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Although there have been numerous mobile learning studies, relatively few concerns the moderating impact of perceived fit on mobile learning outcomes. A total of 335 adult learners with a mobile language learning experience in Taiwan took part in this study. Partial least squares structural equation modelling (PLS-SEM) is used to determine the key factors that lead to better mobile learning performance. The results of this study show that perceived usefulness, playfulness and self-management of learning are positively linked to the intention to continue with mobile learning. The results also show that perceived flexibility and personal innovativeness have a positive impact on perceived usefulness and playfulness. It is also shown that perceived fit plays a moderating role in determining mobile learning continuance intention.

Background: Tele-assisted home-based palliative care (THPC) usually fulfills the desire of terminal patients to pass away at home. The overall costs of such a service deserve evaluation. Objectives: This study aims to determine health care utilization and costs for cancer patients at the end of life, stratified by THPC service. Design: Patients who received THPC were matched 1:1 based on age, gender, year of death, and propensity score with those who did not receive THPC. Setting/Subjects: A total of 773 cancer patients passed away in a regional hospital in Taiwan during the period of 2012–2020, of which 293 received THPC. Measurements: We measured the rates and costs of outpatient clinic visits, emergency department (ED) visits, hospitalizations, and intensive care unit (ICU) admissions during the last week, the last two weeks and the last month before death. In addition, we estimated the driving times and expenses required for transportation from each cancer patient's home to the hospital using Google Maps. National Health Insurance (NHI) reimbursements and out-of-pocket expenses were also calculated. Results: In comparison with patients without THPC, those who received THPC had a 50% lower likelihood of visiting the ED or being hospitalized, a more than 90% reduced chance of ICU admission, but were four times more likely to obtain their medicines from outpatient clinics. THPC patients had similar out-of-pocket expenditures, approximately half of the NHI costs, and lower rates and costs for ambulance transportation to the ED. Conclusions: THPC reduced health care costs for terminal cancer patients in the last week, the last two weeks, and the last month before death, while also increasing the likelihood of patients being able to rest and pass away at home. [ABSTRACT FROM AUTHOR]

Excessive use of synthetic fertilizer has been proven to be an important cause of greenhouse gas emissions and water pollution in many Asian countries. This article aims to provide a better understanding of rice farmers' preferences for a chemical fertilizer reduction scheme (CFRS) by integrating economic and psychometric factors. A survey of 292 farmers was conducted in Taiwan. The results show that farmers using more chemical fertilizers have a negative attitude towards implementing SAP and less trust in government and would prefer a higher entry payment over an eco-label. On the other hand, farmers using less chemical fertilizer prefer to receive an eco-label rather than incentive payments. Our findings indicate that an eco-label and higher entry payment could overcome the psychological factors that hinder farmers' engagement. This study provides policymakers with insights into farmers' decision-making, which could lead to chemical fertilizer reduction, thereby mitigating climate change. [ABSTRACT FROM AUTHOR]

The reference evapotranspiration (ET0) information is crucial for irrigation planning and water resource management. While the Penman-Monteith (PM) equation is widely recognized for ET0 calculation, its reliance on numerous meteorological parameters constrains its practical application. This study used 28 years of meteorological data from 18 stations in four geographic regions of Taiwan to evaluate the effectiveness of an artificial intelligence (AI) model for estimating PM-calculated ET0 using limited meteorological variables as input and compared it with traditional methods. The AI models were also employed for short-term ET0 forecasting with limited meteorological variables. The findings suggested that AI models performed better than their counterpart methods for ET0 estimation. The artificial neural network using temperature, solar radiation, and relative humidity as input variables performed best, with the correlation coefficient (r) ranging from 0.992 to 0.998, mean absolute error (MAE) ranging from 0.07 to 0.16 mm/day, and root mean square error (RMSE) ranging from 0.12 to 0.25 mm/day. For short-term ET0 forecasting, the long short-term memory model using temperature, solar radiation, and relative humidity as input variables was the best structure to forecast four-day-ahead ET0, with the r ranging from 0.608 to 0.756, MAE ranging from 1.05 to 1.28 mm/day, and RMSE ranging from 1.35 to 1.62 mm/day. The percentage error of this structure was within ± 5% for most meteorological stations over the one-year test period, underscoring the potential of the proposed models to deliver daily ET0 forecasts with acceptable accuracy. Finally, the proposed estimating and forecasting models were developed in regional and variable-limited scenarios, making them highly advantageous for practical applications. [ABSTRACT FROM AUTHOR]

Increasing insomnia signals a public health problem, alongside rising zolpidem use. This study investigates the factors behind the disproportionate rise in zolpidem prescriptions in Taiwan. It aims to identify the determinants of high-dose zolpidem users in Taiwan's Yilan County and employ an innovative approach to outline their medication-seeking patterns, using Taiwan's healthcare database. The associations between sociodemographic and clinical factors and low-dose and high-dose users were analyzed using multiple logistic regression. Social network analysis was employed to explore medication-seeking behavior among these user groups across different healthcare institutions. Of our 5290 participants, 22.82% are high-dose users. This study found that males face a 1.33-fold higher risk and that having chronic diseases is a major risk factor, contributing to a more than four-times higher risk (adjusted OR = 4.27, 95% CI 1.55–11.70) of being a high-dose user of zolpidem. A social network analysis showed a higher density (0.52) for high-dose users, revealing their frequent visits, for zolpidem, to different healthcare institutions. Psychiatrists have a central role in both low-dose and high-dose user networks, with a greater influence on low-dose users (64.4) than high-dose users (32.2). In sum, patients seeking high doses of zolpidem are driven by personal factors. Future efforts should include regulated dispensing, public health education, and specialized training for healthcare professionals on drug addiction. [ABSTRACT FROM AUTHOR]

In patients with atrial fibrillation (AF) and end-stage renal disease (ESRD), oral anticoagulants are contraindicated, and left atrial appendage occlusion (LAAO) is an alternative treatment. However, the efficacy of thromboembolic prevention using LAAO in these patients has rarely been reported in Asian populations. To our knowledge, this is the first long-term LAAO study in patients with AF undergoing dialysis in Asia. In this study, 310 patients (179 men) with a mean age of 71.3 ± 9.6 years and mean CHA2DS2-VASc 4.2 ± 1.8 were consecutively enrolled at multiple centers in Taiwan. The outcomes of 29 patients with AF and ESRD undergoing dialysis who underwent LAAO were compared to those without ESRD. The primary composite outcomes were stroke, systemic embolization, or death. No difference in mean CHADS-VASc score was noted between patients with versus without ESRD (4.1 ± 1.8 vs. 4.6 ± 1.9, p = 0.453). After a mean follow-up of 38 ± 16 months, the composite endpoint was significantly higher in patients with ESRD (hazard ratio, 5.12 [1.4–18.6]; p = 0.013) than in those without ESRD after LAAO therapy. Mortality was also higher in patients with ESRD (hazard ratio, 6.6 [1.1–39.7]; p = 0.038). The stroke rate was numerically higher in patients with versus without ESRD, but the difference was not statistically significant (hazard ratio, 3.2 [0.6–17.7]; p = 0.183). Additionally, ESRD was associated with device-related thrombosis (odds ratio, 6.15; p = 0.047). Long-term outcomes of LAAO therapy may be less favorable in patients with AF undergoing dialysis, possibly because of the poor condition of patients with ESRD. [ABSTRACT FROM AUTHOR]

