expression were significantly and transiently increased in the mantle of Asian hard clams following exposure to seawater; although the expression of TAUT mRNA in the gills of Asian hard clams was also transiently stimulated by exposure to hyperosmotic salinity, the relative TAUT protein abundance decreased only at later stages. Accordingly, the findings of this study improve our understanding of the dynamic processes of ion and amino acid regulation in the peripheral tissues of bivalves under hyperosmotic stress.

Abstract Background Pelvic ring fracture is often combined with other injuries and such patients are considered at high risk of mortality and complications. There is controversy regarding the gold standard protocol for the initial treatment of pelvic fracture. The aim of this study was to assess which risk factors could affect the outcome and to analyze survival using our multidisciplinary institutional protocol for traumatic pelvic ring fracture. Material and methods This retrospective study reviewed patients who sustained an unstable pelvic ring fracture with Injury Severity Score (ISS) ≥ 5. All patients were admitted to the emergency department and registered in the Trauma Registry System of a level I trauma center from January 1, 2008, to December 31, 2017. The annular mortality rate after the application of our institutional protocol was analyzed. Patients with different systems of injury and treatments were compared, and regression analysis was performed to adjust for factors that could affect the rate of mortality and complications. Results During the 10-year study period, there were 825 unstable pelvic ring injuries, with a mean ISS higher than that of other non-pelvic trauma cases. The annual mortality rate declined from 7.8 to 2.4% and the mean length of stay was 18.1 days. A multivariable analysis showed that unstable initial vital signs, such as systolic blood pressure ISS > 15 (OR 4.84; CI 0.85–27.65), pulse rate

Older adults often experience functional decline following acute medical care. This functional decline may lead to permanent disability, which will increase the burden on the medical and long-term care systems, families, and society as a whole. Post-acute care aims to promote the functional recovery of older adults, prevent unnecessary hospital readmission, and avoid premature admission to a long-term care facility. Research has shown that post-acute care is a cost-effective service model, with both the hospital-at-home and community hospital post-acute care models being highly effective. This paper describes the post-acute care models of the United States and the United Kingdom and uses the example of Taiwan’s highly effective post-acute care system to explain the benefits and importance of post-acute care. In the face of rapid demographic aging and smaller household size, a post-acute care system can lower medical costs and improve the health of older adults after hospitalization.

State-of-charge (SOC) is a relative quantity that describes the ratio of the remaining capacity to the present maximum available capacity. Accurate SOC estimation is essential for a battery-management system. In addition to informing the user of the expected usage until the next recharge, it is crucial for improving the utilization efficiency and service life of the battery. This study focuses on applying deep-learning techniques, and specifically convolutional residual networks, to estimate the SOC of lithium-ion batteries. By stacking the values of multiple measurable variables taken at many time instants as the model inputs, the process information for the voltage or current generation, and their interrelations, can be effectively extracted using the proposed convolutional residual blocks, and can simultaneously be exploited to regress for accurate SOCs. The performance of the proposed network model was evaluated using the data obtained from a lithium-ion battery (Panasonic NCR18650PF) under nine different driving schedules at five ambient temperatures. The experimental results demonstrated an average mean absolute error of 1.260%, and an average root-mean-square error of 0.998%. The number of floating-point operations required to complete one SOC estimation was 2.24 × 106. These results indicate the efficacy and performance of the proposed approach.

BackgroundThis study investigated risks of mortality from and morbidity (emergency room visits (ERVs) and outpatient visits) of asthma and chronic obstructive pulmonary disease (COPD) associated with extreme temperatures, fine particulate matter (PM2.5), and ozone (O3) by sex, and age, from 2005 to 2016 in 6 metropolitan cities in Taiwan.MethodsThe distributed lag non-linear model was employed to assess age (0-18, 19-39, 40-64, and 65 years and above), sex-cause-specific deaths, ERVs, and outpatient visits associated with extreme high (99th percentile) and low (5th percentile) temperatures and PM2.5 and O3 concentrations at 90th percentile. Random-effects meta-analysis was adopted to investigate cause-specific pooled relative risk (RR) and 95% confidence intervals (CI) for the whole studied areas.ResultsOnly the mortality risk of COPD in the elderly men was significantly associated with the extreme low temperatures. Exposure to the 90th percentile PM2.5 was associated with outpatient visits for asthma in 0-18 years old boys [RR = 1.15 (95% CI: 1.09-1.22)]. Meanwhile, significant elevation of ERVs of asthma for females aged 40-64 years was associated with exposure to ozone, with the highest RR of 1.21 (95% CI: 1.05-1.39).ConclusionsThis study identified vulnerable subpopulations who were at risk to extreme events associated with ambient environments deserving further evaluation for adaptation.

