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Background Psoriasis is regarded as a systemic inflammatory disease, having been linked in recent studies, to a wide range of systemic disorders. Previous studies have reported a positive correlation between psoriasis and chronic obstructive pulmonary disease (COPD); however, no studies have been conducted on an ethnic Chinese population. Methods We conducted a population-based study, using a representative cohort from the National Health Insurance database in Taiwan, between 2004 and 2006. The risk of COPD was compared between patients with psoriasis and a matched reference cohort. This study included 2096 psoriasis patients and 8384 randomly selected controls. Results After adjusting for sociodemographic characteristics and selected chronic diseases, the hazard ratio (HR) for COPD in psoriasis patients was 2.35 (95% confidence interval (CI): 1.42-3.89) compared with the control group in 18 months of follow-4 up. Men (HR = 2.38, 95% CI: 1.36-4.18) and patients with psoriasis over 50 years of age (HR = 2.19, 95% CI: 1.27-3.77) were more likely to contract COPD. Conclusions We concluded that psoriasis patients were at a greater risk of developing COPD with significantly lower COPD-free survival rates than the comparison cohort ( P < 0.001). Physicians should be aware of this potential risk to reduce comorbidity and mortality. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the experience of cancer-related fatigue in children of different ages in Taiwan. A total of 17 children with different stages of cancer were interviewed. The methods of data collection included interviews, participants' observations, medical chart reviews and the researcher's reflexive journals. Data were progressively analysed by using qualitative data analysis method throughout the process of data collection. The results indicated that children in all age groups used the word ‘tiredness’ or ‘weary’ instead of ‘fatigue’. Patients in different age groups described the fatigue differently. Younger children (<9 years) reported that fatigue affected their ability to participate in physical activities. Children aged 10–12 years described fatigue as extreme tiredness that affected their daily lives both physically and psychosocially by altering their daily routine and school attendance and performance. Adolescents described fatigue as unrelievable tiredness that differed from normal tiredness and had a great impact on physical and psychosocial aspect, particularly altering their future life plans and self-performance. This study shows that the definition and impact of fatigue differs among children by age group. Defining and understanding the effects of fatigue can help clinicians assess fatigue and implement effective strategies to alleviate it. [ABSTRACT FROM AUTHOR]

AIMS: The aim of this study was to develop and evaluate the psychometric properties of a Chinese version of the Fatigue Scale-Children (FS-C-C). BACKGROUND: Cancer-related fatigue is one of the most distressing and prevalent symptoms reported by paediatric oncology patients during and after their cancer treatment. A reliable and valid instrument to measure fatigue is essential to the successful clinical care of paediatric oncology patients in Taiwan who experience this troubling symptom. DESIGN AND METHODS: A total of 108 paediatric oncology Taiwanese patients who were aged 7-12 years participated in this cross-sectional, instrumentation study. The FS-C was translated into Chinese by using an established translation/back-translation method. The psychometric testing of the FS-C-C included internal consistency, content validity, construct validity, convergent validity, criterion-related validity and known-group validity. RESULTS: The FS-C-C achieved an acceptable internal consistency coefficient. Content validity was moderately high (content validity indices ranged from 83-100%). Confirmatory factor analysis supported the three-factor model as an acceptable model fit (the goodness-of-fit index and adjusted goodness-of-fit index both were greater than 0.9; normed fit index, 0.89; root-mean-square residual, 0.15). Although the results did not support the known-group hypothesis, the convergent validity, concurrent validity and predictive validity of the FS-C-C were supported by significant associations with the PedsQL Multidimensional Fatigue Scale, the Anxious/Depressed subscale of the Child Behaviour Checklist and the generic and disease-specific scores on the Quality of Life for Children with Cancer instrument, respectively. CONCLUSION: Our newly developed FS-C-C is a reliable and valid instrument for the measurement of cancer-related fatigue intensity in Taiwanese children. RELEVANCE TO CLINICAL PRACTICE: The FS-C-C could provide useful information to guide clinical practice in assessing and managing cancer-related fatigue in childhood cancer patients in Taiwan. [ABSTRACT FROM AUTHOR]

Species whose geographical distribution encompasses both mainland and island populations provide an ideal system for examining isolation and genetic divergence. In this study, paternally transmitted chloroplast DNA (cpDNA) and maternally transmitted mitochondrial DNA (mtDNA) were used to estimate population structure and phylogeography of Pinus luchuensis, a species found in eastern China (ssp. hwangshanensis), Taiwan (ssp. taiwanensis), and the Ryukyu Archipelago (ssp. luchuensis). Gene genealogies of both mtDNA and cpDNA reveal two major lineages. Molecular dating indicates that these lineages diverged before the colonization of P. luchuensis subspecies in Taiwan and the Ryukyu Archipelago. Both mtDNA and cpDNA show a lack of correspondence between molecular phylogeny and subspecies designation. Phylogeographical analysis suggests that paraphyly of the subspecies is the result of recent divergence rather than secondary contacts. In spite of the short divergence history of P. luchuensis on islands, the island populations show the same degree of genetic divergence as mainland populations. Low levels of genetic diversity in the mainland ssp. hwangshanensis suggest demographic bottlenecks. In contrast, the high heterogeneity of genetic composition for island populations is likely to be associated with a history of multiple colonization from the mainland. The spatial apportionment of organelle DNA polymorphisms is consistent with a pattern of stepwise colonization on island populations. [ABSTRACT FROM AUTHOR]

