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Background: Individuals experiencing subjective cognitive decline (SCD) are at an increased risk of developing mild cognitive impairment and dementia. Early identification of SCD and neurodegenerative diseases using biomarkers may help clinical decision-making and improve prognosis. However, few cross-sectional and longitudinal studies have explored plasma biomarkers in individuals with SCD using immunomagnetic reduction. Objective: To identify plasma biomarkers for SCD. Methods: Fifty-two participants [38 with SCD, 14 healthy controls (HCs)] underwent baseline assessments, including measurements of plasma Aß42, Aß40, t-tau, p-tau, and a-synuclein using immunomagnetic reduction (IMR) assays, cognitive tests and the Mini-Mental State Examination (MMSE). Following initial cross-sectional analysis, 39 individuals (29 with SCD, 10 HCs) entered a longitudinal phase for reassessment of these biomarkers and the MMSE. Biomarker outcomes across different individual categories were primarily assessed using the area under the receiver operating characteristic (ROC) curve. The SCD subgroup with an MMSE decline over one point was compared to those without such a decline. Results: Higher baseline plasma Aß1-42 levels significantly discriminated participants with SCD from HCs, with an acceptable area under the ROC curve (AUC) of 67.5% [95% confidence interval (CI), 52.7-80.0%]. However, follow-up and changes in MMSE and IMR data did not significantly differ between the SCD and HC groups (p > 0.05). Furthermore, lower baseline plasma Aß1-42 levels were able to discriminate SCD subgroups with and without cognitive decline with a satisfied performance (AUC, 75.0%; 95% CI, 55.6-89.1%). At last, the changes in t-tau and Aß42 × t-tau could differentiate between the two SCD subgroups (p < 0.05). Conclusion: Baseline plasma Aß42 may help identify people with SCD and predict SCD progression. The role of plasma Aß42 levels as well as their upward trends from baseline in cases of SCD that progress to mild cognitive impairment and Alzheimer's disease require further investigation. [ABSTRACT FROM AUTHOR]

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Objective: The present study is to analyze the effects of the coronavirus disease 2019 (COVID 2019) outbreak and the subsequent lockdown on the outcomes of spinal metastasis patients. Methods: The study was a retrospective analysis of data from a prospective cohort study. All patients underwent surgical intervention for spinal metastases between January 2019 and December 2021 and had at least 3 months of postoperative follow-up. The primary outcome was overall mortality during the 4 different stages (pre-COVID-19 era, COVID-19 pandemic except in Taiwan, national lockdown, lifting of the lockdown). The secondary outcomes were the oncological severity scores, medical/surgical accessibility, and patient functional outcome during the 4 periods as well as survival/mortality. Results: A total of 233 patients were included. The overall mortality rate was 41.20%. During the Taiwan lockdown, more patients received palliative surgery than other surgical methods, and no total en bloc spondylectomy was performed. The time from surgeon visit to operation was approximately doubled after the COVID-19 outbreak in Taiwan (75.97, 86.63, 168.79, and 166.91 hours in the 4 periods, respectively). The estimated survival probability was highest after the national lockdown was lifted and lowest during the lockdown. In the multivariate analysis, increased risk of mortality was observed with delay of surgery, with emergency surgery having a higher risk with delays above 33 hours, urgent surgery (below 59 and above 111 hours), and elective surgery (above 332 hours). Conclusion: The COVID-19 pandemic and related policies have altered daily clinical practice and negatively impacted the survival of patients with spinal metastases. [ABSTRACT FROM AUTHOR]

Snare polypectomy is commonly used to remove polyps during colonoscopy. For small to medium polyps, it can be done with (hot) or without (cold) applying electrical cautery. This trial examined whether cold snare is better than hot snare in reducing delayed bleeding after removal of small to medium polyps. Visual Abstract. Cold Snare Polypectomy for Small Polyps.: Snare polypectomy is commonly used to remove polyps during colonoscopy. For small to medium polyps, it can be done with (hot) or without (cold) applying electrical cautery. This trial examined whether cold snare is better than hot snare in reducing delayed bleeding after removal of small to medium polyps. Background: Although cold snare polypectomy (CSP) is considered effective in reducing delayed postpolypectomy bleeding risk, direct evidence supporting its safety in the general population remains lacking. Objective: To clarify whether CSP would reduce delayed bleeding risk after polypectomy compared with hot snare polypectomy (HSP) in the general population. Design: Multicenter randomized controlled study. (ClinicalTrials.gov: NCT03373136) Setting: 6 sites in Taiwan, July 2018 through July 2020. Participants: Participants aged 40 years or older with polyps of 4 to 10 mm. Intervention: CSP or HSP to remove polyps of 4 to 10 mm. Measurements: The primary outcome was the delayed bleeding rate within 14 days after polypectomy. Severe bleeding was defined as a decrease in hemoglobin concentration of 20 g/L or more, requiring transfusion or hemostasis. Secondary outcomes included mean polypectomy time, successful tissue retrieval, en bloc resection, complete histologic resection, and emergency service visits. Results: A total of 4270 participants were randomly assigned (2137 to CSP and 2133 to HSP). Eight patients (0.4%) in the CSP group and 31 (1.5%) in the HSP group had delayed bleeding (risk difference, −1.1% [95% CI, −1.7% to −0.5%]). Severe delayed bleeding was also lower in the CSP group (1 [0.05%] vs. 8 [0.4%] events; risk difference, −0.3% [CI, −0.6% to −0.05%]). Mean polypectomy time (119.0 vs. 162.9 seconds; difference in mean, −44.0 seconds [CI, −53.1 to −34.9 seconds]) was shorter in the CSP group, although successful tissue retrieval, en bloc resection, and complete histologic resection did not differ. The CSP group had fewer emergency service visits than the HSP group (4 [0.2%] vs. 13 [0.6%] visits; risk difference, −0.4% [CI, −0.8% to −0.04%]). Limitation: An open-label, single-blind trial. Conclusion: Compared with HSP, CSP for small colorectal polyps significantly reduces the risk for delayed postpolypectomy bleeding, including severe events. Primary Funding Source: Boston Scientific Corporation. [ABSTRACT FROM AUTHOR]

The emerging Vancomycin-resistant Enterococcus faecium (VRE-fm) is an opportunistic pathogen causing nosocomial infections. The identification of VRE-fm is important for successful prevention and control in healthcare settings. VRE-fm clinical isolates obtained from regional hospitals in northern Taiwan were characterized for antimicrobial susceptibility, virulence genes and biofilm production. Most isolates exhibited multi-drug resistance and carried the virulence genes, esp and hyl. While all isolates produce biofilms, those isolates that carried esp exhibited greater biofilm production. Isolates with different virulence gene carriages were examined for pathogenicity by using a nematode model, Caenorhabditis elegans, for determining microbial-host interactions. The survival assay showed that C. elegans was susceptible to Linezolid-resistant VRE-fm isolates with hyl. Combining the molecular epidemiological profiles regarding pathogenesis in C. elegans can serve as a guide for physicians in limiting opportunistic infections caused by VRE-fm. [ABSTRACT FROM AUTHOR]

Introduction: The genetic association between depression and migraine has not been well investigated in Asian populations. Furthermore, the genetic basis of depression and comorbid migraine subtypes remains nebulous. Hence, in the current study we investigate the susceptibility loci associated with depression and migraine comorbidity in the Han Chinese population in Taiwan. Methods: We perform a genome-wide association study involving 966 migraine patients, with or without comorbid depression. Genotyping is performed using participant genomic DNA. Association analyses are performed for the entire migraine cohort (subgroups: episodic migraine, chronic migraine, and migraine with or without aura). Results: Results show that the single nucleotide polymorphism variants of the CDH4 intron region (rs78063755), NTRK3-AS1 downstream region (rs57729223), and between LINC01918 and GPR45 (rs2679891) are suggestively associated with depression. Twenty additional susceptibility loci occur within the subgroups. A multivariate association study demonstrated that a variant in the intron region of CDH4 rs78063755 was associated with Beck Depression Inventory and Migraine Disability Assessment scores. Discussion: The findings of this study identify several genetic loci suggestively associated with depression among migraine patients in the Han Chinese population. Moreover, a potential genetic basis has been characterized for depression and migraine comorbidity, thus providing genetic candidates for further investigation. [ABSTRACT FROM AUTHOR]

Introduction: The most widely used instruments to assess food addiction - the Yale Food Addiction Scale 2.0 (YFAS 2.0) and its modified version (mYFAS 2.0) - have not been validated in a Taiwanese population. The present study compared the psychometric properties between the Taiwan versions of YFAS 2.0 and mYFAS 2.0 among university students. Methods: An online survey comprising the YFAS 2.0, mYFAS 2.0, Weight Self-Stigma Questionnaire (WSSQ) and International Physical Activity Questionnaire-Short Form (IPAQ-SF) were used to assess food addiction, self-stigma, and physical activity. Results: All participants (n = 687; mean age = 24.00 years [SD ± 4.48 years]; 407 females [59.2%]) completed the entire survey at baseline and then completed the YFAS 2.0 and mYFAS 2.0 again three months later. The results of confirmatory factor analysis (CFA) indicated that the YFAS 2.0 and mYFAS 2.0 both shared a similar single-factor solution. In addition, both the YFAS 2.0 and mYFAS 2.0 reported good internal consistency (Cronbach's a = 0.90 and 0.89), good test-retest reliability (ICC = 0.71 and 0.69), and good concurrent validity with the total scores being strongly associated with the WSSQ (r = 0.54 and 0.57; p < 0.01), and less strongly associated with BMI (r = 0.17 and 0.13; p < 0.01) and IPAQ-SF (r = 0.23 and 0.25; p < 0.01). Discussion: Based on the findings, the Taiwan versions of the YFAS 2.0 and mYFAS 2.0 appear to be valid and reliable instruments assessing food addiction. [ABSTRACT FROM AUTHOR]