Nowadays, it remains unclear whether the accumulation of Internet buzz can accurately predict customer preferences and buying intentions. We study two related perspectives with regard to what people talk about online and what they intend to do in the adoption phase to offer advice to companies aiming to excel in online marketing efforts. Drawing on the consumption value theory, we examine buyers' discussions about and intention to use wearable devices for a sample of consumers in Taiwan. A framework is advanced to explore the results of big data analysis employing text-mining techniques (i.e., what people talk about) and survey-based research using structural equation modelling (i.e., what people intend to do). Functional, emotional and conditional values surfaced as the highest Internet buzzes of wearable devices. Conversely, emotional, epistemic and functional values emerged as the most influential drivers of customers' adoption intention. Our findings suggest that different value dimensions are relevant at different points of the purchase-related decision-making process. Some values animate Internet discussions that pertain to the pre-purchase information search stage, and others appear significant during the formation of people's purchase intentions. We discuss the theoretical and practical implications of our study and provide suggestions for future research. [ABSTRACT FROM AUTHOR]

This study investigates the impact of financial technology (fintech) on bank efficiency in Taiwan from 2007 to 2020, using parametric and non-parametric analyses. In the future, fintech is expected to play an important role in bank sustainability operations. The findings show that fintech-related initiatives affect bank efficiency. These results illustrate how fintech can help banks directly or indirectly improve their efficiency, leading to higher profits or lower costs. For instance, mobile payment systems, a fintech-related initiative, improve bank efficiency. However, this degree of improvement is not substantial. In general, the findings imply that fintech-related initiatives do not significantly improve bank efficiency, implying an IT "productivity paradox." [ABSTRACT FROM AUTHOR]

Objectives: Most studies of body size perception have been performed in adolescents, and most focus on gender differences in accurate perception of body size. This study investigated misperceptions of body sizes among males and females at different stages of adulthood in Taiwan. Designs: In-person home interviews were used to proportionally and randomly select 2095 adult men and women to answer the East Asian Social Survey. Participants were divided into 18–39, 40–64, and 65 + age groups. The main variables analyzed were self-perceived body size and standardized BMI. Results: Women, unlike men, were more likely to misperceive their body size as being overweight (OR = 2.92; p <.001). People with higher self-perceived social status were less likely to misperceive themselves as overweight (OR = 0.91; p =.01). People with college educations were 2.35 times more likely to overestimate their body size as being heavier than they were (p <.001) and less likely to underestimate it as being thinner than they were (OR = 0.45; p <.001). Women 18–35 and 36–64 years old were 6.96 and 4.31 times more likely (p <.001) to misperceive themselves as being overweight than women 65 or older, who were more likely to misperceive themselves as being too thin. There were no significant differences in body size misperceptions among the three age groups of adult men (p >.05). We found no different significant discrepancies between self-perceived body size and actual BMI between the older men and women (p =.16). However, younger and middle-aged men were 6.67 and 3.1 times more likely to misperceive themselves as being too thin than women in their same age groups (OR = 0.15 and OR = 0.32, respectively). Conclusions: Age and gender affect self-perceptions of body size in Taiwan. Overall, women are more likely than men to misperceive themselves as being too big, and men are more likely than women to misperceive themselves as too thin. Older women, however, were more likely to misperceive themselves as being too thin. Clinicians and health educators should know that people's perceptions and concerns regarding their body size vary by age and gender. [ABSTRACT FROM AUTHOR]

This study investigates whether deregulation has affected bank efficiency in the 'cross-strait' relationship between China and Taiwan. I measure bank efficiency across three periods – after Taiwan and China joined the World Trade Organization, the global financial crisis, and the signing of the Economic Cooperation Framework Agreement (ECFA) – and show that Taiwanese banks were significantly more efficient than their Chinese counterparts. These results show that the ECFA platform has not improved bank efficiency and thus has failed to function effectively. This finding suggests that China and Taiwan should continue negotiating within the ECFA context to enhance cross-strait financial cooperation. [ABSTRACT FROM AUTHOR]

This is the first study to integrate structural and non-structural approaches into the evaluation of competitive conditions for banks in Taiwan. It is found that the results of structural and non-structural approaches are compatible. This study finds that market share may not have a significant impact on banks' efficiency but may significantly impact profitability. This implies that banks are willing to sacrifice something to expand their market share, such as not enforcing minimum cost targets and wasting resources to raise an already unrealistic market share target. Furthermore, it is essential to pay attention to the observation that the degrees of competition deteriorated after the Global Financial Crisis (GFC). This argues that the transmission mechanism from market structure to performance occurring through product differentiation is able to exercise market power in banks products and earn supernormal profit, which is normally associated with dominant banks and not with collusive behaviour. [ABSTRACT FROM AUTHOR]

Aim: To examine the longitudinal trajectory of intrinsic capacity over a 3‐year period among long‐term care recipients in Taiwan, its association with functional decline and the onset of severe dependency. Methods: A total of 9448 individuals aged ≥50 years utilizing home and community‐based long‐term care services with complete data from three separate evaluations in Taiwan were included in the study. We carried out a latent class linear mixed model to identify heterogeneous patterns of intrinsic capacity over time, a mixed‐effects model to investigate their impact on activities of daily living and a Kaplan–Meier analysis to examine the onset year of severe dependency among different intrinsic capacity classes. Results: The results identified four classes sharing similar longitudinal the intrinsic capacity trajectories: "high‐stable" (20.13%), "normal‐stable" (40.58%), "sensory‐dysfunction" (29.53%) and "all‐dysfunction" (9.76%). Individuals with predisposing characteristics were associated with lower activities of daily living, with the exception of age and education level. In addition, the poor intrinsic capacity class (b from −16.94 to −6.61, P < 0.001) had a worse evolution in terms of activity of daily living scores, and was associated with an earlier onset of severe dependency in 2.5 years in the all‐dysfunction class. Conclusions: Heterogeneous patterns of intrinsic capacity that delay further functional decline are promising markers of function trajectories for a person‐centered care approach in long‐term care services. Targeting the needs of intrinsic capacity groups to prevent functional decline offer insights into: (i) strengthening function‐centered care modalities to delay severe dependency as individuals get older; and (ii) validating regular monitoring intrinsic capacity as an early warning system to achieve healthy aging. Geriatr Gerontol Int 2022; 22: 516–522. [ABSTRACT FROM AUTHOR]

Background Reuse of cardiac implantable electronic devices (CIEDs) can reduce the cost of using these expensive devices. However, whether resterilized CIEDs will increase the risk of reinfection in patients with previous device infection remains unknown. The aim of the present study is to compare the reinfection rates in patients who had initial CIED infection and underwent reimplantation of resterilized CIEDs or new devices. Methods Data from patients with initial CIED infection who received debridement of the infected pocket and underwent reimplantation of new or resterilized CIEDs at MacKay Memorial Hospital, Taipei, Taiwan, between January 2014 and June 2019 were retrospectively analyzed. Patient characteristics, relapse rates of infection, and potential contributing factors to the infection risk were examined. Results Twenty-seven patients with initial CIED infection and reimplanted new CIEDs (n = 11) or resterilized CIEDs (n = 16) were included. During the 2-year follow-up, there were 1 (9.1%) and 2 (12.5%) infection relapses in the new and resterilized CIED groups, respectively. No relapse occurred for either group if the lead was completely removed or cut short. The median duration between debridement and device reimplantation in patients with infection relapse vs patients without relapse was 97 vs 4.5 days for all included patients, and 97 vs 2 days and 50.5 vs 5.5 days for the new and resterilized CIED groups, respectively. Conclusions Subpectoral reimplanting of resterilized CIEDs in patients with previous device infection is safe and efficacious. With delicate debridement and complete extraction of the leads, the CIED pocket infection relapse risk can be greatly decreased. [ABSTRACT FROM AUTHOR]

Background/purpose: We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan.Methods: We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002-2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC.Results: The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million.Conclusion: Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted. [ABSTRACT FROM AUTHOR]