South Asia, with more than one-fifth of the world’s population, is highly vulnerable to heatwaves and associated health consequences. The population experiences considerably higher residential vulnerability due to limited infrastructural capacities, economic resources, and health and environmental quality deficiencies. However, a limited number of studies are available from the region to account for the health effects of heatwaves. Therefore, this study has conducted a comprehensive review to characterize heatwaves across South Asian countries. The review explicitly identifies the population’s vulnerability to heatwaves during recent years and heatwave management policies in the region. The literature review suggests increased heat-related deaths in most South Asian countries, with few exceptions. In addition, the analysis of historical temperature records identified an upward trend in annual average temperature across the South Asian countries. The study highlights various heatwave definitions that have been used in the region to facilitate comparative evidence. The review of policies identified that only a few South Asian countries have functional heatwave management plans and majorly lack community and residential preparedness for heatwaves. Therefore, this study identifies potential community- and residential-based adaptation strategies to mitigate heat discomfort. As prospective solutions, the study recommends adaptation strategies such as blue–green spaces, indoor passive cooling, infrastructural adjustments, heat action plans, etc. However, such adaptation measures require a holistic amalgamation of different stakeholders to fabricate heatwave-resilient cities.

Fish of the tribe Thunnini represent a significant proportion of the stock caught by the fishing industry, with many of these fishes being collectively called tuna. However, only certain species can be used legally as an ingredient in canned tuna products, depending on regional food regulations. In Taiwan, only Thunnus species or Katsuwonus pelamis can be used as canned tuna. Here, we authenticated 90 canned tuna products, including 25 cat food samples, by sequencing two mitochondrial regions, 16S rRNA (16S) and the control region (CR). BLAST analysis revealed that Sarda orientalis, Euthynnus affinis, Auxis rochei, and Auxis thazard are all used as substitutes for legitimate tuna products. We found that 63.33% of investigated samples are true canned tuna, i.e., contain Thunnus species or skipjack tuna. We advocate that the Taiwanese government publishes an official standardized list of fishes, especially so that scientific, Chinese and vernacular names can be assigned unambiguously based on a “one species-one name policy”, thereby clarifying which species can be used in seafood products such as tuna. Furthermore, we feel that the large-scale and long-term monitoring of canned tuna products is warranted to fully assess the extent of tuna product adulteration in Taiwan.

Abstract Cholangiocarcinoma (CCA), a biliary tract malignancy, accounts for 20% of all liver cancers. There are several existing methods for diagnosis of CCA, though they are generally expensive, laborious, and suffer from low detection rates. Herein we first developed a means of partially purifying human bile for consequent injection into a microfluidic chip. Then, the novel microfluidic system, which featured 1) a cell capture module, 2) an immunofluorescence (IF) staining module featuring two CCA-specific biomarkers, and 3) an optical detection module for visualization of antibody probes bound to these CCA marker proteins, was used to detect bile duct cancer cells within partially purified bile samples. As a proof of concept, CCA cells were successfully captured and identified from CCA cell cultures, blood samples inoculated with CCA cells, and clinical bile specimens. In 7.5 ml of bile, this system could detect >2, 0, and 1 positive cells in advanced stage patients, healthy patients, and chemotherapy-treated patients, respectively. In conclusion, our microfluidic system could be a promising tool for detection of cancer cells in bile, even at the earliest stages of CCA when cancer cells are at low densities relative to the total population of epithelial cells.

Mislocalisation of tau occurs in several neurodegenerative diseases and is thought to contribute to synaptic function. The authors show that presynaptically, tau binds to synaptic vesicles via the N-terminus which contributes to synaptic dysfunction.