Introduction: Curriculum integration and cross-disciplinary/cross-curricular integrated learning have become worldwide trends. Taiwan's directives for its 12-year education curricula encourage that secondary schools' flexible learning programs include cross-disciplinary topics to foster the cross-disciplinary learning. The use of virtual reality (VR) for integrated teaching, particularly in physical education (PE), is likely to be developed in the future. This paper aims to explore the effectiveness of VR in PE classes to teach badminton and to discover potential difficulties while employing this method, as well as the coping techniques teachers may need to adopt. Methods: The participants were a PE teacher and their seventh-grade students who were enrolled in Taipei City high school, Taiwan. The study used a qualitative approach, and the data were collected from semi-structured interviews, course reviews, student feedback questionnaires, study notes, and cognitive tests after the implementation of a four-week, eight-session badminton course, where VR was used to teach the forehand serve. The data analysis was conducted using various qualitative methods. Results: 1. The VR-based badminton teaching method improved learning effectiveness from the following aspects: "understanding essentials and mastering the skill," "repeated practice and adjusting posture," "teamwork and mutual support," and "promoting motivation and learning." 2. Teachers encountered three potential types of dilemmas when using VR-based teaching: "moving," "playing," and "learning." "Moving" refers to the conflict between class time spent engaged in physical activities and using technology. "Playing" encompasses the dilemma that occurs when the frequent use of the device decreased its novelty, and some students discontinued using it. "Learning" refers to the conflict between the students' desire to enjoy their class and the teacher's desire to educate during class. Conclusion: VR-based badminton teaching in PE can effectively improve the learning effect. However, teachers should reflect upon the design and implementation of teaching and understand students' perceptions of the PE curriculum to overcome the dilemmas of VR-based badminton teaching methods. [ABSTRACT FROM AUTHOR]

Background: The impact of amoxicillin resistance on the efficacy of regimens containing amoxicillin for Helicobacter pylori eradication remains unknown.Objectives: To investigate whether the efficacy of an amoxicillin-containing regimen is affected by amoxicillin resistance and to identify the optimal breakpoint for amoxicillin resistance.Methods: This was a pooled analysis of five randomized trials conducted in Taiwan from 2007 to 2016. Patients who received amoxicillin-containing regimens were recruited. MICs were determined by agar dilution testing. Meta-analysis was performed to assess the risk ratio of eradication failure in amoxicillin-resistant strains compared with susceptible strains of seven different regimens. We performed further the pooled analysis and logistic regression in patients treated with clarithromycin triple therapy to identify the optimal breakpoint for amoxicillin resistance.Results: A total of 2339 patients with available amoxicillin MICs were enrolled. Meta-analysis showed that the presence of amoxicillin resistance was consistently associated with increased risk of treatment failure of amoxicillin-containing regimens at different breakpoints (risk ratio: 1.41, 95% CI 1.12-1.78, P = 0.004 when the cut-off was 0.5 mg/L). The heterogeneity was low (I2 = 0%, P = 0.615). Pooled analysis also showed that amoxicillin resistance was an independent risk factor for treatment failure of clarithromycin triple therapy at different breakpoints. The best correlation was observed when the breakpoint of amoxicillin resistance was ≥0.125 mg/L (kappa coefficient 0.298), at which the resistance rate was 11.1% (110 of 990).Conclusions: The efficacies of amoxicillin-containing regimens are affected by amoxicillin resistance and the optimal breakpoint MIC is ≥ 0.125 mg/L. [ABSTRACT FROM AUTHOR]

Background: Primary headache disorders (PHDs) are associated with sleep problems. It is suggested that headache and sleep disorder share anatomical and physiological characteristics. We hypothesised that patients with PHDs were exposed to a great risk for developing sleep apnoea (SA).Methods: In this retrospective longitudinal study, the data obtained from the Longitudinal Health Insurance Database in Taiwan were analysed. The study included 1346 patients with PHDs who were initially diagnosed and 5348 patients who were randomly selected and age/sex matched with the study group as controls. PHDs, SA, comorbidities and other confounding factors were defined based on International Classification of Diseases, Ninth Revision, Clinical Modification. Cox proportional hazards regressions were employed to examine adjusted HRs after adjusting with confounding factors.Results: Our data revealed that patients with PHDs had a higher risk (HR 2.17, 95% CI 1.259 to 3.739, p<0.05) to develop SA compared with matched cohorts, whereas patients with migraine exhibited a high risk (HR 2.553, 95% CI 1.460 to 4.395, p<0.01). The results showed that patients with PHDs aged 18-44 exhibited highest risk of developing SA. In addition, males with PHDs exhibited an HR 3.159 (95% CI 1.479 to 6.749, p<0.01) for developing SA, respectively. The impact of PHDs on SA risk was progressively increased by various follow-up time intervals.Conclusion: Our results suggest that PHDs are linked to an increased risk for SA with sex-dependent and time-dependent characteristics. [ABSTRACT FROM AUTHOR]

Background/purpose: The predictors of off-therapy response in patients treated with neucleos(t)ide analogue (NA) have not been elucidated. It remained unexplored whether serum level of hepatitis B core antibody (anti-HBc) at the end of NA therapy was associated with relapse risks.Methods: This prospective study monitored 82 chronic hepatitis B (CHB) patients after discontinuing entecavir. All patients had been treated for 3 years or longer and serologically negative for viral DNA and HBeAg at treatment cessation. Patients were monitored for virological relapse (viral DNA > 2000 IU/mL), and clinical relapse (serum alanine aminotransferase > 80 U/L plus virological relapse). The association between anti-HBc levels and the risk of relapse was assessed by the Cox analysis.Results: Clinical and virological relapses occurred in 29 and 60 participants, respectively, with the cumulative incidences of 23.7% (95% CI, 15.8-34.6%) and 62.0% (95% CI, 51.5-72.5%) at 1 year, and 36.2% (95% CI, 26.2-48.4%) and 78.8% (95% CI, 68.2-87.8%) at 2 years, respectively. There was a trend for an inverse association between anti-HBc and clinical relapse (crude hazard ratio [HR], 0.50; 95% CI, 0.24-1.05). All 3 patients with the level <100 IU/mL had a rapid clinical relapse (P = 0.002). This trend remained after adjustment for HBsAg and age (adjusted HR 0.50, 95% CI, 0.24-1.03). On the other hand, anti-HBc quantity was unrelated to virological relapse (crude HR, 0.97; 95% CI, 0.58-1.62; adjusted HR, 0.97; 95% CI, 0.58-1.60).Conclusion: This pilot study suggests a trend for an inverse association between anti-HBc levels and clinical relapse in CHB patients off entecavir. [ABSTRACT FROM AUTHOR]

Background/purpose: This study aims to quantify and identify risk factors for intraocular lens (IOL) tilt and decentration early after surgery using Scheimpflug imaging.Methods: We prospectively included 268 eyes of 253 patients who underwent uneventful cataract surgery and one-piece IOL implantation using a superior or temporal approach. Scheimpflug imaging was used to evaluate the tilt and decentration of IOLs at 1 week, 1 month, and 3 months postoperatively. Differences in IOL tilt and decentration between the approaches were examined. Correlations of age and axial length with the magnitudes of IOL decentration and tilt were also examined.Results: In total, 139 right and 129 left eyes were included. IOL displacement averaged 150 μm upward and 150 μm to the nasal side of the pupil. Over 50% of the eyes were tilted upward and approximately 90% to the temporal side. The surgical approach was significantly associated with horizontal decentration in both eyes, but significantly associated with only vertical decentration in the right eye 1 week postoperatively. In the left eyes, IOLs were shifted to the nasal side in 57.1% and 36.8% of the eyes that received the temporal and the superior approach, respectively, compared with 75.8% and 50% in the right eyes. The differences were significant only at 1-week follow-up (p = 0.035 and p = 0.003, respectively). Age or axial length was not associated with IOL tilt or decentration in either eye.Conclusion: Scheimpflug imaging can be used as a quantitative tool to evaluate IOL position. The incision site affected the IOL position, this finding was significant at 1 week postoperatively only. [ABSTRACT FROM AUTHOR]

Rhododendron, one of the most famous ornamental plants in the world, is traditionally a medicinal plant. However, the potential bioactivities of native Rhododendron in Taiwan have not been completely studied. In this study, the results revealed that Rhododendron pseudochrysanthum exhibited the best antioxidant activities among 10 native Rhododendron species in Taiwan. Furthermore, based on a bioactivity-guided isolation principle, nine specific phytochemicals were isolated and identified as (2R,3S)-catechin (1), (2R,3R)-epicatechin (1'), (2R,3R)-dihydromyricetin 3-O-β-L-arabinopyranoside (2), (2S,3S)-taxifolin 3-O-β-L-arabinopyranoside (2'), (2R,3R)-taxifolin 3-O-β-L-arabinopyranoside (3), myricetin 3-O-β-d-glucopyranoside (3'), rutin (4), hyperoside (5), and quercitrin (6). Of these compounds, 2 and 3 were found to be major bioactive compounds, and their concentrations in the n-butanol (BuOH) fraction were determined to be 52.0 and 67.3 mg per gram, respectively. These results demonstrated that methanolic extracts of Rhododendron pseudochrysanthum leaves have excellent antioxidant activities and great potential as a source for natural health products. [ABSTRACT FROM AUTHOR]