Vegetable soybeans [ Glycine max (L.) Merr.] have characteristics of larger seeds, less beany flavor, tender texture, and green-colored pods and seeds. Rich in nutrients, vegetable soybeans are conducive to preventing neurological disease. Due to the change of dietary habits and increasing health awareness, the demand for vegetable soybeans has increased. To conserve vegetable soybean germplasms in Taiwan, we built a core collection of vegetable soybeans, with minimum accessions, minimum redundancy, and maximum representation. Initially, a total of 213 vegetable soybean germplasms and 29 morphological traits were used to construct the core collection. After redundant accessions were removed, 200 accessions were retained as the entire collection, which was grouped into nine clusters. Here, we developed a modified Roger's distance for mixed quantitative–qualitative phenotypes to select 30 accessions (denoted as the core collection) that had a maximum pairwise genetic distance. No significant differences were observed in all phenotypic traits (p- values > 0.05) between the entire and the core collections, except plant height. Compared to the entire collection, we found that most traits retained diversities, but seven traits were slightly lost (ranged from 2 to 9%) in the core collection. The core collection demonstrated a small percentage of significant mean difference (3.45%) and a large coincidence rate (97.70%), indicating representativeness of the entire collection. Furthermore, large values in variable rate (149.80%) and coverage (92.5%) were in line with high diversity retained in the core collection. The results suggested that phenotype-based core collection can retain diversity and genetic variability of vegetable soybeans, providing a basis for further research and breeding programs. [ABSTRACT FROM AUTHOR]

Background: Long-term use of oral corticosteroids has known adverse effects, but the risk from brief oral steroid bursts (≤14 days) is largely unknown.Objective: To examine the associations between steroid bursts and severe adverse events, specifically gastrointestinal (GI) bleeding, sepsis, and heart failure.Design: Self-controlled case series.Setting: Entire National Health Insurance Research Database of medical claims records in Taiwan.Participants: Adults aged 20 to 64 years with continuous enrollment in the National Health Insurance program from 1 January 2013 to 31 December 2015.Measurements: Incidence rates of severe adverse events in steroid burst users and non-steroid users, as well as incidence rate ratios (IRRs) for severe adverse events within 5 to 30 and 31 to 90 days after initiation of steroid therapy.Results: Of 15 859 129 adult participants, 2 623 327 who received a single steroid burst were included. The most common indications were skin disorders and respiratory tract infections. The incidence rates per 1000 person-years in steroid bursts were 27.1 (95% CI, 26.7 to 27.5) for GI bleeding, 1.5 (CI, 1.4 to 1.6) for sepsis, and 1.3 (CI, 1.2 to 1.4) for heart failure. Rates of GI bleeding (IRR, 1.80 [CI, 1.75 to 1.84]), sepsis (IRR, 1.99 [CI, 1.70 to 2.32]), and heart failure (IRR, 2.37 [CI, 2.13 to 2.63]) significantly increased within 5 to 30 days after steroid therapy initiation and attenuated during the subsequent 31 to 90 days.Limitation: Persons younger than 20 years or older than 64 years were not included.Conclusion: Oral corticosteroid bursts are frequently prescribed in the general adult population in Taiwan. The highest rates of GI bleeding, sepsis, and heart failure occurred within the first month after initiation of steroid therapy.Primary Funding Source: National Health Research Institutes, Ministry of Science and Technology of Taiwan, Chang Gung Medical Foundation, and Eunice Kennedy Shriver National Institute of Child Health and Human Development. [ABSTRACT FROM AUTHOR]

Although research suggests that Eastern, collectivist cultures do not benefit as much from practicing gratitude compared to Western, individualist cultures, the reasons for these differences remain unclear. In a single time-point randomized controlled intervention, participants in India (N = 431), Taiwan (N = 112), and the U.S. (N = 307) were randomly assigned either to write a gratitude letter to someone who had done a kind act for them, to write a gratitude letter to themselves for a kind act they had done for another person, or to complete a neutral control writing activity. Immediately after completing their assigned writing activity, participants completed measures of state gratitude, elevation, and emotions (guilt, indebtedness, embarrassment, positive affect, and negative affect). U.S. (but not Indian and Taiwanese) participants who expressed gratitude reported greater state gratitude relative to controls. Although not explicitly grateful, however, Indian and Taiwanese participants who wrote gratitude letters reported higher elevation (and Indian participants, reduced negative affect) compared to control participants. Finally, compared to control participants, Taiwanese (but not U.S.) participants felt less guilty when writing a gratitude letter to themselves. The results provide new insights for why expressing gratitude may be a less effective happiness-promoting activity in collectivist cultures. [ABSTRACT FROM AUTHOR]

Background: The number of patients receiving prolonged mechanical ventilation (PMV) or maintenance dialysis (MD) is increasing worldwide. Identification of those with a short life expectancy is useful for early referral of palliative care. Objective: To determine the survival rate, life expectancy, and major prognostic factors in patients under both PMV and MD. Design: We extracted a 1:3.4 random sample of patients treated with mechanical ventilation (MV) from the National Health Insurance (NHI) Research Database of Taiwan from 2003 to 2007. Subjects who had undergone MD and received MV for longer than 21 days were enrolled. Setting/Subjects: There were 1035 patients who received both PMV and MD. Measurements: The survival rates and life expectancy were estimated. A multivariate proportional hazards model was constructed to validate the effects of different prognostic factors, including age, gender, hospital size, and major comorbidities. Results: The median length of survival of patients under both PMV and MD was 54 days. The three-month, six-month, and one-year survival rates were 40.8%, 24.1%, and 12.6%, respectively. The life expectancies of those older than 70 years were five months; those comorbid with cancer and septicemia were 112 and 90 days, respectively. After adjustments for covariates, we found following prognostic factors were statistically significant: gangrene, peritonitis, liver cirrhosis, cancer, septicemia, hydrocephalus, having device complications, and shock. Conclusions: More than 85% of patients receiving both PMV and MD died within one year. Communication and early referral for palliative care would be indicated for those comorbid with significant prognostic factors. [ABSTRACT FROM AUTHOR]

Purpose: Few empirical studies have investigated hematological parameters among people with a heroin use disorder. This study explores the prevalence of macrocytosis and associated factors among patients with heroin use disorder who were entering methadone maintenance treatment (MMT) in Taiwan. Patients and methods: In this cross-sectional study, hematological parameters were measured and the prevalence of macrocytosis was assessed in a sample of 958 patients with a heroin use disorder entering the MMT program at Tsaotun Psychiatric Center in Taiwan. The demographic characteristics, heroin-related issues, other substance use history, and other clinical variables were analyzed. Univariate analysis was used to assess the association of all variables. Multivariable logistic regression was used to identify the relationship between the significant factors and macrocytosis. Results: The study found that nearly one-fifth (19.5%) of the participants had macrocytosis. Older age, longer duration of heroin use, and more days of alcohol use within the previous month were associated with macrocytosis. Conclusion: We found that concurrent use of alcohol was an important factor related to macrocytosis among people with a heroin use disorder. The prevalence of macrocytosis indicated that alcohol use is common among this population. It is suggested that policies and practices regarding alcohol use should be addressed within methadone maintenance programs. [ABSTRACT FROM AUTHOR]

Background: Targeted therapies have become important treatment options for cancer care in many countries. This study aimed to examine recent trends in utilization of antineoplastic drugs, particularly the use of targeted therapies for treatment of cancer, by geographic region in Taiwan (northern, midwestern, southern, and eastern regions and the outer islands).Methods: This was a retrospective observational study of antineoplastic agents using 2009-2012 quarterly claims data from Taiwan's National Health Insurance Research Database. Yearly market shares by prescription volume and costs for targeted therapies among total antineoplastic agents by region were estimated. We used multivariate regression model and ANOVA to examine variations in utilization of targeted therapies between geographic regions and used ARIMA models to estimate longitudinal trends.Results: Population-adjusted use and costs of antineoplastic drugs (including targeted therapies) were highest in the southern region of Taiwan and lowest in the outer islands. We found a 4-fold difference in use of antineoplastic drugs and a 49-fold difference in use of targeted therapies between regions if the outer islands were included. There were minimal differences in use of antineoplastic drugs between other regions with about a 2-fold difference in use of targeted therapies. Without considering the outer islands, the market share by prescription volume and costs of targeted therapies increased almost 2-fold (1.84-1.90) and 1.5-fold (1.26-1.61) respectively between 2009 and 2012. Furthermore, region was not significantly associated with use of antineoplastic agents or use of targeted therapies after adjusting for confounders. Region was associated with costs of antineoplastic agents but it was not associated with costs of targeted therapies after confounding adjustments.Conclusions: Use of antineoplastic drugs overall and use of targeted therapies for treatment of cancer varied somewhat between regions in Taiwan; use was notably low in the outer islands. Strategies might be needed to ensure access to cancer care in each region as economic burden of cancer care increase due to growing use of targeted therapies. [ABSTRACT FROM AUTHOR]