To convert external light into internal neural signal, vertebrates rely on a special group of proteins, the visual opsins. Four of the five types of visual opsins-short-wavelength sensitive 1 (Sws1), short-wavelength sensitive 2 (Sws2), medium-wavelength sensitive (Rh2), and long-wavelength sensitive (Lws)-are expressed in cone cells for scotopic vision, with the fifth, rhodopsin (Rh1), being expressed in rod cells for photopic vision. Fish often display differing ontogenetic cone opsin expression profiles, which may be related to dietary and/or habitat ontogenetic shift. The western mosquitofish (Gambusia affinis) is an aggressive invader that has successfully colonized every continent except Antarctica. The strong invasiveness of this species may be linked to its visual acuity since it can inhabit turbid waters better than other fishes. By genome screening and transcriptome analysis, we identify seven cone opsin genes in the western mosquitofish, including one sws1, two sws2, one rh2, and three lws. The predicted maximal absorbance wavelength (λmax) values of the respective proteins are 353 nm for Sws1, 449 nm for Sws2a, 408 nm for Sws2b, 516 nm for Rh2-1, 571 nm for Lws-1, and 519 nm for Lws-3. Retention of an intron in the lws-r transcript likely renders this visual opsin gene non-functional. Our real-time quantitative PCR demonstrates that adult male and female western mosquitofish do not differ in their cone opsin expression profiles, but we do reveal an ontogenetic shift in cone opsin expression. Compared to adults, larvae express proportionally more sws1 and less lws-1, suggesting that the western mosquitofish is more sensitive to shorter wavelengths in the larval stage, but becomes more sensitive to longer wavelengths in adulthood.

The tea cultivar ‘Xiaoxueya’, a temperature-sensitive albino mutant, is a rare tea germplasm because of its highly enriched amino acid content and brisk flavour. In comparison with green leaf tissues of ‘Xiaoxueya’, albino leaves show significant deficiency in chlorophylls and carotenoids and severely disrupted chloroplasts. Furthermore, the accumulation of quality-related secondary metabolites is altered in ‘Xiaoxueya’ albino leaf, with significantly increased contents of total amino acids, theanine, and glutamic acid and significantly decreased contents of alkaloids, catechins, and polyphenols. To uncover the molecular mechanisms underlying albinism and quality-related constituent variation in ‘Xiaoxueya’ leaves, expression profiles of pivotal genes involved in the biosynthetic pathways of pigments, caffeine, theanine, and catechins were investigated by quantitative real-time PCR technology. The results revealed that suppressed expression of the chloroplast-localized 1-deoxy-D-xylulose-5-phosphate synthase genes DXS1 and DXS2 involved in the 2-C-methyl-D-erythritol-4-phosphate (MEP) pathway and protochlorophyllide oxidoreductase genes POR1 and POR2 involved in the chlorophyll biosynthetic pathway is responsible for the pigment deficiency in ‘Xiaoxueya’ albino leaf. Additionally, the low expression of the tea caffeine synthase gene (TCS) involved in caffeine biosynthesis and the chalcone synthase genes CHS1, CHS2, and CHS3, the chalcone isomerase gene CHI, the flavonoid 3’,5’-hydroxylase genes F3’5’H1 and F3’5’H2, and the anthocyanidin reductase genes ANR1 and ANR2 involved in the flavonoid pathway is related to the reduction in alkaloid and catechin levels in ‘Xiaoxueya’ albino leaves.