Psychologists have different perspectives about well-being. In the satisfaction of needs theory it is stated that well-being is achieved when an individual's needs are satisfied. In this study we explored the relationships among leisure involvement, perceived health status, and leisure benefits to construct a model of the well-being of college students. A structural model based on the descriptive statistics from a convenience sample revealed that although leisure involvement was not directly related to leisure benefits, it did have an impact on well-being. In addition, perceived health status and leisure benefits were found to have a direct effect of well-being. The results are discussed in terms of their relevance to future researchers. [ABSTRACT FROM AUTHOR]

In a sample of 442 part-time MBA and undergraduate students, the relationships between emotional intelligence and the integrating style and between emotional intelligence and the dominating style of conflict management were moderated by extraversion. In addition, agreeableness moderated the relationships between emotional intelligence and compromising style and between emotional intelligence and dominating style. [ABSTRACT FROM AUTHOR]

Since Taiwan became a World Trade Organization member in 2002, large quantities of grain have been imported from different countries, and insect pests are frequently intercepted from these imported commodities in quarantine inspection. Because most insects are intercepted as immature forms, morphological identification is problematic; therefore, we developed a DNA identification method based on a sequence- characterized amplified region- polymerase chain reaction (SCAR-PCR). Three sets of multiplex SCAR- PCR mixtures, namely SCAR-I, -II, and -HI, were developed with each set composed of four species- specific primer pairs derived from the genomic DNA of four major lepidopterous stored-product pests: Corcyra cephalonica (Stainton), Cadra cautella (Walker), Sitotroga cerealella Oliver, and Plodia interpunctella (Hiibner). The SCAR-I amplicons of C. cephalonica, C. cautella, S. cerealella, and P. interpunctella were 205, 550, 324, 382 bp, respectively, while those of SCAR-II were 341, 565, 261, and 170 bp, and those of SCAR-IE were 514, 555, 445, and 299 bp. These multiplex PCR mixtures could sensitively and unambiguously detect and identify in ≈5 h individuals among the four lepidopterous pests intercepted in imported stored-products. In summary, the SCAR-PCR method we developed represents a rapid, sensitive and accurate technique for identifying insect species of stored products in plant quarantine operation. [ABSTRACT FROM AUTHOR]

Background/Purpose: Endoscopic submucosal dissection (ESD) is an advanced endoscopic procedure to resect early gastrointestinal neoplasm. It is technically more difficult and risky when used to treat early esophageal tumors. We report our experiences related to performing ESD for early esophageal neoplasia. The efficacy, complications, and outcome were also analyzed. Methods: From December 2007 to April 2010, 22 patients with documented early esophageal neoplasm underwent ESD. All patients completed a meticulous endoscopic examination using conventional endoscopy followed by narrow-band imaging. Lugol’s staining was performed to identify the margin of the suspicious lesion. Insulation-tipped diathermic knife 2 was used for ESD. Results: A total of 26 neoplastic lesions (including 13 tumors with high-grade dysplasia, 12 tumors with squamous cell carcinoma, and one tumor with adenocarcinoma) in 22 patients were enrolled. All patients were men. The mean age was 47.6 ± 8.6 years (range, 30–68 years). The mean size of tumors was 33.7 ± 21.7 mm (range, 8–80 mm). ESD was performed for 24 lesions in 20 patients. The mean size of resected specimens was 43.1 ± 19.2 mm (range, 15–90 mm). The mean operation time was 92.7 ± 69minutes (range, 30–310 minutes). There were three ESD-related complications, including one with delayed bleeding, one with subcutaneous emphysema, and one with perforation. Two patients received additional operations after ESD due to deep submucosal invasion by cancer. Three lesions in two patients (12.5%) developed post-ESD esophageal stricture that needed repeated endoscopic bougination. There was no procedure-related mortality. No local recurrence was found during the follow-up period. Conclusion: ESD is a promising local curative treatment option for early esophageal neoplasia in Taiwan. However, this procedure may result in complications that are worth noting, especially post-ESD esophageal stricture. Education regarding this procedure and more hands-on training will facilitate endoscopists to improve the outcomes of patients undergoing this procedure. [ABSTRACT FROM AUTHOR]

Background/purpose: Helicobacter pylori infection and drugs are the two major risk factors for peptic ulcer bleeding. The role of these two factors may change with changes in the prevalence of H pylori and use of NSAIDs. This study aimed to determine the cause, endoscopic features, and outcome of peptic ulcer bleeding in a community hospital in southern Taiwan.Methods: Patients who received esophagogastroduodenoscopy on arrival at the emergency department and were found to have actively bleeding ulcers or ulcers with stigmata of recent hemorrhage were included. H pylori infection was documented by the rapid urease test, histology, and/or C-13 urease breath test. Medication history, comorbidities, requirement for endoscopic therapy, blood transfusion, hospitalization days, and rebleeding rates were analyzed.Results: A total of 204 patients were enrolled with a mean age of 64.8 ± 15.2 years, with 58.3% of the subjects being female. There were 62 patients (30.4%) with H pylori infection only, 40 patients (19.6%) with drug use only, 67 patients (32.8%) with H pylori infection and drug use, and 37 patients (17.2%) without H pylori or drug use. A total of 107 patients (52.5%) were found to have had drug exposure. Drug exposure had an odds ratio (OR) of 2.34 [95% Confidence Interval (CI) = 1.30-4.20] for gastric ulcer bleeding and H pylori had an OR of 2.64 (95% CI = 1.17-5.97) for combined gastric and duodenal ulcer bleeding. The mean hospitalization period was 5.7 ± 4.0 days and the overall re-bleeding rate was 4.0%. The H pylori negative and drug negative subjects needed more endoscopic therapy (p < 0.05).Conclusion: Drug use, especially NSAIDs, aspirin, and clopidogrel has become an important cause of peptic ulcer bleeding in southern Taiwan. [ABSTRACT FROM AUTHOR]

Background: Obesity has become a major worldwide public health issue. There is a need for tools to measure patient-reported outcomes. The Moorehead-Ardelt Quality of Life Questionnaire II (MA II) contains six items. The objective of this study was to translate the MA II into Chinese and validate it in patients with morbid obesity. Methods: The MA II was translated into Chinese and back-translated into English by two language specialists to create the Taiwan version, which was validated by correlations with two other generic questionnaires of health-related quality of life (HRQOL), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and World Health Organization Quality of Life (WHOQOL)-BREF Taiwan version. The convergent validity was accomplished by a series of Spearman rank correlations. Reliability of the MA II Taiwan version was determined by internal consistency obtained by Cronbach's alpha coefficient and test-retest reliability obtained by intraclass correlation coefficient. Results: One hundred subjects with morbid obesity were enrolled to test the MA II Taiwan version convergent validity and internal consistency. Test-retest studies (2 weeks apart) were applied to 30 morbidly obese patients. Satisfactory internal consistency was demonstrated by a Cronbach's alpha coefficient of 0.79. Good test-retest reliability was shown by intraclass correlations ranging from 0.73 to 0.91. The total sum of MA II scores was significantly correlated with all four domains of the WHOQOL-BREF and two major components of SF-36 (all correlations, p < 0.01; range, 0.44-0.64). All six MA II items showed significant correlations with each other ( r = 0.34-0.69, p < 0.01), and the total sum of MA II scores was negatively correlated with body mass index ( r = −0.31, p < 0.01), indicating a one-dimensional questionnaire of HRQOL. Conclusions: The MA II Taiwan version is an obesity-specific questionnaire for QOL evaluation with satisfactory reliability and validity. It has the advantages of extensive evaluation for HRQOL, cross-cultural application, rapid completion, high response rates, and an advanced scoring system. [ABSTRACT FROM AUTHOR]

Obesity has become a major health issue not only in the West but also in Asia. Morbid obesity can lead to much comorbidity and can markedly interfere with quality of life. The aim of this study was to compare the health-related quality of life (HRQL) between patients with morbid obesity coming for bariatric surgery and the healthy population in Taiwan. Patients were between age 18 and 65 years. Patients had a BMI between 32 and 40 kg/m2 with obesity-related comorbidities or a BMI > 40 kg/m2. Patients were enrolled for bariatric surgery by a modified recommendation of the Asia-Pacific consensus. Physical and psychiatric evaluations were accomplished simultaneously. The World Health Organization Quality of Life (WHOQOL-BREF), Taiwan version, was administered 1 month before the operation. The quality of life of the obese patients was compared with age-, sex-, education-, marriage-, and municipality-matched healthy control patients taken from a national survey in Taiwan. Multiple regression analyses were conducted to study risk factors for impairment of HRQL. A total of 114 consecutive patients with obesity coming for bariatric surgery at our hospital were enrolled in 2007. Obese subjects had poorer WHOQOL-BREF scores than those of the healthy referents in physical, psychological, and social domains but not in environmental domain ( P < 0.05). Patients with BMI levels above 32 kg/m2 had consistently poorer scores in various facets after adjusting for other risk factors. The higher the BMI level the poorer the HRQL. Our findings seem to support the recommendations of Asia-Pacific consensus based on HRQL considerations. [ABSTRACT FROM AUTHOR]