Background/purpose: Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma type. The immunophenotypic and genetic features of DLBCL in Taiwan have not been characterized.Methods: In this study, we performed immunohistochemical analysis and interphase fluorescence in situ hybridization (FISH) using tissue microarray sections to investigate a cohort of unselected DLBCL cases in a single institution in Taiwan from 1990 to 2010.Results: Of the 153 cases investigated, CD10, bcl-6, and MUM1 were expressed in 16.3%, 71.2%, and 71.9% cases, respectively, with 27.5% (n = 42) of cases being classified as having a germinal center B-cell (GCB) origin by the Hans algorithm. By FISH analysis, 19.6%, 4.6%, 26.1%, and 3.9% cases showed rearrangement at IGH, BCL2, BCL6, and MYC loci, respectively, including three (2.0%) cases of double-hit lymphoma. As compared with the non-GCB tumors, GCB tumors more frequently expressed CD10 (p < 0.001) and bcl-6 (p = 0.001) with less frequent expression of MUM1 (p = 0.007). Moreover, GCB tumors more frequently exhibited rearrangement at the BCL2 (p = 0.024) and MYC (p = 0.038) loci than non-GCB tumors. However, there was no survival difference between these two groups.Conclusion: In this first series of DLBCL evaluation from Taiwan, we found that the relative frequency of GCB tumors among DLBCL was low in most East Asian countries. There is a wide range of BCL2 rearrangement rates, higher in the West and lower in East Asia. A larger and/or national study is warranted to better understand the immunophenotypic and molecular features of DLBCL in Taiwan and their respective impact on patient survival. [ABSTRACT FROM AUTHOR]

This study evaluates an appropriate business model for e-book firms in Taiwan. We apply expert questionnaires to calculate the weights, which contain five criteria, namely, business strategy (BS), finance characteristics (FC), market characteristics (MC), quality measurements of product and service (QS) and implementation (IM) (BCCSM) for the capability of developing the firms’ business. Then, a fuzzy analytic hierarchy process (FAHP) is adopted to explore the weights of indices, and the VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR), grey relation analysis (GRA), and the technique for order preference by similarity to ideal solution (TOPSIS) are utilized to rank the three alternatives. The results show that a single brand is the best e-book firms’ business strategy that is simultaneously integrated by content, platforms, and devices, while the top two weights of the evaluation criteria are the business strategy and market characteristics to enable firms to develop an appropriate e-book business model. [ABSTRACT FROM AUTHOR]

Aims Connective tissue growth factor ( CTGF) is an emerging marker for tissue fibrosis. We investigated the association between CTGF and cardiac diastolic function using cellular and animal models and clinical human data. Methods and results A total of 125 patients with a diagnosis of diastolic heart failure ( DHF) were recruited from 1283 patients of the Taiwan Diastolic Heart Failure Registry. The severity of DHF was determined by tissue Doppler imaging (E/e′). Cardiac magnetic resonance imaging ( CMRI) was used to evaluate myocardial fibrosis in some of the patients ( n = 25). Stretch of cardiomyocytes on a flexible membrane base serves as a cellular phenotype of cardiac diastolic dysfunction ( DD). A canine model of DD was induced by aortic banding. A significant correlation was found between plasma CTGF and E/e′ in DHF patients. The severity of cardiac fibrosis evaluated by CMRI also correlated with CTGF. In the cell model, stretch increased secretion of CTGF from cardiomyocytes. In the canine model, myocardial tissue CTGF expression and fibrosis significantly increased after 2 weeks of aortic banding. Notably, the expression of CTGF paralleled the severity of LV DD ( r = 0.40, P < 0.001 for E/e') and haemodynamic changes ( r = 0.80, P < 0.001). After adjusting for confounding factors, CTGF levels still correlated with diastolic parameters in both human and canine models (human plasma CTGF, P < 0.001; canine tissue CTGF, P = 0.04). Conclusion Plasma CTGF level correlated with the severity of DD and tissue fibrosis in DHF patients. The mechanism may be through myocardial stretch. Our study indicated that CTGF may serve as an early marker for DHF. [ABSTRACT FROM AUTHOR]

Aims To investigate t(14;18)/ IGH-BCL2 in follicular lymphoma ( FL) cases from Taiwan. Methods and results We retrospectively studied 93 consecutive cases, using immunohistochemistry and fluorescence in-situ hybridization ( FISH). Fifty-nine (63%) tumours were low-grade ( LG) and 34 (37%) were high-grade ( HG; 24% FL3A and 13% FL3B). FISH showed IGH, BCL2 and BCL6 rearrangements in 59%, 47% and 11% of cases, respectively, and MYC rearrangement in 5% of FL3A tumours and 25% of FL3B tumours. The translocation partner of all BCL2 rearrangements was IGH, with IGH-BCL2 fusion in 63% of LG tumours and 18% of HG tumours. LG tumours were enriched with a CD10+/bcl-2+/ MUM1- phenotype, and were frequently associated with BCL2 rearrangement but less commonly with BCL6 rearrangement. FL3A tumours were more closely related to FL3B tumours than to LG tumours in immunophenotype and genetic aberrations. There was no statistically significant difference between grade 1 and two tumours, between FL3A and FL3B tumours or between nodal and extranodal tumours in immunophenotypic or FISH findings. The cumulative survival rate was higher in LG FL patients with IGH-BCL2 translocation than in those without rearrangement. Conclusions In Taiwan, FL3A tumours were more closely related to FL3B tumours than to LG tumours, and a literature review showed that the frequency of t(14;18)/ IGH-BCL2 in FL in Taiwan is among the lowest in the world. [ABSTRACT FROM AUTHOR]

Summary: Background: Aging is known to play a key role in the development of cardiovascular diseases (CVDs). Although aging is associated with mitochondria dysfunction, the impact of mitochondria-related aging on CVDs has remained unclear in Taiwan. Methods: The Mitochondria-AGing in NorthErn Taiwan (MAGNET) study, a prospective study, was initiated in December 2010 to investigate the prevalence, determinants and the progress of CVDs and related risks in a community-dwelling sample of about 3000 men and women from suburban areas of northern Taiwan. The middle-aged population comprises the majority of the whole cohort in a 3-year collection period. This study also examines a link between baseline characteristics and the development of subclinical atherosclerosis. Data obtained will include information regarding baseline demographics, body surface electrocardiography, blood bio-specimen components, measurement of cardiac and carotid structure and function by ultrasonography, socioeconomic status, life styles, and life quality scoring including short-form SF-36. Additional survey of blood samples, including analysis of endothelial progenitor cells and the mitochondria function, and biomarkers, for a nested case-control study will be performed. All participants will be followed for incidence and characterization of related cardiovascular events. Conclusion: This study is expected to clarify the role of mitochondria-related aging in the development of CVDs and functional changes in sub-urban areas of Taiwan. [ABSTRACT FROM AUTHOR]