INTRODUCTION:Enteral nutrition (EN) is important in the management of critically illness. Yet, the best route (e.g. pre-pyloric or post-pyloric) for EN in critically ill patients remains to be investigated, especially in specific surgical patients group. In addition, EN could be associated with a higher risk of aspiration pneumonia. Therefore, we evaluate the effect of various EN routes in surgical critically ill perforated peptic ulcer (PPU) patients who underwent surgery and required mechanical ventilation. METHOD:We collected data of surgical critically ill PPU patients admitted to intensive care unit. The patients were managed with appropriate care bundle and program. To reduce the impact of surgery types, we excluded those who had received other surgical procedures and included patients that only received simple closure. Patients were classified into nasogastric and jejunostomy feeding groups. The demographics, severity scores (e.g.: APACHE II, SOFA, and POSSUM), body mass index (BMI), comorbidities, ventilator days, use of proton pump inhibitors (PPIs), pneumonia occurrence, mortality and complications were collected for analysis. RESULTS:A total of 136 critically ill PPU patients that received surgery and mechanical ventilation were enrolled. There were 53 patients in NG group and 83 patients in FJ group. There were no differences in demographics, severity scores, BMI, comorbidities, ventilator days, use of PPIs, pneumonia occurrence, mortalities and complications between groups. CONCLUSION:Our study indicates that there are no differences in mortalities and pneumonia occurrence using nasogastric or feeding jejunostomy in surgical critically ill PPU patients underwent surgery. However, further studies are required.

Dengue fever is caused by four different serotypes of dengue virus (DENV) which is the leading cause of worldwide arboviral diseases in humans. Virus-like particles (VLPs) containing flavivirus prM/E proteins have been demonstrated to be a potential vaccine candidate; however, the structure of dengue VLP is poorly understood. Herein VLP derived from DENV serotype-2 were engineered becoming highly matured (mD2VLP) and showed variable size distribution with diameter of ~31 nm forming the major population under cryo-electron microscopy examination. Furthermore, mD2VLP particles of 31 nm diameter possess a T = 1 icosahedral symmetry with a groove located within the E-protein dimers near the 2-fold vertices that exposed highly overlapping, cryptic neutralizing epitopes. Mice vaccinated with mD2VLP generated higher cross-reactive (CR) neutralization antibodies (NtAbs) and were fully protected against all 4 serotypes of DENV. Our results highlight the potential of ‘epitope-resurfaced’ mature-form D2VLPs in inducing quaternary structure-recognizing broad CR NtAbs to guide future dengue vaccine design.

BACKGROUND:This study evaluated risks of emergency room visit (ERV) for out-of-hospital cardiac arrest (OHCA) in 2005-2011, among patients with cardiologic and metabolic syndromes (CMS), in association with ambient environments. METHODS:Pooled and area-specific weather related cumulative six-day (lags 0 to 5) relative risks (RRs) and confidence intervals (CIs) of ERV for OHCA were evaluated for CMS cases, using distributed lag nonlinear models and multivariate meta-analytical second-stage model in association with the daily average temperatures and daily concentrations of air pollutants. RESULTS:ERV risk increased as average temperature dropped to

Background/Aims: Copper is an essential trace element for normal cellular function and contributes to critical physiological or pathological processes. The aim of the study was to investigate the effects of copper on vascular tone of rat mesenteric artery and compare the effects of copper on noradrenaline (NA) and high K+ induced vasoconstriction. Methods: The rat mesenteric arteries were isolated and the vessel tone was measured by using multi wire myograph system in vitro. Blood pressure of carotid artery in rabbits was measured by using physiological data acquisition and analysis system in vivo. Results: Copper dose-dependently blunted NA-induced vasoconstriction of rat mesenteric artery. Copper-induced vasorelaxation was inhibited when the vessels were pretreated with NG-nitro-L-arginine methyl ester (L-NAME). Copper did not blunt high K+-induced vasoconstriction. Copper preincubation inhibited NA-evoked vasoconstriction and the inhibition was not affected by the presence of L-NAME. Copper preincubation showed no effect on high K+-evoked vasoconstriction. Copper chelator diethyldithiocarbamate trihydrate (DTC) antagonized the vasoactivity induced by copper in rat mesenteric artery. In vivo experiments showed that copper injection (iv) significantly decreased blood pressure of rabbits and NA or DTC injection (iv) did not rescue the copper-induced hypotension and animal death. Conclusion: Copper blunted NA but not high K+-induced vasoconstriction of rat mesenteric artery. The acute effect of copper on NA-induced vasoconstriction was depended on nitric oxide (NO), but the effect of copper pretreatment on NA-induced vasoconstriction was independed on NO, suggesting that copper affected NA-induced vasoconstriction by two distinct mechanisms.