This paper describes our studies on non-parametric maximum-likelihood estimators in a semiparametric mixture model for competing-risks data, in which proportional hazards models are specified for failure time models conditional on cause and a multinomial model is specified for the marginal distribution of cause conditional on covariates. We provide a verifiable identifiability condition and, based on it, establish an asymptotic profile likelihood theory for this model. We also provide efficient algorithms for the computation of the non-parametric maximum-likelihood estimate and its asymptotic variance. The success of this method is demonstrated in simulation studies and in the analysis of Taiwan severe acute respiratory syndrome data. [ABSTRACT FROM AUTHOR]

The purpose of this study is to understand nutrition knowledge, attitude, and behavior in Taiwanese elementary school children, and the relationship of these various components. The results indicated that children's knowledge was fair in nutrition basics, but poor in 'the physiological function of nutrients', 'relationships between diet/nutrients and disease', and 'the daily serving requirement for different food groups'. Children in general valued the importance of nutrition, but they did not concern the health benefit of foods in food selections. Their dietary quality was not satisfactory, and the diet of most children did not meet the recommended serving requirements for milk, vegetable, fruit, and cereals and grains groups. Positive relationships were found among nutrition knowledge, attitude, caring- about-nutrition behavior and dietary quality score. The restraint or disinhibited eating behavior of 4th to 6th graders was not serious, but a large number of children already performed some self-controlling practices to avoid obesity, but not frequently. One fourth of the students skipped meals, especially breakfast, and one quarter of 4th to 6th graders prepared their own breakfast; which may have some impact on children's diet quality. A gap was found between nutrition knowledge, attitude and eating behavior, especially vegetable and fruit consumption, indicating that the attitude toward eating for health was not strong in this age group. Future nutrition education for school children should not only include food serving requirements of food groups, but also apply appropriate theories to improve the motivation for healthy eating. [ABSTRACT FROM AUTHOR]

TWO new optical storage formats, forward versa- tile disk (FVD) and blue high-definition digital versatile disk (HD-DVD), developed in Taiwan, are introduced. Some major technologies, including new modulation code and multilayer technology, are adopted in these formats to differentiate from current optical disc formats. For the further HD storage, several advanced technologies have been developed. [ABSTRACT FROM AUTHOR]

The object of this study was to assess the relationship between occupational Portland cement dust exposure and respiratory health Respiratory symptoms and ventilatory func tion were studied in a group of 591 male Portland cement workers employed in four cement plants The prevalence of chronic respiratory symptoms was higher in exposed than in control workers The exposed group had a significantly lower mean forced vital capacity FVC forced expiratory volume at 1 s FEV1 and forced expiratory flows after exhalation of 50 and 75 of the vital capacity FEF50 FEF75 than the control group The data suggest that occupational exposure to Portland cement dust may lead to higher prevalence of chronic respiratory symptoms and the reduction of ventilatory capacity. [ABSTRACT FROM AUTHOR]

Abstract: Polybrominated diphenyl ethers (PBDEs) may contaminate food through bioconcentration and biomagnification. PBDEs often exist in the food chain and are consumed by humans. This study aims to determine the concentrations of PBDEs in food intake and to estimate the daily exposure of Taiwanese citizens to PBDEs. One hundred and eight food samples from nine types of commonly consumed foodstuffs were collected from northern, central, southern, and eastern regions of Taiwan. The samples were analyzed for PBDE level by gas chromatography mass spectrometry. Also, a daily dietary intake survey was conducted of 466 adults (153 men, 313 women) in these four regions of Taiwan. Taiwanese daily dietary intake of PBDE is calculated by means of food PBDEs level and daily dietary intake. The result of this study showed the highest concentration of ΣPBDE was found in butter (890.3±309.0pg/g wet weight), followed by egg and pork (553.0±185.0pg/g wet weight and 545.4±181.0pg/g wet weight). Deca-BDE was found the highest concentration among eight kinds PBDEs. The average daily intake of PBDEs for the 466 subjects was 67.95±23.01ng/day. There was a significant difference between the daily intake of ΣPBDE in different regions of Taiwan (p<0.05). The highest daily intake of ΣPBDE was in northern Taiwan, which is also the most urbanized area. [Copyright &y& Elsevier]

The purpose of this study is to understand nutrition knowledge, attitude, and behavior in Taiwanese adults. Results indicated that adults' knowledge on "relationship between diet and disease" and "comparison of foods in terms of specific nutrients" is acceptable. However, they lack knowledge on "daily serving requirements" and "weight and weight loss". Although they recognize the importance of nutrition, nutrition was not the major concern of food selection. Significant differences were found among gender and age groups. Females of most age groups are better than males in many aspects of nutrition knowledge, attitude and behavior except emotional and external eating behavior. Young (age 19-30) and prime (age 31-44) adults have better knowledge than that of middle adults (age 45-64), while prime adults hold a more positive attitude than young adults. As for nutrition behavior, prime and middle adults are better than young adults. Nutrition knowledge and attitude of adults in urban areas is generally better than those in suburban and remote areas. However, adults in urban areas perform "emotional and external cued eating" more frequently than those in suburban and remote areas. There are significantly positive correlations among nutrition knowledge, attitude and behavior; and attitude has stronger correlation (r=0.42) with behavior than knowledge does (r=0.27). Therefore, to achieve desirable eating behaviors, the adult nutrition education program should include knowledge of what constitutes a balanced diet and what constitutes being overweight. Proper strategies to enhance the behavioral motivation of healthy food selection must also not be neglected. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the relationship between the snack intake and snack availability of elementary school children. Data analyzed were from 722 4th to 6th graders' food availability and food intake questionnaires collected in the Nutrition and Health Survey in Taiwan Elementary School Children 2001-2002. The snacks commonly eaten were divided into two groups. Healthy snacks included dairy products, 100% fruit juice and fresh fruits. Unhealthy snacks included high fat/sugar snacks, cookies, candy, carbonated/sugared beverages and fast food. Structural equating modeling was used to test the models that describe the availability and intake of two snack groups. Results indicated that parents' intake and children's preference were major predictors of children intake of both healthy and unhealthy snacks. Other than that, the intake of unhealthy snacks was positively associated with "purchase by children themselves" but not the intake of healthy snacks, which was influenced predominantly by "present in home". The results support the perception that a positive family food environment is important for improving children's diet quality. To build a healthy family food environment, parents have to not only provide healthy snacks but also limit the unhealthy snacks in home. In addition to that, the role modeling of parents as eating healthy snacks instead of unhealthy snacks themselves may help children to develop similar behaviors. INSET: 47. [ABSTRACT FROM AUTHOR]

Background: Antiviral therapy for patients with non-cirrhotic chronic hepatitis B and minimally raised alanine aminotransferase (ALT) is controversial. We aimed to investigate the efficacy and safety of tenofovir disoproxil fumarate in reducing the risk of disease progression in this patient population.Methods: TORCH-B is a multicentre, double-blind, placebo-controlled, parallel-group, randomised trial done at six teaching hospitals in Taiwan that enrolled patients with chronic hepatitis B. Eligible patients were aged 25-70 years and had substantial viraemia (viral DNA >2000 IU/mL) and minimally raised serum ALT concentrations more than one-fold but less than two-fold the upper limit of normal (ULN). Exclusion criteria included liver cirrhosis and previous antiviral treatment. Eligible participants were randomly assigned (1:1), stratified by site with a fixed block size of ten, to receive either 300 mg of oral tenofovir disoproxil fumarate or placebo once daily for 3 years. The participants, investigators, research coordinators, pathologists, laboratory personnel, and staff involved in patient care or assessment were masked to treatment assignment. 0·5 mg/day of oral entecavir was added to rescue acute hepatitis flare. The coprimary outcomes were change in necroinflammation severity on the Knodell scale and change in fibrosis stage on the Ishak scale and were evaluated in the modified intention-to-treat population, which comprised all patients with paired liver biopsies. Safety was evaluated in all patients who were randomly assigned. This trial is registered at ClinicalTrials.gov, NCT01522625, and is completed.Findings: From Jan 30, 2012, to Nov 10, 2015, 875 patients were screened and 160 were randomly assigned to receive either tenofovir disoproxil fumarate (n=79) or placebo (n=81). The coprimary outcomes were assessed in 146 patients (73 in each group). Liver fibrosis progressed (an increase of ≥1 stage) in 19 (26%, 95% CI 17-38) of 73 patients in the tenofovir disoproxil fumarate group and in 34 (47%, 35-59) of 73 patients in the placebo group (relative risk [RR] 0·56, 95% CI 0·35-0·88; p=0·013), whereas necroinflammation progressed (an increase of ≥2 points) in five (7%, 95% CI 2-15) patients in the tenofovir disoproxil fumarate group and in 12 (16%, 9-27) patients in the placebo group (RR 0·42, 95% CI 0·15-1·12; p=0·084). Two (3%) of 79 patients in the tenofovir disoproxil fumarate group and 13 (16%) of 81 patients in the placebo group had acute hepatitis flare requiring add-on entecavir (RR 0·16, 95% CI 0·04-0·68; p=0·013). The two groups were otherwise similar in occurrences of adverse events. No patients died.Interpretation: Tenofovir disoproxil fumarate reduces the risk of progression in liver fibrosis in patients with chronic hepatitis B and minimally raised ALT, but its effect on necroinflammation is non-significant.Funding: The Taiwan Ministry of Science and Technology, E-Da Hospital, the Taipei Institute of Pathology, Gilead Sciences. [ABSTRACT FROM AUTHOR]