Foxtail millet is one of the world's oldest cultivated crops. It has been adopted as a model organism for providing a deeper understanding of plant biology. In this study, 45 simple sequence repeats (SSR) markers of Setaria italica were developed. These markers showing polymorphism were screened in 223 samples from 12 foxtail millet populations around Taiwan. The most common dinucleotide and trinucleotide repeat motifs are AC/TG (84.21%) and CAT (46.15%). The average number of alleles (Na), the average heterozygosities observed (Ho) and expected (He) are 3.73, 0.714, 0.587, respectively. In addition, 24 SSR markers had shown transferability to six related Poaceae species. These new markers provide tools for examining genetic relatedness among foxtail millet populations and other related species. It is suitable for germplasm management and protection in Poaceae. [ABSTRACT FROM AUTHOR]

Galectin-3 is a beta-galactoside-binding lectin which is involved in modulating inflammation and apoptosis. Elevated expression of galectin-3 has been demonstrated in synovium of rheumatoid arthritis (RA). The aim of our study is to investigate the genetic polymorphisms of galectin-3 in association with RA. Polymorphisms of galectin-3 gene ( LGALS3) were compared between 151 RA patients and 182 healthy subjects in Taiwan. Variants at two LGALS3 single nucleotide polymorphism (SNP) sites (rs4644 and rs4652, corresponding to LAGLS3 +191 and +292) were genotyped by polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) and sequence-specific oligonucleotide probe hybridization, respectively. The allelic carriage of LGALS3 +292C was increased in patients with RA (66.9% in RA vs. 52.7% in controls, odds ratio = 1.8, 95% confidence interval = 1.2-2.8, p = 0.009). These results implicate that the genetic polymorphisms in galectin-3 gene may contribute to development of RA. [ABSTRACT FROM AUTHOR]

Abstract: Nasal and nasal-type NK/T-cell lymphomas are predominantly extranodal tumors with a specific immunophenotype and a strong association with EBV. The cutaneous lymphocyte-associated antigen (CLA) is the homing receptor for skin-homing T cells and NK cells. In the literature, the prognostic impact of CLA expression in primary cutaneous T-cell lymphomas and nasal NK-cell lymphomas is contradictory. We present 2 non-nasal NK-cell lymphomas with nodal presentation. Both tumors showed the phenotype of CD3+ (cytoplasmic), CD5−, CD7−, CD16+, CD56+, cytotoxic molecules+, EBV+ (by in situ hybridization), and CLA+. They were polyclonal for T-cell receptor γ chain gene rearrangement, indicating an NK cell lineage. The aggressive course in these two patients suggested that in nasal and nasal-type NK-cell lymphomas, CLA expression might be an indicator of poor prognosis. More studies are needed to elucidate the prognostic impact of CLA expression in T cell and NK-cell lymphomas. [Copyright &y& Elsevier]

Background Measuring parameters in the management of acute myocardial infarction (AMI) has been used as the standard for evaluating quality of care (QC). The purpose of this study was to elucidate the completeness of information retrieval from electronic discharge notes (EDN) as well as to measure QC for AMI in Taiwan. Methods All the narrative reports in EDN in the clinical information systems (CIS) of National Taiwan University Hospital from 2002 to 2004 were retrieved, and the patients who presented to the emergency room (ER) with AMI were identified. Ten parameters related to QC for AMI were measured through data-mining of EDN alone as well as through an extensive search of the CIS and paper medical records. Results Information retrieval from EDN alone could obtain some parameters with a high recall, such as the use and timing of reperfusion therapy and the prescription of medication at discharge. Other parameters, such as the early management at ER and lipid profile after discharge, could not be retrieved from EDN. The use of medication and early reperfusion therapy was comparable to the US standards, while lipid control at and after discharge were suboptimal. Conclusions This study has demonstrated that information retrieval from EDN alone could faithfully extract sufficient measures of QC for AMI in some aspects, as well as could quantify the current process of QC for AMI in Taiwan. [ABSTRACT FROM AUTHOR]

Primary non-Hodgkin's lymphoma of bone (PLB) is a rare disorder representing less than 1% of all non-Hodgkin's lymphomas and has rarely been reported in Taiwan. A retrospective clinicopathological study was performed according to the 2002 World Health Organization criteria and identified 14 cases during a 13-year period in 2 medical centers in southern Taiwan. There was male predominance (M:F = 6:1) with a median age of 42 and bone pain (6 patients, 43%) as the most common symptom. Half of the patients had monostotic and the other half polyostotic lesions. Axial skeletons (10 cases, 71%) were the most frequent sites of involvement. The staging results were stage I (9 patients, 64%), stage II (2, 14%) and stage IV (3, 21%). Eight cases (57%) were of B-cell phenotype and the remaining 6 (43%), T-cell. Histologically, 7 (50%) were diffuse large B-cell lymphomas (DLBCLs) and 5 (36%) anaplastic large cell lymphomas. Seven patients received chemotherapy and radiotherapy; 4 chemotherapy and 3 radiotherapy alone. Of the 11 patients with follow-up information, 6 (55%) died of disease within 1 year including 5 with T-cell lymphomas, while all the 5 patients surviving over 1 year were of B-cell phenotype. The overall 1-year survival rate was 45%. The survival of B-cell lymphomas was significantly better than T-cell tumors ( p = 0.016, log-rank test). In summary, this study reported the largest series of PBL in Taiwan and confirmed that the majority was DLBCL and B-cell tumors had more favorable prognosis. As compared to the Western series, the cases showed a striking male predominance, higher percentage of axial skeleton involvement, higher relative frequency of T-lineage tumors and poorer prognosis. [ABSTRACT FROM AUTHOR]

Generic quality of life (QoL) is an important issue in decision making related to the primary treatment of localized prostate cancer (PC). This study assessed the dynamic changes of QoL in patients with localized PC under different treatment modalities. From 2013 to 2018, we prospectively assessed QoL scores in patients with localized PC under unitary treatment using the World Health Organization Quality of Life (WHOQOL) BREF version. The trajectories of the QoL scores after different treatments were estimated using a kernel-smoothing method. Dynamic changes in the major determinants were analyzed using a mixed effects model. The clinical features of the participants in our institute were compared with PC patients in Taiwan's cancer registry. A total of 196 patients were enrolled with 491 repeated assessments. The participants shared similar clinical characteristics with the PC patients in Taiwan as a whole. Patients with lower household incomes showed statistically significant lower scores on all four domains and related facets, while PC survivors with comorbidities of anxiety and/or diabetes appeared to be affected on the physical domain and related facets. After controlling for these determinants, patients under active surveillance or observation demonstrated significantly higher QoL scores in the physical and social domains, as well as several facets belonging to these domains, in mixed models compared with patients undergoing radical prostatectomy or radiotherapy within the first year. The generic QoL scores were higher within the first year in patients receiving active surveillance or observation after controlling other significant factors. The difference diminished after one year of post management. More studies are needed to corroborate our findings. [ABSTRACT FROM AUTHOR]

Presents the analysis of samples of sailfish fillet that was eaten during a 1994 food poisoning outbreak in western Taiwan. Analysis for amines by a gradient elution system of HPCL; Detection of amines; Toxic level of concentration of histamine; Reasonable evidence of food poisoning.