Floods are known to cause serious environmental damage and health impacts. Studies on flood-related diseases have been primarily on individual events, and limited evidence could be drawn on potential health impacts from floods using large population data. This study used reimbursement records of one million people of the Taiwan National Health Insurance program to compare incident diseases of the eyes, skin and gastrointestinal (GI) tract associated with floods. Incidence rates for the selected diseases were calculated according to outpatient/emergency visit data. The incidence rates were evaluated by flood status: in 10 days before floods, during floods and within 10 days after the floods receded. Outpatient/emergency visit rates for the eye, skin and GI tract diseases were highest after floods and lowest during floods. Results from multivariate Poisson regression analyses showed that, when compared with the incidence in 10 days before floods, the incidence rate ratios (IRR) of diseases within 10 days after floods were 1.15 (95% confidence interval (CI) = 1.10-1.20) for eyes, 1.08 (95% C.I. = 1.05-1.10) for skin, and 1.11 (95% CI = 1.08-1.14) for GI tract, after controlling for covariates. All risks increased with ambient temperature. V-shaped trends were found between age and eye diseases, and between age and GI tract diseases. In contrast, the risk of skin diseases increased with age. In conclusion, more diseases of eyes, skin and GI tract could be diagnosed after the flood.

BackgroundExplosive growth of next-generation sequencing data has resulted in ultra-large-scale data sets and ensuing computational problems. Cloud computing provides an on-demand and scalable environment for large-scale data analysis. Using a MapReduce framework, data and workload can be distributed via a network to computers in the cloud to substantially reduce computational latency. Hadoop/MapReduce has been successfully adopted in bioinformatics for genome assembly, mapping reads to genomes, and finding single nucleotide polymorphisms. Major cloud providers offer Hadoop cloud services to their users. However, it remains technically challenging to deploy a Hadoop cloud for those who prefer to run MapReduce programs in a cluster without built-in Hadoop/MapReduce.ResultsWe present CloudDOE, a platform-independent software package implemented in Java. CloudDOE encapsulates technical details behind a user-friendly graphical interface, thus liberating scientists from having to perform complicated operational procedures. Users are guided through the user interface to deploy a Hadoop cloud within in-house computing environments and to run applications specifically targeted for bioinformatics, including CloudBurst, CloudBrush, and CloudRS. One may also use CloudDOE on top of a public cloud. CloudDOE consists of three wizards, i.e., Deploy, Operate, and Extend wizards. Deploy wizard is designed to aid the system administrator to deploy a Hadoop cloud. It installs Java runtime environment version 1.6 and Hadoop version 0.20.203, and initiates the service automatically. Operate wizard allows the user to run a MapReduce application on the dashboard list. To extend the dashboard list, the administrator may install a new MapReduce application using Extend wizard.ConclusionsCloudDOE is a user-friendly tool for deploying a Hadoop cloud. Its smart wizards substantially reduce the complexity and costs of deployment, execution, enhancement, and management. Interested users may collaborate to improve the source code of CloudDOE to further incorporate more MapReduce bioinformatics tools into CloudDOE and support next-generation big data open source tools, e.g., Hadoop BigTop and Spark.AvailabilityCloudDOE is distributed under Apache License 2.0 and is freely available at http://clouddoe.iis.sinica.edu.tw/.

Effervescent multiple-unit floating drug delivery systems (muFDDSs) consisting of drug (lorsartan)- and effervescent (sodium bicarbonate)-containing pellets were characterized in this study. The mechanical properties (stress and strain at rupture, Young's modulus, and toughness) of these plasticized polymeric films of acrylic (Eudragit RS, RL, and NE) and cellulosic materials (ethyl cellulose (EC), and Surelease) were examined by a dynamic mechanical analyzer. Results demonstrated that polymeric films prepared from Surelease and EC were brittle with less elongation compared to acrylic films. Eudragit NE films were very flexible in both the dry and wet states. Because plasticizer leached from polymeric films during exposure to the aqueous medium, plasticization of wet Eudragit RS and RL films with 15% triethyl citrate (TEC) or diethyl phthalate (DEP) resulted in less elongation. DEP might be the plasticizer of choice among the plasticizers examined in this study for Eudragit RL to provide muFDDSs with a short time for all pellets to float (TPF) and a longer period of floating. Eudragit RL and RS at a 1∶1 ratio plasticized with 15% DEP were optimally selected as the coating membrane for the floating system. Although the release of losartan from the pellets was still too fast as a result of losartan being freely soluble in water, muFDDSs coated with Eudragit RL and RS at a 1∶1 ratio might have potential use for the sustained release of water-insoluble or the un-ionized form of drugs from gastroretentive drug delivery systems.