Background: In first-line treatment of Helicobacter pylori, we have previously shown that the eradication frequency was 83·7% (95% CI 80·4-86·6) for triple therapy for 14 days (T14; lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg, all given twice daily), 85·9% (82·7-88·6) for concomitant therapy for 10 days (C10; lansoprazole 30 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg, all given twice daily), and 90·4% (87·6-92·6) for bismuth quadruple therapy for 10 days (BQ10; bismuth tripotassium dicitrate 300 mg four times a day, lansoprazole 30 mg twice daily, tetracycline 500 mg four times a day, and metronidazole 500 mg three times a day). In this follow-up study, we assess short-term and long-term effects of these therapies on the gut microbiota, antibiotic resistance, and metabolic parameters.Methods: This was a multicentre, open-label, randomised trial done at nine medical centres in Taiwan. Adult patients (>20 years) with documented H pylori infection were randomly assigned (1:1:1, with block sizes of six) to receive T14, C10, or BQ10. We assessed long-term outcomes (reinfection frequency, changes in the gut microbiota, antibiotic resistance, and metabolic parameters) in patients with available data, excluding all protocol violators and those with unknown post-treatment H pylori status. Faecal samples were collected before treatment and 2 weeks, 2 months, and at least 1 year after eradication therapy. Amplification of the V3 and V4 hypervariable regions of the 16S rRNA was done followed by high-throughput sequencing. Susceptibility testing for faecal Escherichia coli and Klebsiella pneumoniae was done. This trial is complete and registered with ClinicalTrials.gov, NCT01906879.Findings: Between July 17, 2013, and April 20, 2016, 1620 participants were randomly assigned to the three treatment groups (540 [33%] per group). 1214 (75%) attended 1-year follow-up and are included in this analysis. Compared with baseline, alpha diversity was significantly reduced 2 weeks after T14 (p=0·0002), C10 (p<0·0001), and BQ10 (p<0·0001) treatment. Beta diversity was also significantly altered 2 weeks after T14 (p=0·0010), C10 (p=0·0001), and BQ10 (p=0·0001). Alpha diversity and beta diversity were restored at week 8 (p=0·14 and p=0·918, respectively) and 1 year (p=0·14 and p=0·918) after T14, but were not fully recovered at week 8 and after 1 year in patients treated with C10 (p=0·0001 and p=0·013 at week 8; p=0·019 and p=0·064 at 1 year) and BQ10 (p<0·0001 and p=0·0002; p=0·001 and p=0·029). A transient increase at week 2 after T14 and C10 of the resistance rates of E coli to ampicillin-sulbactam (12% [15/127] to 66% [38/58] for T14, 7% [10/135] to 64% [28/44] for C10), cefazolin (13% [16/127] to 43% [25/58] for T14, 10% [13/135] to 41% [18/44] for C10), cefmetazole (8% [10/127] to 26% [15/58] for T14, 4% [5/135] to 18% [8/44] for C10), levofloxacin (8% [10/127] to 35% [20/58] for T14, 7% [10/135] to 32% [14/44] for C10), gentamicin (13% [19/146] to 47% [27/58] for T14, 15% [22/149] to 45% [20/44] for C10), and trimethoprim-sulfamethoxazole (33% [48/146] to 86% [50/58] for T14, 28% [42/148] to 86% [38/44] for C10; p<0·05 in paired samples in the above analyses) returned to basal state at week 8 and after 1 year. Although bodyweight and body-mass index slightly increased, there were significant improvements in metabolic parameters, with a decrease in insulin resistance, triglycerides, and LDL and an increase in HDL. Overall, there was no significant change in the prevalence of metabolic syndrome at week 8 and 1 year after T14, C10, and BQ10.Interpretation: Eradication of H pylori infection has minimal disruption of the microbiota, no effect on antibiotic resistance of E coli, and some positive effects on metabolic parameters. Collectively, these results lend support to the long-term safety of H pylori eradication therapy.Funding: National Taiwan University Hospital and Ministry of Science and Technology of Taiwan. [ABSTRACT FROM AUTHOR]

Background: Whether concomitant therapy is superior to bismuth quadruple therapy or 14-day triple therapy for the first-line treatment of Helicobacter pylori infection remains poorly understood. We aimed to compare the efficacy and safety of 10-day concomitant therapy, 10-day bismuth quadruple therapy, and 14-day triple therapy in the first-line treatment of H pylori.Methods: In this multicentre, open-label, randomised trial, we recruited adult patients (aged >20 years) with H pylori infection from nine medical centres in Taiwan. Patients who had at least two positive tests from the rapid urease test, histology, culture, or serology or who had a single positive 13C-urea breath test for gastric cancer screening were eligible for enrolment. Patients were randomly assigned (1:1:1) to either concomitant therapy (lansoprazole 30 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg, all given twice daily) for 10 days; bismuth quadruple therapy (bismuth tripotassium dicitrate 300 mg four times a day, lansoprazole 30 mg twice daily, tetracycline 500 mg four times a day, and metronidazole 500 mg three times a day) for 10 days; or triple therapy (lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg, all given twice daily) for 14 days. A computer-generated permuted block randomisation sequence with a block size of 6 was used for randomisation, and the sequence was concealed in an opaque envelope until the intervention was assigned. Investigators were masked to treatment allocation. The primary outcome was the eradication frequency of H pylori with first-line therapy assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01906879.Findings: Between July 17, 2013, and April 20, 2016, 5454 patients were screened for eligibility. Of these, 1620 patients were randomly assigned in this study. The eradication frequencies were 90·4% (488/540 [95% CI 87·6-92·6]) for 10-day bismuth quadruple therapy, 85·9% (464/540 [82·7-88·6]) for 10-day concomitant therapy, and 83·7% (452/540 [80·4-86·6]) for 14-day triple therapy in the intention-to-treat analysis. 10-day bismuth quadruple therapy was superior to 14-day triple therapy (difference 6·7% [95% CI 2·7-10·7, p=0·001), but not 10-day concomitant therapy. 10-day concomitant therapy was not superior to 14-day triple therapy. The frequency of adverse events was 67% (358/533) in patients treated with 10-day bismuth quadruple therapy, 58% (309/535) in patients treated with 10-day concomitant therapy, and 47% (252/535) in patients treated with 14-day triple therapy.Interpretation: Bismuth quadruple therapy is preferable to 14-day triple therapy in the first-line treatment in the face of rising prevalence of clarithromycin resistance. Concomitant therapy given for 10 days might not be optimum and a longer treatment length should be considered.Funding: National Taiwan University Hospital and Ministry of Science and Technology of Taiwan. [ABSTRACT FROM AUTHOR]

Background & Aims: Taiwan has a high prevalence of hepatitis B viral (HBV) infection and hepatocellular carcinoma (HCC) with increasing consumption of alcohol. We investigated the impact of heavy alcohol consumption and HBV infection on HCC in cirrhotic patients. Methods: 966 cirrhotic patients (132 with HBV infection and alcoholism, 632 with HBV infection, and 202 patients with alcoholism) were enrolled between 2000 and 2009 and followed until 2011. The primary end point was newly developed HCC. Results: Within the three patient groups (cirrhotic patients with HBV infection and alcoholism, HBV infection alone, and alcoholism alone) 38 (28.8%), 100 (15.8%), and 21 (10.4%) showed newly developed HCC, respectively. The 10-year cumulative (52.8% vs. 39.8% vs. 25.6%, p <0.001) and annual incidences (9.9%, 4.1%, and 2.1%) of HCC were significantly higher in cirrhotic patients with HBV infection and alcoholism than those in patients with HBV infection or alcoholism alone. For patients with HBV infection and alcoholism, baseline serum HBV DNA (OR=16.8, p =0.025), antiviral nucleos(t)ides analogues (NUCs) therapy (OR=0.01, p =0.035), and serum α-fetoprotein (OR=1.18, p =0.045) were risk predictors of HCC by multivariate logistic regression models. The cumulative incidence of HCC was higher in patients with higher baseline serum HBV DNA. Antiviral NUCs therapy reduced the incidence of HCC. Conclusions: Heavy alcohol consumption significantly increased the risk of HCC in HBV-related cirrhotic patients. Elevated baseline serum HBV DNA was a strong risk predictor of HCC and antiviral NUCs therapy reduced the incidence of HCC in cirrhotic patients with HBV infection and alcoholism. [Copyright &y& Elsevier]

The article discusses a study which compared the efficacy of sequential treatment for 10 and 14 days and 14 days triple therapy in treating Helicobacter pylori infection. The study included patients with Helicobacter pylori infection from six centers in Taiwan, who were randomized to receive either sequential treatment for 10 to 14 days or 14 days of triple therapy. Study authors concluded in support of sequential treatment as the standard first-line treatment for Helicobacter pylori infection.