Background and Objectives: The relationships of dietary choline and folate intake with hepatic function have yet to be established in the Taiwanese population. We investigated the associations of choline and folate intake with hepatic inflammatory injury in Taiwanese adults.Methods and Study Design: Blood samples and data on dietary choline components and folate intake from 548 Taiwanese adults without pathological liver disease were collected. Dietary intake was derived using a semiquantitative food-frequency questionnaire. Serum liver injury markers of alanine transaminase, aspartate transaminase, and hepatitis viral infection were measured.Results: Elevated serum hepatic injury markers (>40 U/L) were associated with low folate and free choline intake (p<0.05). Folate intake was the most significant dietary determinant of serum aspartate transaminase concentration (beta=-0.05, p=0.04), followed by free choline intake (beta=-0.249, p=0.055). Folate intake exceeding the median level (268 μg/d) was correlated with a reduced rate of hepatitis viral infection (p=0.032) and with normalized serum aspartate transaminase (odds ratio [OR]=0.998, 95% confidence interval [CI]=0.996-1, p=0.042) and alanine transaminase (OR=0.998, 95% CI=0.007-1, p=0.019). Total choline intake exceeding the median level (233 mg/d) was associated with normalized serum aspartate transaminase (OR=0.518, 95% CI=0.360-0.745, p=0.018).Conclusions: The newly established relationships of dietary intake of total choline and folate with normalized hepatic inflammatory markers can guide the development of dietary choline and folate intake recommendations for Taiwanese adults. [ABSTRACT FROM AUTHOR]

Genetic mutagenesis can create novel alleles that do not exist in nature germplasms and has been widely used for the improvement of crop plants. Rice blast caused by Magnaporthe oryzae is one of the most destructive disease for rice production. For now, limited mutation-derived varieties associated with blast resistance were reported. In this study, a rice TNG67 mutant pool, developed by using sodium azide (SA) mutagenesis, contained more than 3000 pure mutant lines (SA mutants), were utilized. 50 SA mutants derived from rice blast susceptible variety TNG67 as well as other commercial and differential varieties were challenged with 89 blast isolates collected in Taiwan to understand their blast resistance spectrum. The results showed that SA mutants displayed different responses to M. oryzae, ranging from highly susceptible (6.7%) to highly resistant (100%). Seven mutants showed broad-spectrum resistance against the tested blast isolates. Bidirectional interaction analysis revealed a better understanding of plant–pathogen interaction. Our studies demonstrate that sodium azide mutagenesis is an efficient and effective method to induce rice blast resistance and generate valuable genetic resource for blast resistance improvement. [ABSTRACT FROM AUTHOR]

Summary: Objective: To investigate whether clinical exposure in the hospital affects nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among medical students. Methods: A total of 322 medical students, both pre-clinical (n =167) and clinical (n =155), were recruited. Specimens were obtained from the nares of the subjects for the detection of S. aureus. A questionnaire was completed for each subject. All the MRSA isolates were further molecularly characterized. Results: The overall S. aureus carriage rate was 19.3%, with a rate of 16.8% for pre-clinical students and 21.9% for clinical students (p =0.26). The carriage rate of MRSA was 2.2%, with a rate of 2.4% for pre-clinical students and 1.9% for clinical students (p =0.54). There was no significant difference between the pre-clinical and clinical students in terms of nasal carriage of S. aureus and MRSA. All seven MRSA isolates were categorized as community strains in Taiwan. The risk factors for acquisition of S. aureus included male gender, age ≥23 years, and not taking antibiotics in the past year. Conclusions: As in the general population, less than 5% of medical students in northern Taiwan harbored MRSA, categorized as community strains, in their nares. The carriage of MRSA was not affected by clinical exposure in the hospital for 1–2 years. [Copyright &y& Elsevier]

Abstract: This paper reports the first successful preparation of biotechnological grade agarose from Gelidium amansii found in Taiwan. The scale-efficiency preparation was achieved by shortening EDTA treatment time through dispersing G. amansii agar in water in the presence of heat and EDTA, removing agaropectin impurity with a heat-compatible and strong-anion exchange resin, and precipitating agarose with a cost-effective isopropanol method. The yield of agarose from prepared G. amansii agar was 11.3%. The acquired agarose has a gel strength of 853gcm−2, a sulfate content of 0.14%, a pyruvate content of 1.03%, a degree of electroendosmosis of 0.16 and very limited binding affinity to DNA. The excellent properties of agarose from G. amansii of Taiwan confirm its potential diverse biotechnological applications. This innovative agarose preparation method with the significantly improved scale-efficiency can be modified for large-scale preparation of agarose for use in biotechnological industry and biochemical research. [Copyright &y& Elsevier]

Background: Recently, several studies revealed a much higher prevalence of later onset Fabry disease (FD) than previously expected. It suggested that later onset FD might present as an important hidden health issue in certain ethnic or demographic populations in the world. However, the natural history of its phenotype has not been systemically investigated, especially the cardiac involvement.Objectives: The study analyzed a large-scale newborn screening program for FD to understand the natural course of later onset FD.Methods: To date, 916,383 newborns have been screened for FD in Taiwan, including more than 1,200 individuals with the common, later onset IVS4+919G>A (IVS4) mutation. Echocardiography was performed in 620 adults with the IVS4 mutation to analyze the prevalence of left ventricular hypertrophy (LVH), and gadolinium-enhanced cardiac magnetic resonance imaging was performed in 129 patients with FD, including 100 IVS4 adults.Results: LVH was observed in 67% of men and 32% of women older than 40 years. Imaging evidenced significant late gadolinium enhancement in 38.1% of IVS4 men and 16.7% of IVS4 women with the IVS4 mutation but without LVH. Seventeen patients underwent endomyocardial biopsies, which revealed significant globotriaosylceramide substrate accumulation in their cardiomyocytes.Conclusions: Significant cardiomyocyte substrate accumulation in IVS4 patients led to severe and irreversible cardiac fibrosis before development of LVH or other significant cardiac manifestations. Thus, it might be too late to start enzyme replacement therapy after the occurrence of LVH or other significant cardiac manifestations in patients with later onset FD. This study also indicated the importance of newborn screening for early detection of the insidious, ongoing, irreversible cardiac damage in patients with later onset FD. [ABSTRACT FROM AUTHOR]

Abstract: Background: To contain cost, Taiwan's previous National Health Insurance Reimbursement Policy requested that physicians discontinue their patients' statin therapy once the serum cholesterol had reached appropriate levels. This allowed us to evaluate the association between statin continuation and the occurrence of atrial fibrillation/flutter and whether it was modified by chronic kidney disease (CKD) status. Methods: Patients who initiated statin therapy between January 1, 2001 and December 31, 2009 were identified from a random sample of one million subjects in the Taiwan National Health Insurance Research Database. The outcome was atrial fibrillation/flutter. A proportional hazard regression model with time-varying statin use was applied to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) for atrial fibrillation/flutter according to current statin use versus treatment discontinuation, adjusted for baseline disease risk scores and time-varying covariates. Results: A total of 6767 CKD and 63,678 non-CKD patients initiating statin therapy were included and followed for an average of 4.0 years. A total of 1118 participants experienced new-onset atrial fibrillation/flutter. The incidence of atrial fibrillation/flutter was approximately 2 fold higher in the CKD patients. Continuation of statin therapy was associated with a 22% (adjusted hazard ratio 0.78; 95% CI: 0.65–0.93) and 57% (adjusted HR 0.43; 95% CI: 0.27–0.68) decrease in atrial fibrillation/flutter hazard as compared with discontinuation in non-CKD and CKD patients, respectively. Conclusions: Continuation of statin therapy was associated with a decreased risk of atrial fibrillation/flutter among CKD and non-CKD patients. However, further randomized studies are still needed to assess the association. [Copyright &y& Elsevier]