This study evaluated risks of the emergency room visits (ERV) for cerebrovascular diseases, heart diseases, ischemic heart disease, hypertensive diseases, chronic renal failure (CRF), diabetes mellitus (DM), asthma, chronic airway obstruction not elsewhere classified (CAO), and accidents associated with the ambient temperature from 2000 to 2009 in metropolitan Taipei.The distributed lag non-linear model was used to estimate the cumulative relative risk (RR) and confidence interval (CI) of cause-specific ERV associated with daily temperature from lag 0 to lag 3 after controlling for potential confounders.This study identified that temperatures related to the lowest risk of ERV was 26 °C for cerebrovascular diseases, 18 °C for CRF, DM, and accidents, and 30 °C for hypertensive diseases, asthma, and CAO. These temperatures were used as the reference temperatures to measure RR for the corresponding diseases. A low temperature (14°C) increased the ERV risk for cerebrovascular diseases, hypertensive diseases, and asthma, with respective cumulative 4-day RRs of 1.56 (95% CI: 1.23, 1.97), 1.78 (95% CI: 1.37, 2.34), and 2.93 (95% CI: 1.26, 6.79). The effects were greater on, or after, lag one. At 32°C, the cumulative 4-day RR for ERV was significant for CRF (RR = 2.36; 95% CI: 1.33, 4.19) and accidents (RR = 1.23; 95% CI: 1.14, 1.33) and the highest RR was seen on lag 0 for CRF (RR = 1.69; 95% CI: 1.01, 3.58), DM (RR = 1.69; 95% CI: 1.09, 2.61), and accidents (RR = 1.19; 95% CI: 1.11, 1.27).Higher temperatures are associated with the increased ERV risks for CRF, DM, and accidents and lower temperatures with the increased ERV risks for cerebrovascular diseases, hypertensive diseases, and asthma in the subtropical metropolitan.

BACKGROUND: Cardiovascular diseases are the leading causes of death worldwide, especially for developed countries. Elevated mortality from cardiovascular diseases has been shown related to extreme temperature. We thus assessed the risk of mortality from cerebrovascular diseases, heart diseases, and ischemic heart disease (IHD) in relation to temperature profiles in four subtropical metropolitans (Taipei, Taichung, Tainan, and Kaohsiung) from 1994 to 2007 in Taiwan. METHODS: Distributed lag non-linear models were applied to estimate the cumulative relative risks (RRs) with confidence intervals of cause-specific mortality associated with daily temperature from lag 0 to 20 days, and specific effect of extreme temperature episodes with PM10, NOx, and O3, and other potential confounders controlled. Estimates for cause-specific mortalities were then pooled by random-effect meta-analysis. RESULTS: Comparing to centered temperature at 27 °C, the cumulative 4-day (lag 0 to 3) risk of mortality was significantly elevated at 31 °C for cerebrovascular diseases (RR = 1.14; 95% CI: 1.00, 1.31) and heart diseases (RR = 1.22; 95% CI: 1.02, 1.46) , but not for IHD (RR = 1.09; 95% CI: 0.99, 1.21). To the other extreme, at 15 °C, the cumulative 21-day (lag 0 to 20) risk of mortality were also remarkably increased for cerebrovascular diseases, heart diseases, and IHD (RRs = 1.48 with 95% CI: 1.04, 2.12, 2.04 with 95% CI: 1.61, 2.58, and 1.62 with 95% CI: 1.30, 2.01, respectively). Mortality risks for cardiovascular diseases were generally highest on the present day (lag 0) of extreme heat. No particular finding was detected on prolonged extreme temperature event by pooling estimations for cause-specific mortality. CONCLUSIONS: Low temperature was associated with greater risk of mortality from cardiovascular diseases in comparison with that of high temperature. Adverse effects of extreme temperatures are acute at the beginning of exposure.