Background: Real-world data are scarce about the effectiveness and safety of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) for retreating East Asian patients with hepatitis C virus (HCV) infection who previously received NS5A direct-acting antivirals (DAAs). We conducted a multicenter study to assess the performance of SOF/VEL/VOX in patients who were not responsive to prior NS5A inhibitors in Taiwan., Methods: Between September 2021 and May 2022, 107 patients who failed NS5A inhibitor-containing DAAs with SOF/VEL/VOX salvage therapy for 12 weeks were included at 16 academic centers. The sustained virologic response at off-treatment week 12 (SVR 12 ) was assessed in the evaluable (EP) and per-protocol (PP) populations. The safety profiles were also reported., Results: All patients completed 12 weeks of treatment and achieved an end-of-treatment virologic response. The SVR 12 rates were 97.2% (95% confidence interval (CI) 92.1-99.0%) and 100% (95% CI 96.4-100%) in EP and PP populations. Three (2.8%) patients were lost to off-treatment follow-up and did not meet SVR 12 in the EP population. No baseline factors predicted SVR 12 . Two (1.9%) not-fatal serious adverse events (AE) occurred but were unrelated to SOF/VEL/VOX. Sixteen (15.0%) had grade 2 total bilirubin elevation, and three (2.8%) had grade 2 alanine transaminase (ALT) elevation. Thirteen (81.3%) of the 16 patients with grade 2 total bilirubin elevation had unconjugated hyperbilirubinemia. The estimated glomerular filtration rates (eGFR) were comparable between baseline and SVR 12 , regardless of baseline renal reserve., Conclusions: SOF/VEL/VOX is highly efficacious and well-tolerated for East Asian HCV patients previously treated with NS5A inhibitor-containing DAAs., Clinical Trials Registration: The study was not a drug trial. There was no need for clinical trial registration., (© 2023. Asian Pacific Association for the Study of the Liver.)

The lesser grain borer Rhyzopertha dominica is the major pest of stored paddy rice globally, including in Taiwan. It has strong phototaxis and is good at flying, suitable for developing a light-trapping method to monitor and control it. In the present study, a wavelength of light-emitting diodes (LEDs), i.e., 373 nm, was determined to be the most efficient to trap R. dominica using a dodecagon maze. Accordingly, an LED trap, named the Taiwan Agricultural Research Institute-LED (TARI-LED) trap, was invented, which comprised LEDs of two distinct wavelengths (373 and 408 nm), a wavelength switch, a suction fan, and an insect collector. The trapping efficiency was assessed in a 4-m3 laboratory arena and two paddy rice storehouses. An initial assessment was performed in the laboratory arena and showed that the TARI-LED trap with 373-nm wavelength for R. dominica rapidly increased in the first 30 min, reaching the highest trapping rate (68.5%) after 3 h. In addition, no significant difference was observed between the suction fan turned on or off. The field tests showed that the 373-nm wavelength had the highest effectiveness for trapping R. dominica in the two paddy rice storehouses, and no significant difference was observed in the number of R. dominica trapped by the 373-nm TARI-LED trap or the CDC-UV light trap. In conclusion, our TARI-LED trap 373 nm exhibited high efficiency in trapping R. dominica in paddy rice storehouses. Moreover, a suction fan-free design should benefit long-term and safe use in paddy rice storehouses trapping R. dominica., (© The Author(s) 2022. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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.

Background: Data regarding the real-world effectiveness and safety of sofosbuvir/velpatasvir (SOF/VEL) for East Asian patients with chronic hepatitis C virus (HCV) infection and compensated liver disease are limited. We evaluated the performance of SOF/VEL for 12 weeks for HCV-infected patients with compensated liver disease in a large real-world cohort in Taiwan., Methods: Between July 2019 and March 2020, 1880 HCV-infected patients with compensated liver disease who received SOF/VEL 400/100 mg once daily for 12 weeks were included at 15 academic centers in Taiwan. The sustained virologic response at off-treatment week 12 (SVR 12 ) was assessed for evaluable (EP) and per-protocol populations (PP). The tolerance was also reported., Results: The SVR 12 rates by EP and PP analyses were 95.6% [1798 of 1880 patients; 95% confidence interval (CI) 94.6-96.5%] and 99.3% (1798 of 1811 patients; 95% CI 98.8-99.6%), respectively. Among 82 patients who failed to achieve SVR 12 , 13 (15.9%) were attributed to virologic failures. The SVR 12 rates were comparable regardless of baseline characteristics. A total of 1859 (98.9%) patients completed 12-week SOF/VEL treatment. Four (0.2%) patients discontinued treatment due to adverse events (AEs). All patients with serious AEs or deaths were judged not related to SOF/VEL. The AEs occurring in ≥ 10% included headache (16.8%), fatigue (16.2%), nausea (11.8%), and insomnia (11.1%). Nine (0.5%) and 2 (0.1%) patients had grade 3 total bilirubin and alanine aminotransferase elevations., Conclusions: SOF/VEL for 12 weeks is efficacious and well-tolerated by chronic HCV-infected patients with compensated liver disease in Taiwan.

Peroxisome-proliferator activator receptor γ (PPARγ) has an anti-inflammatory role that inhibits the nuclear factor-κB (NF-κB) pathway and regulates the expressions of pro-inflammatory proteins, whereas its role in parasitic meningoencephalitis remains unknown. In this study we investigated the role of PPARγ and related mechanisms in eosinophilic meningoencephalitis caused by the rat lungworm Angiostrongylus cantonensis. We observed increased protein NF-κB expression in mouse brain tissue using GW9662, which is the specific antagonist of PPARγ, in a mouse model of angiostrongyliasis. Then we investigated NF-κB-related downstream proteins, such as COX-2, NOSs, and IL-1β, with Western blot or enzyme-linked immunosorbent assay and found that the protein expression was upregulated. The results of gelatin zymography also showed that the MMP-9 activities were upregulated. Treatment with GW9662 increased the permeability of the blood-brain barrier and the number of eosinophils in cerebrospinal fluid. These results suggested that in angiostrongyliasis, PPARγ may play an anti-inflammation role in many inflammatory mediators, including NOS-related oxidative stress, cytokines, and matrix metalloproteinase cascade by decreasing the NF-κB action., (© American Society of Parasitologists 2021.)