Background: Congestive heart failure (CHF) as a risk of stroke in patients with atrial fibrillation (AF) mainly referred to patients with left ventricular systolic dysfunction. Whether this should include patients with preserved ejection fraction is debatable., Objective: The study aimed to investigate the variation in stroke risk of AF patients with heart failure with preserved ejection fraction (HFpEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF) for enhancing risk assessment and subsequent management strategies., Methods: In a longitudinal study using the National Taiwan University Hospital integrated Medical Database, 8358 patients with AF were observed for 10 years (mean follow-up, 3.76 years). The study evaluated the risk of ischemic stroke in patients with differing ejection fractions and CHA 2 DS 2 -VASc score, further using Cox models adjusted for risk factors of AF-related stroke., Results: Patients with HFpEF and HFmrEF had a higher mean CHA 2 DS 2 -VASc score compared with patients with HFrEF (4.30 ± 1.729 vs 4.15 ± 1.736 vs 3.73 ± 1.712; P < .001) and higher risk of stroke during follow-up (hazard ratio [HR], 1.40 [1.161-1.688; P < .001] for HFmrEF; HR, 1.184 [1.075-1.303; P = .001] for HFpEF vs no CHF) after multivariate adjustment). In patients with lower CHA 2 DS 2 -VASc score (0-4), presence of any type of CHF increased ischemic stroke risk (HFrEF HR, 1.568 [1.189-2.068; P = .001]; HFmrEF HR, 1.890 [1.372-2.603; P < .001]; HFpEF HR, 1.800 [1.526-2.123; P < .001] vs no CHF)., Conclusion: After multivariate adjustment, HFpEF and HFmrEF showed a similar risk of stroke in AF patients. Therefore, it is important to extend the criteria for C in the CHA 2 DS 2 -VASc score to include patients with HFpEF and HFmrEF. In patients with fewer concomitant stroke risk factors, the presence of any subtype of CHF increases risk for ischemic stroke., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the associations between exposure to antenatal corticosteroids and serious infection in children during the first three, six, and 12 months of life., Design: Nationwide cohort study., Setting: National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database, 1 January 2008 to 31 December 2019, to identify all pregnant individuals and their offspring in Taiwan., Participants: 1 960 545 pairs of pregnant individuals and their singleton offspring. 45 232 children were exposed and 1 915 313 were not exposed to antenatal corticosteroids., Main Outcome Measures: Incidence rates were estimated for overall serious infection, sepsis, pneumonia, acute gastroenteritis, pyelonephritis, meningitis or encephalitis, cellulitis or soft tissue infection, septic arthritis or osteomyelitis, and endocarditis during the first three, six, and 12 months of life in children exposed versus those not exposed to antenatal corticosteroids. Cox proportional hazards models were performed to quantify adjusted hazard ratios with 95% confidence intervals for each study outcome., Results: The study cohort was 1 960 545 singleton children: 45 232 children were exposed to one course of antenatal corticosteroids and 1 915 313 children were not exposed to antenatal corticosteroids. The adjusted hazard ratios for overall serious infection, sepsis, pneumonia, and acute gastroenteritis among children exposed to antenatal corticosteroids were significantly higher than those not exposed to antenatal corticosteroids during the first six months of life (adjusted hazard ratio 1.32, 95% confidence interval 1.18 to 1.47, P<0.001, for overall serious infection; 1.74, 1.16 to 2.61, P=0.01, for sepsis; 1.39, 1.17 to 1.65, P<0.001, for pneumonia; and 1.35, 1.10 to 1.65, P<0.001, for acute gastroenteritis).Similarly, the adjusted hazard ratios for overall serious infection (P<0.001), sepsis (P=0.02), pneumonia (P<0.001), and acute gastroenteritis (P<0.001) were significantly higher from birth to 12 months of life. In the sibling matched cohort, the results were comparable with those observed in the whole cohort, with a significantly increased risk of sepsis in the first six (P=0.01) and 12 (P=0.04) months of life., Conclusions: This nationwide cohort study found that children exposed to one course of antenatal corticosteroids were significantly more likely to have an increased risk of serious infection during the first 12 months of life. These findings suggest that before starting treatment, the long term risks of rare but serious infection associated with antenatal corticosteroids should be carefully weighed against the benefits in the perinatal period., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Few studies on humans have comprehensively evaluated the intake composition of methyl-donor nutrients (MDNs: choline, betaine, and folate) in relation to visceral obesity (VOB)-related hepatic steatosis (HS), the hallmark of non-alcoholic fatty liver diseases. In this case-control study, we recruited 105 patients with HS and 104 without HS (controls). HS was diagnosed through ultrasound examination. VOB was measured using a whole-body analyzer. MDN intake was assessed using a validated quantitative food frequency questionnaire. After adjustment for multiple HS risk factors, total choline intake was the most significant dietary determinant of HS in patients with VOB (Beta: -0.41, p = 0.01). Low intake of choline (<6.9 mg/kg body weight), betaine (<3.1 mg/kg body weight), and folate (<8.8 μg/kg body weight) predicted increased odds ratios (ORs) of VOB-related HS (choline: OR: 22, 95% confidence interval [CI]: 6.5-80; betaine: OR: 14, 95% CI: 4.4-50; and folate: OR: 19, 95% CI: 5.2-74). Combined high intake of choline and betaine, but not folate, was associated with an 81% reduction in VOB-related HS (OR: 0.19, 95% CI: 0.05-0.69). Our data suggest that the optimal intake of choline and betaine can minimize the risk of VOB-related HS in a threshold-dependent manner.

Importance: The adverse effects from the long-term use of oral corticosteroids are known, but, to our knowledge, few studies have reported the risk of corticosteroid bursts, particularly among children., Objective: To quantify the associations of corticosteroid bursts with severe adverse events, including gastrointestinal (GI) bleeding, sepsis, pneumonia, and glaucoma, in children., Design, Setting, and Participants: This study used data derived from the National Health Insurance Research Database in Taiwan from January 1, 2013, to December 31, 2017, on children younger than 18 years of age and used a self-controlled case series design. Data were analyzed from January 1 to July 30, 2020., Exposure: Oral corticosteroid bursts (defined as oral corticosteroid use for ≤14 days)., Main Outcomes and Measures: Incidence rates were calculated of 4 severe adverse events (GI bleeding, sepsis, pneumonia, and glaucoma) in children who did or did not receive corticosteroid bursts. Conditional fixed-effect Poisson regression was used to estimate incidence rate ratios (IRRs) of severe adverse events within 5 to 30 days and 31 to 90 days after initiation of corticosteroid bursts., Results: Among 4 542 623 children, 23% (1 064 587; 544 268 boys [51.1%]; mean [SD] age, 9.7 [5.8] years) were prescribed a single corticosteroid burst. The most common indications were acute respiratory tract infections and allergic diseases. The incidence rate differences per 1000 person-years between children administered a single corticosteroid burst and those not prescribed corticosteroids were 0.60 (95% CI, 0.55-0.64) for GI bleeding, 0.03 (95% CI, 0.02-0.05) for sepsis, 9.35 (95% CI, 9.19-9.51) for pneumonia, and 0.01 (95% CI, 0.01-0.03) for glaucoma. The IRRs within 5 to 30 days after initiating corticosteroid bursts were 1.41 (95% CI, 1.27-1.57) for GI bleeding, 2.02 (95% CI, 1.55-2.64) for sepsis, 2.19 (95% CI, 2.13-2.25) for pneumonia, and 0.98 (95% CI, 0.85-1.13) for glaucoma; the IRRs within the subsequent 31 to 90 days were 1.10 (95% CI, 1.02-1.19) for GI bleeding, 1.08 (95% CI, 0.88-1.32) for sepsis, 1.09 (95% CI, 1.07-1.11) for pneumonia, and 0.95 (95% CI, 0.85-1.06) for glaucoma., Conclusions and Relevance: This study suggests that corticosteroid bursts, which are commonly prescribed for children with respiratory and allergic conditions, are associated with a 1.4- to 2.2-fold increased risk of GI bleeding, sepsis, and pneumonia within the first month after initiation of corticosteroid therapy that is attenuated during the subsequent 31 to 90 days.