Background & Aims: We aimed to compare the efficacy of genotypic resistance-guided therapy vs empirical therapy for eradication of refractory Helicobacter pylori infection in randomized controlled trials., Methods: We performed 2 multicenter, open-label trials of patients with H pylori infection (20 years or older) failed by 2 or more previous treatment regimens, from October 2012 through September 2017 in Taiwan. The patients were randomly assigned to groups given genotypic resistance-guided therapy for 14 days (n = 21 in trial 1, n = 205 in trial 2) or empirical therapy according to medication history for 14 days (n = 20 in trial 1, n = 205 in trial 2). Patients received sequential therapy containing esomeprazole and amoxicillin for the first 7 days, followed by esomeprazole and metronidazole, with levofloxacin, clarithromycin, or tetracycline (doxycycline in trial 1, tetracycline in trial 2) for another 7 days (all given twice daily) based on genotype markers of resistance determined from gastric biopsy specimens (group A) or empirical therapy according to medication history. Resistance-associated mutations in 23S ribosomal RNA or gyrase A were identified by polymerase chain reaction with direct sequencing. Eradication status was determined by 13 C-urea breath test. The primary outcome was eradication rate., Results: H pylori infection was eradicated in 17 of 21 (81%) patients receiving genotype resistance-guided therapy and 12 of 20 (60%) patients receiving empirical therapy (P = .181) in trial 1. This trial was terminated ahead of schedule due to the low rate of eradication in patients given doxycycline sequential therapy (15 of 26 [57.7%]). In trial 2, H pylori infection was eradicated in 160 of 205 (78%) patients receiving genotype resistance-guided therapy and 148 of 205 (72.2%) patients receiving empirical therapy (P = .170), according to intent to treat analysis. The frequencies of adverse effects and compliance did not differ significantly between groups., Conclusions: Properly designed empirical therapy, based on medication history, is an acceptable alternative to genotypic resistance-guided therapy for eradication of refractory H pylori infection after consideration of accessibility, cost, and patient preference. ClinicalTrials.gov ID: NCT01725906., (Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: The impact of amoxicillin resistance on the efficacy of regimens containing amoxicillin for Helicobacter pylori eradication remains unknown., Objectives: To investigate whether the efficacy of an amoxicillin-containing regimen is affected by amoxicillin resistance and to identify the optimal breakpoint for amoxicillin resistance., Methods: This was a pooled analysis of five randomized trials conducted in Taiwan from 2007 to 2016. Patients who received amoxicillin-containing regimens were recruited. MICs were determined by agar dilution testing. Meta-analysis was performed to assess the risk ratio of eradication failure in amoxicillin-resistant strains compared with susceptible strains of seven different regimens. We performed further the pooled analysis and logistic regression in patients treated with clarithromycin triple therapy to identify the optimal breakpoint for amoxicillin resistance., Results: A total of 2339 patients with available amoxicillin MICs were enrolled. Meta-analysis showed that the presence of amoxicillin resistance was consistently associated with increased risk of treatment failure of amoxicillin-containing regimens at different breakpoints (risk ratio: 1.41, 95% CI 1.12-1.78, P = 0.004 when the cut-off was 0.5 mg/L). The heterogeneity was low (I2 = 0%, P = 0.615). Pooled analysis also showed that amoxicillin resistance was an independent risk factor for treatment failure of clarithromycin triple therapy at different breakpoints. The best correlation was observed when the breakpoint of amoxicillin resistance was ≥0.125 mg/L (kappa coefficient 0.298), at which the resistance rate was 11.1% (110 of 990)., Conclusions: The efficacies of amoxicillin-containing regimens are affected by amoxicillin resistance and the optimal breakpoint MIC is ≥ 0.125 mg/L., (© The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Whether concomitant therapy is superior to bismuth quadruple therapy or 14-day triple therapy for the first-line treatment of Helicobacter pylori infection remains poorly understood. We aimed to compare the efficacy and safety of 10-day concomitant therapy, 10-day bismuth quadruple therapy, and 14-day triple therapy in the first-line treatment of H pylori., Methods: In this multicentre, open-label, randomised trial, we recruited adult patients (aged >20 years) with H pylori infection from nine medical centres in Taiwan. Patients who had at least two positive tests from the rapid urease test, histology, culture, or serology or who had a single positive 13 C-urea breath test for gastric cancer screening were eligible for enrolment. Patients were randomly assigned (1:1:1) to either concomitant therapy (lansoprazole 30 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg, all given twice daily) for 10 days; bismuth quadruple therapy (bismuth tripotassium dicitrate 300 mg four times a day, lansoprazole 30 mg twice daily, tetracycline 500 mg four times a day, and metronidazole 500 mg three times a day) for 10 days; or triple therapy (lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg, all given twice daily) for 14 days. A computer-generated permuted block randomisation sequence with a block size of 6 was used for randomisation, and the sequence was concealed in an opaque envelope until the intervention was assigned. Investigators were masked to treatment allocation. The primary outcome was the eradication frequency of H pylori with first-line therapy assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01906879., Findings: Between July 17, 2013, and April 20, 2016, 5454 patients were screened for eligibility. Of these, 1620 patients were randomly assigned in this study. The eradication frequencies were 90·4% (488/540 [95% CI 87·6-92·6]) for 10-day bismuth quadruple therapy, 85·9% (464/540 [82·7-88·6]) for 10-day concomitant therapy, and 83·7% (452/540 [80·4-86·6]) for 14-day triple therapy in the intention-to-treat analysis. 10-day bismuth quadruple therapy was superior to 14-day triple therapy (difference 6·7% [95% CI 2·7-10·7, p=0·001), but not 10-day concomitant therapy. 10-day concomitant therapy was not superior to 14-day triple therapy. The frequency of adverse events was 67% (358/533) in patients treated with 10-day bismuth quadruple therapy, 58% (309/535) in patients treated with 10-day concomitant therapy, and 47% (252/535) in patients treated with 14-day triple therapy., Interpretation: Bismuth quadruple therapy is preferable to 14-day triple therapy in the first-line treatment in the face of rising prevalence of clarithromycin resistance. Concomitant therapy given for 10 days might not be optimum and a longer treatment length should be considered., Funding: National Taiwan University Hospital and Ministry of Science and Technology of Taiwan., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Early esophageal squamous cell neoplasias (ESCNs) are easily missed with conventional white-light endoscopy. This study aimed to assess whether early ESCNs have a spatial predilection and the patterns of recurrence after endoscopic treatment. We analyzed the circumferential and longitudinal location of early ESCNs, as well as their correlations with exposure to carcinogens in a cohort of 162 subjects with 248 early ESCNs; 219 of which were identified by screening and 29 by surveillance endoscopy. The circumferential location was identified using a clock-face orientation, and the longitudinal location was identified according to the distance from the incisor. The most common circumferential and longitudinal distributions of the early ESCNs were found in the 6 to 9 o'clock quadrant (38.5%) and at 26 to 30 cm from the incisor (41.3%), respectively. A total of 163 lesions (75%) were located in the lower hemisphere arc, and 149 (68.4%) were located at 26 to 35 cm from the incisor. One hundred eleven (51%) early ESCNs were centered within the "hot zone" (i.e., lower hemisphere arc of the esophagus at 26 to 35 cm from the incisor), which comprised 20% of the esophageal area. Exposure to alcohol, betel nut, or cigarette was risk factors for the development of early ESCNs in the lower hemisphere. After complete endoscopic treatment, the mean annual incidence of metachronous tumors was 10%. In addition, 43% of the metachronous recurrent neoplasias developed within the "hot zone." Cox regression analysis revealed that the index tumor within the hot zone (hazard ratio [HR]: 3.19; 95% confidence interval [CI]: 1.17-8.68; P = 0.02) and the presence of numerous Lugol-voiding lesions in the esophageal background mucosa were independent predictors for metachronous recurrence (HR: 4.61; 95% CI: 1.36-15.56; P = 0.01). We identified a hot zone that may be used to enhance the detection of early ESCNs during endoscopic screening and surveillance, especially in areas that lack resources and have a high prevalence of ESCNs.

Objective: The Taiwan Government issued a policy to restrict antimicrobial usage since 2001. We aimed to assess the changes in the antibiotic consumption and the primary resistance of H. pylori after this policy and the impact of virulence factors on resistance., Methods: The defined daily dose (DDD) of antibiotics was analyzed using the Taiwan National Health Insurance (NHI) research database. H. pylori strains isolated from treatment naïve (N=1395) and failure from prior eradication therapies (N=360) from 9 hospitals between 2000 and 2012 were used for analysis. The minimum inhibitory concentration was determined by agar dilution test. Genotyping for CagA and VacA was determined by PCR method., Results: The DDD per 1000 persons per day of macrolides reduced from 1.12 in 1997 to 0.19 in 2008, whereas that of fluoroquinolones increased from 0.12 in 1997 to 0.35 in 2008. The primary resistance of amoxicillin, clarithromycin, metronidazole, and tetracycline remained as low as 2.2%, 7.9%, 23.7%, and 1.9% respectively. However, the primary levofloxacin resistance rose from 4.9% in 2000-2007 to 8.3% in 2008-2010 and 13.4% in 2011-2012 (p=0.001). The primary resistance of metronidazole was higher in females than males (33.1% vs. 18.8%, p<0.001), which was probably attributed to the higher consumption of nitroimidazole. Neither CagA nor VacA was associated with antibiotic resistance., Conclusions: The low primary clarithromycin and metronidazole resistance of H. pylori in Taiwan might be attributed to the reduced consumption of macrolides and nitroimidazole after the national policy to restrict antimicrobial usage. Yet, further strategies are needed to restrict the consumption of fluoroquinolones in the face of rising levofloxacin resistance.

Introduction: Patients with rheumatoid arthritis (RA) and osteoarthritis (OA) may require total hip replacement (THR) or total knee replacement (TKR). The present study aimed to compare the demographic characteristics and medical costs of RA and OA patients from Taiwan who underwent either THR or TKR., Methods: The medical records of patients who had undergone THR or TKR from 1 January 1996 to 31 December 2010 were obtained from the Taiwan National Health Insurance Research Database (NHIRD). In all, we found 49 and 146 RA patients who received THR and TKR, respectively, and 1,191 and 6,574 OA patients who received THR and TKR, respectively. The gender, age, Charlson comorbidity index (CCI), hospital grade, age at registration in the catastrophic illness dataset, and medical utilisation costs of the different groups were compared., Results: There were statistically significant differences in age, CCI score, drug costs and surgery costs between RA and OA patients. Joint replacement incidence was lower in RA patients than in OA patients, and among patients who underwent THR, total medical costs incurred were higher for RA patients than OA patients. RA patients who underwent THR incurred a significantly greater total medical utilisation cost in the outpatient department (3 months before surgery and 12 months after surgery) than OA patients who underwent THR., Conclusion: Analysis of Taiwan NHIRD with regard to patients who had undergone either THR or TKR indicated that RA patients were younger than OA patients, and that significantly more medical resources were used for RA patients before, during and after hospitalisation for these procedures.

Objectives: To evaluate if esomeprazole prevents recurrent peptic ulcer in adult patients with a history of peptic ulcer receiving low-dose acetylsalicylic acid (ASA, aspirin) for cardiovascular protection in East Asia., Methods: In this prospective, randomised, double-blind, placebo-controlled trial conducted in Japan, Korea and Taiwan, eligible patients receiving low-dose ASA for cardiovascular protection (81-324 mg/day) were randomised to esomeprazole 20 mg/day or placebo for ≤72 weeks. All patients received concomitant mucosal protection (gefarnate 100 mg/day). The primary endpoint was time to ulcer recurrence (Kaplan-Meier analysis). Efficacy findings are presented up to week 48, as per a planned interim analysis within the study protocol., Results: A total of 364 patients (79.9% men; mean age, 67.1 years) comprised the full analysis set (esomeprazole, n=182; placebo, n=182). There was a statistically significant difference in the time to ulcer recurrence between esomeprazole and placebo (HR 0.09; 96.65% CI 0.02 to 0.41; p<0.001). The estimated ulcer-free rate at week 12 was 99.3% (esomeprazole) and 89.0% (placebo). The high estimated ulcer-free rate for esomeprazole was maintained through to week 48 (98.3% vs. 81.2% of placebo-treated patients). No factors, other than female gender, reduced time to ulcer recurrence in addition to the effect of esomeprazole (p<0.001). Treatment with esomeprazole was generally well tolerated., Conclusions: Daily esomeprazole 20 mg is efficacious and well tolerated in reducing the recurrence of peptic ulcer in East-Asian patients with a history of ulcers who are taking low-dose ASA for cardiovascular protection., Clinicaltrialgov Identifier: NCT01069939., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: The Bioenterics Intragastric Balloon (BIB) is effective for weight loss. However, comparisons of its effectiveness between groups with different body mass index (BMI) are rare. This study compared the effectiveness of BIB treatment in patients with BMI <32 kg/m(2) and those with BMI ≥ 32 kg/m(2) at the time of BIB removal and at 1 year later., Methods: Between April 2009 and June 2011, 28 obese patients who completed a full course of BIB treatment were enrolled. There are 16 patients with BMI <32 and 12 with BMI ≥ 32. Patients who lost more than 20 % of excess weight (% EWL) were categorized as responders., Results: The BMI significantly fell from 32.4 ± 3.7 to 28.5 ± 3.7 kg/m(2) (P < 0.01) at the time of BIB removal. All biochemical measurements except for cholesterol level were significantly improved. The median value of %EWL of all patients at BIB removal was 40.1, and 20 patients (71.4 %) were responders. Adherence to dietitian counseling was significantly better in responders than in non-responders (85 vs. 25 %, respectively; P < 0.01). The percentage of responders at 1 year after BIB removal was significantly higher among patients with BMI <32 than those with ≥ 32 (62.5 vs. 16.7 %, respectively; P = 0.02)., Conclusions: BIB placement can achieve significant weight loss and improvement of co-morbidities in obese patients. Better adherence to dietitian counseling is associated with better response. Patients with BMI <32 maintain better weight loss at 1 year after BIB removal.

Background: This study investigated the risk factors for synchronous esophageal neoplasia in patients with head and neck squamous cell carcinoma (HNSCC)., Methods: All 315 consecutive patients with newly diagnosed HNSCC received endoscopic esophageal screening with image-enhanced endoscopy., Results: Sixty-nine patients (21.9%) had synchronous esophageal neoplasia, 37 (53.6%) with superficial neoplasia and 21 (30.4%) with multiple esophageal lesions. Univariate analysis revealed age <50 years, drinking alcohol, and location of index HNSCC were significant risk factors for developing synchronous esophageal neoplasia. In multivariate analysis, drinking alcohol (odds ratio [OR], 3.792; p = .0035), index oropharynxgeal cancers (OR, 3.618; p = .0045) and hypopharyngeal cancers (OR, 2.627; p = .0029) were independent risk factors. Drinking alcohol was clearly dose-response related (p = .001)., Conclusion: Alcohol consumption and index tumor location are associated with the development of synchronous esophageal neoplasia in patients with HNSCC. Because of the high prevalence, routine endoscopic examination of the esophagus should be recommended, especially in patients with the risk factors identified., (© 2010 Wiley Periodicals, Inc. Head Neck, 2011.)

Background: Obesity has become a major worldwide public health issue. There is a need for tools to measure patient-reported outcomes. The Moorehead-Ardelt Quality of Life Questionnaire II (MA II) contains six items. The objective of this study was to translate the MA II into Chinese and validate it in patients with morbid obesity., Methods: The MA II was translated into Chinese and back-translated into English by two language specialists to create the Taiwan version, which was validated by correlations with two other generic questionnaires of health-related quality of life (HRQOL), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and World Health Organization Quality of Life (WHOQOL)-BREF Taiwan version. The convergent validity was accomplished by a series of Spearman rank correlations. Reliability of the MA II Taiwan version was determined by internal consistency obtained by Cronbach's alpha coefficient and test-retest reliability obtained by intraclass correlation coefficient., Results: One hundred subjects with morbid obesity were enrolled to test the MA II Taiwan version convergent validity and internal consistency. Test-retest studies (2 weeks apart) were applied to 30 morbidly obese patients. Satisfactory internal consistency was demonstrated by a Cronbach's alpha coefficient of 0.79. Good test-retest reliability was shown by intraclass correlations ranging from 0.73 to 0.91. The total sum of MA II scores was significantly correlated with all four domains of the WHOQOL-BREF and two major components of SF-36 (all correlations, p < 0.01; range, 0.44-0.64). All six MA II items showed significant correlations with each other (r = 0.34-0.69, p < 0.01), and the total sum of MA II scores was negatively correlated with body mass index (r  = -0.31, p < 0.01), indicating a one-dimensional questionnaire of HRQOL., Conclusions: The MA II Taiwan version is an obesity-specific questionnaire for QOL evaluation with satisfactory reliability and validity. It has the advantages of extensive evaluation for HRQOL, cross-cultural application, rapid completion, high response rates, and an advanced scoring system.

Background and Aim: The occurrence of peri-procedural myocardial ischemia with endoscopic retrograde cholangiopancreatography (ERCP) has been documented, but its significance remains controversial. This study aimed to investigate the incidence and risk factors of myocardial ischemia during ERCP procedures and to analyze the potential association between myocardial ischemia and post-ERCP complications., Methods: Ambulatory 24-h ST-segment monitoring from 30 min prior to 24 h after ERCP was obtained on 71 patients from September 2006 to August 2007. Changes in vital signs during ERCP, post-ERCP complications, and their outcomes were recorded and analyzed., Results: Cardiac ischemia occurred in 13 patients (18.3%) during ERCP and one patient developed myocardial infarction. More patients in the ischemic group (38.5%) than in the non-ischemic group (5.2%) had ST-T changes in pre-ERCP resting electrocardiography (P < 0.01). Hypotension during ERCP was found only in the ischemic group (15.4% vs 0%; P = 0.03). Patients with cardiac ischemia during ERCP had a significantly higher rate of elevated serum amylase and lipase levels (53.8% vs 15.5%; P < 0.01) and post-ERCP pancreatitis (30.8% vs 6.9%; P = 0.03). Multivariable logistic regression analysis revealed that cardiac ischemia during ERCP (OR: 5.21, P = 0.050) and pancreatic duct cannulation (OR: 5.7, P = 0.036) were independent predictors for post-ERCP pancreatitis., Conclusions: ST-T changes on resting electrocardiography and intra-procedural hypotension are risk factors of myocardial ischemia during ERCP. Post-ERCP hyperamylasemia, hyperlipasemia, and pancreatitis were associated with myocardial ischemia during ERCP.

Background: Obesity has become a major health issue not only in the West but also in Asia. Morbid obesity can lead to much comorbidity and can markedly interfere with quality of life. The aim of this study was to compare the health-related quality of life (HRQL) between patients with morbid obesity coming for bariatric surgery and the healthy population in Taiwan., Methods: Patients were between age 18 and 65 years. Patients had a BMI between 32 and 40 kg/m(2) with obesity-related comorbidities or a BMI > 40 kg/m(2). Patients were enrolled for bariatric surgery by a modified recommendation of the Asia-Pacific consensus. Physical and psychiatric evaluations were accomplished simultaneously. The World Health Organization Quality of Life (WHOQOL-BREF), Taiwan version, was administered 1 month before the operation. The quality of life of the obese patients was compared with age-, sex-, education-, marriage-, and municipality-matched healthy control patients taken from a national survey in Taiwan. Multiple regression analyses were conducted to study risk factors for impairment of HRQL., Results: A total of 114 consecutive patients with obesity coming for bariatric surgery at our hospital were enrolled in 2007. Obese subjects had poorer WHOQOL-BREF scores than those of the healthy referents in physical, psychological, and social domains but not in environmental domain (P < 0.05). Patients with BMI levels above 32 kg/m(2) had consistently poorer scores in various facets after adjusting for other risk factors., Conclusions: The higher the BMI level the poorer the HRQL. Our findings seem to support the recommendations of Asia-Pacific consensus based on HRQL considerations.

Objectives: To investigate the prevalence of endoscopically suspected esophageal metaplasia (ESEM) in an ethnic Chinese population by endoscopic and pathologic evaluation and to assess the utility of Prague C and M criteria., Methods: Consecutive patients who received esophagogastroduodenoscopy either as a part of therapy for various upper abdominal symptoms or as an annual health check-up were evaluated for the existence of ESEM and Barrett's esophagus (BE). Biopsy with standardized random four pieces every 2 cm from the four quarters of esophagus with ESEM lesion was performed. BE was defined by histological verification of specialized intestinal metaplasia and gastric metaplasia and was categorized according to the Prague C and M criteria., Results: A total of 5,179 subjects were screened from Jan. 2007 to Dec. 2007. This study enrolled 4,797, including 3,386 for referral endoscopy and 1,411 for screening endoscopy. Prevalence of BE among the referral endoscopy, screening endoscopy, and overall was 1.06%, 0.35%, and 0.85%, respectively. A total of 41 subjects with BE were detected among 93 ESEM subjects. Short segment BE (75.6%, n=31) was more prevalent than long segment BE (24.4%, n=10). The proportions of BE from subjects with ESEM by Prague C and M criteria were C< or =1M1 38.9% (19/50), C< or =1M2 40% (12/30), and CxM> or =3 76.9% (10/13)., Conclusions: On the basis of the standardized protocol with random four-quadrate endoscopic biopsy, we have demonstrated the utility of Prague C and M criteria to characterize the BE in an ethnic Chinese population.