Aims: Recently, the spectrum of background mutation in the genes implicated in sudden arrhythmic death syndrome (SADS), has been elucidated in the Caucasian populations. However, this information is largely unknown in the Asian populations., Methods and Results: We assessed the background rare variants (minor allele frequency < 0.01) of major SADS genes in whole genome sequence data of 1514 healthy Taiwanese subjects from the Taiwan Biobank. We found up to 45% of healthy subjects have a rare variant in at least one of the major SADS genes. Around 3.44% of healthy subjects had multiple mutations in one or multiple genes. The background mutation rates in long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, and arrhythmogenic right ventricular cardiomyopathy genes were similar, but those in Brugada syndrome (BrS) (SCN5A) and hypertrophic cardiomyopathy (HCM) genes (MYBPC3, MYH7, and TNNT2) were higher, compared to those reported in the Caucasian populations. Furthermore, the rate of incidental pathogenic variant was highest in MYBPC3 gene. Finally, the number of variant was proportional to the exon length of the gene (R2 = 0.486, P = 0.0056) but not related to its functional or evolutionary importance (degree of evolutionary conservation) (R2 = 0.0008, P = 0.9218), suggesting that the mutation was random. The ratio of variant number over exon nucleotide length was highest in MYBPC3, MYH7, and TNNT2 genes., Conclusion: Unique features of background SADS gene mutation in the Asian populations include higher prevalence of incidental variant in HCM, BrS, and long QT 3 (SCN5A) genes. HCM genes have the highest variant number per exon length., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

The Fabry disease-causing mutation, the GLA IVS4+919G>A (designated GLA IVS4), is very prevalent in patients with hypertrophic cardiomyopathy in Taiwan. This X-linked mutation has also been found in patients in Kyushu, Japan and Southeast Asia. To investigate the age and the possible ancestral origin of this mutation, a total of 33 male patients with the GLA IVS4+919G>A mutation, born in Taiwan, Japan, Singapore, Malaysia, Vietnam, and the Fujian and Guangdong provinces of China, were studied. Peripheral bloods were collected, and the Ilumina Infinium CoreExome-24 microarray was used for dense genotyping. A mutation-carrying haplotype was discovered which was shared by all 33 patients. This haplotype does not exist in 15 healthy persons without the mutation. Rather, a wide diversity of haplotypes was found in the vicinity of the mutation site, supporting the existence of a single founder of the GLA IVS4 mutation. The age of the founder mutation was estimated by the lengths of the mutation-carrying haplotypes based on the linkage-disequilibrium decay theory. The first, second, and third quartile of the age estimates are 800.7, 922.6, and 1068.4 years, respectively. We concluded that the GLA IVS4+919G>A mutation originated from a single mutational event that occurred in a Chinese chromosome more than 800 years ago.

Background: This study is aimed toward an analysis of the variations in lung cancer incidence and mortality, adjusted by population factors (age, gender, and year), between administrative areas., Methods: This is a retrospective study, using 2005-2014 data in each administrative area from the Taiwan Cancer Registry database organized by the Health Promotion Administration. The yearly age-standardized (overall) and crude (stratified by gender and age) incidence/mortality (and their growth rates) for each administrative area were collected and calculated. We used a mixed model to analyze the repeated measurements of yearly incidence and mortality rates and used general linear regression to analyze their growth rates., Results: It was found that male and elderly populations had significantly higher lung cancer incidence and mortality in Taiwan. After adjusting for gender, age, and calendar year, there were no significant variations in incidence among the administrative areas, while the mortality in Yilan County was significantly higher than that in Taipei City (the capital city of Taiwan). On the other hand, the incidence in the female and younger population and mortality growth rates were higher. The incidence growth rate in Keelung City was significantly lower than that in Taipei City, while there were no significant variations in mortality growth rate among administrative areas., Conclusions: This study found an inequality in the lung cancer burden among cities in Taiwan, which can serve as the basis for future resource allocations for lung cancer prevention and treatment in Taiwan.

Introduction: This study aimed to estimate the utility values of all subtypes of lung cancer. The trajectories after different kinds of treatments and their major determinants were explored on the basis of real-world data and repeated measurements., Methods: From 2011 to 2017, all patients with lung cancer who visited a medical center were invited to fill out the EuroQol Five-Dimension and WHO Quality of Life-Brief questionnaires at each visit. Utility values of quality of life (QoL) after diagnosis and treatments were depicted using a kernel smoothing method. We constructed linear mixed models to predict health utility in each time period and cross-validated them with domain scores of the WHO Quality of Life-Brief., Results: A total of 1715 patients were enrolled, with 6762 QoL measurements. Utility values were lower in patients with advanced-stage disease and older patients. Patients receiving second-line targeted therapy showed higher utility values at 0 to 3 months, 3 to 6 months, and 6 months and beyond (0.89, 0.90, and 0.88, respectively) than did those undergoing chemotherapy (0.81, 0.85, and 0.80, respectively). After using mixed models to control confounders, including poor performance status and disease progression, patients receiving second-line chemotherapy showed health utility similar to that at quasi-baseline, whereas utility values related to second-line targeted therapy were higher at 3 to 6 months and 6 months and beyond (β = 0.07, p = 0.010 and β = 0.07, p < 0.001, respectively). There was convergent validity between the utility values and scores of the physical and psychological domains., Conclusion: Targeted therapy provided treated patients with a higher health utility value than was provided to those treated with chemotherapy. Development of the longitudinal trajectory may help predict changes in QoL and improve the care of lung cancer survivors., (Copyright © 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Objectives: The feasibility of vaginoscopic hysteroscopy combined with office endometrial biopsy after ultrasonography for management of post-menopausal vaginal bleeding (PMB)., Materials and Methods: A prospective observational study of with PMB whom attending the Outpatient Clinic of Kang Ning Hospital during a four months period (1st Feb to 31st May 2018) was included. Vaginoscopic hysteroscopy was performed with endometrial biopsy after the initial clinical pelvic examination and transvaginal ultrasound examination., Results: A total of 45 consecutive women with PMB was included. The hysteroscopy and endometrial biopsy were successful in 44 out of 45 (98%), a complete view in 82%, adequate tissue was in 91%, only one case was failed both procedures due to pain. The correlation between hysteroscopy and endometrial biopsy by was 100%. The mean operation time was 229 ± 68 s. The most common histological findings was atrophic endometrium 18 (42%). Five endometrial polyps and 2 submucosal leiomyomas were found. One rare case of endometrial carcinosarcoma (2%) was detected. Patients reported less pain for hysteroscopy than endometrial biopsy with rated VAS pain score was 3.5 ± 2.2, with 5 more score in 18%, and for endometrial biopsy 4.2 ± 2 and 33% respectively (p < 0.001). Six cases (13%) experienced vasovagal attacks immediately after the procedure. There is no other complication., Conclusion: The Vaginoscopic hysteroscopy combined endometrial biopsy is safe and feasible for assessment of endometrial pathology with postmenopausal bleeding., (Copyright © 2019. Published by Elsevier B.V.)

ABSTRACTObjectives:As a degenerative disease, the progression of dementia needs continued care provision and poses both psychological and financial burden for family caregivers of persons with dementia (PWD). This study seeks to compare predictors of care costs and caregiver burden, and to identify modifiable factors that could alleviate the burden faced by dementia caregivers., Methods: This study interviewed 231 PWD-caregiver dyads in a dementia clinic at a teaching hospital in southern Taiwan in 2013. A follow-up study was conducted a year later, and 167 dyads completed the second interview. Data collected included PWD characteristics, caregiver characteristics, relationship to PWD, and social support to caregivers. Caregiver burden was measured with the Zarit Burden Interview instrument. The association between each predictor variable and cost of care and caregiver burden scores was examined using linear mixed models., Results: Predictors of care costs were found to be different from predictors of caregiver burden: functional declines measured by Katz's activities of daily living (ADL) scale were associated with total cost as compared to behavioral disturbance measured by Neuropsychiatric Inventory (NPI), which showed no impact on care costs. However, NPI was a significant predictor of caregiver burden. Caregivers who were better-off financially also reported significantly lower caregiver burden., Conclusions: Since predictors of care costs were different from the predictors of caregiver burden, providing training to caregivers in addressing PWD's behavioral disturbance and proving financial assistance to low income caregivers could be effective in reducing caregiver burden.