Background Living-donor kidney transplantation has a positive influence on recipients' life expectancy and improves quality of life for patients with end-stage renal disease compared with dialysis patients. Evaluation of the physical and mental quality of life for donors can promote positive perceptions about donation and help potential donors in their decision-making process. The aim of this study was to explore the predictive factors of quality of life for living kidney donors. Methods A cross-sectional and descriptive design was used, and the study was conducted from January to July 2013. The donors were a convenience sample of 34 participants who had undergone kidney transplant surgery >1 year earlier. Results The results showed that kidney donors had a low to moderate physical and mental quality of life. Multiple regression analysis revealed that financial concerns and anxiety explained 27.8% of the total variance of quality of life in the physical component. Anxiety and paid work explained 61.4% of the total variance of quality of life in the mental component. Conclusions After renal transplantation, living kidney donors experienced low to moderate quality of life. Because donors are family members (siblings, sons or daughters, spouses, or parents), monthly family income is a significant issue that influences both the decision to donate and quality of life after transplantation. Our findings suggest that pre-transplantation assessment must include social workers as part of the health care team to evaluate the impact of a donor's financial status on post-transplantation quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Background: Patients who are no longer in need of dialysis as a consequence save time and reduce stress every day. Social function was an important issue in patients with successful renal transplantation. According Bandura's social cognitive theory, ones' behavior is affected by social context and affective factors continuously. The quality of social function needs further investigation. Purpose: The aims of this study were to describe the degree of social function after renal transplantation and to explore its predictive factors. Method: A cross-sectional and descriptive study design was conducted in the outpatient department of a medical center in northern Taiwan from July to October 2010. The recipients were a convenience sample of 101 participants who had undergone renal transplantation. Hierarchical multivariate regression analysis was used to explore the predictive factors related to social function. Results: The results showed that renal transplant recipients have moderate to high social function. Regression analyses showed that psychological factors (perceived stress, stress after renal transplantation, and depressive symptoms) and social participation (paid-work and leisure activity) explained 37.1% of the total variance for social function. Depressive symptoms explained most of the total variance. Conclusion: After renal transplantation, patients experienced higher levels of social function. Perceived stress, stress after renal transplantation, depressive symptoms, paid-work, and leisure activity were the predictive factors of social function. Managing levels of depressive symptoms is highly recommended to elevate the patient's social function. [Copyright &y& Elsevier]

Background: While most living kidney donors are satisfied with their decision and do not regret donating, few studies have been conducted on the determinants related to the effectiveness and regret of the decision. This study aims to explore the relationship between basic attributes, quality of life, positive affect, negative affect, effectiveness of decision-making, and regret in living kidney donors., Methods: In this cross-sectional study, living kidney donors were recruited from urology and kidney transplant outpatient services. The structured questionnaire used to collect the data included the Positive and Negative Affect Schedule, Medical Outcomes Study 12-Item Short-Form Health Survey, Decision Conflict Scale, and Decision Regret Scale., Results: The findings indicate that living donors with better health status, 24-hour creatinine clearance, physical health-related quality of life (HRQOL), and positive affect experienced greater feelings of effective decision-making. Moreover, women and donors with better physical HRQOL, positive affect, and decision effectiveness were less regretful about the decision of kidney donation., Conclusion: Health status, physical HRQOL, and positive affect are related to decision validity and regret of living donors. Therefore, clinical care providers should regularly assess the mood and health of living kidney donors. Furthermore, activities promoting their health should be encouraged, especially for men., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Therapeutic drug monitoring (TDM) has been advocated to promote the efficacy of anti-tuberculosis agents. Cycloserine (CS) is a second-line anti-tuberculosis drug whose serum concentrations in tuberculosis (TB) patients are largely unknown., Objectives: To investigate serum CS concentrations after drug ingestion in TB patients., Methods: Multidrug-resistant TB patients who were taking CS in a tertiary care centre in northern Taiwan between 1 April 2009 and 31 October 2009 were enrolled in the study. Serum CS concentrations were measured at 2 and 6 h after drug administration., Results: Of 32 patients enrolled, 23 were males and 9 females. The mean CS dose was 8.8 ± 1.3 mg/kg. The mean serum concentrations at 2 and 6 h were respectively 19.7 ± 8.3 and 18.1 ± 8.7 μg/ml. Seven patients (22%) had serum drug concentrations that were higher at 6 h than at 2 h, 12 (38%) had peak serum concentrations within the recommended range of 20-35 μg/ml; 18 patients (56%) had concentrations <20 μg/ml at both 2 h and 6 h; and 2 patients (6%) had at least one measurement >35 μg/ml., Conclusion: Lower than recommended serum CS concentrations and delayed absorption were common. It is essential to develop practical TDM to maintain proper serum drug concentrations.

It has been 10 years since the "Taiwan Organ Registry and Sharing Center" (TORSC) was founded by the Department of Health in June 2002. The mission of TORSC is to build a fair organ sharing and registration network and also a national database collection and analysis mechanism. TORSC is also dedicated to improving the organ donation rate and shortening the waiting times for patients to improve the effective usage of donated organs. The first organ was formally allocated on April 1, 2005. In this article, we will present the initial 8-year results of this allocation system focusing on kidneys. From the first organ shared on April 1, 2005 to March 31, 2013, there were 1502 donors allocated by TORSC. There were 1063 males and 439 females, with a mean age for males of 42.41 and for females of 41.99. Total organs they donated were hearts 642, livers 688, kidneys 1626, lungs 50, pancreas 88, and cornea 1973. The overall nation-wide 3-year survival rate of kidney recipients was 93.72% for patients and 83.08% for kidney grafts. In comparison, the 3-year graft survival rate presented in the 2008 Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR) annual report was 82.4% for kidney. According to our data, graft survival is not inferior to OPTN/SRTR, although the patient numbers are not comparable., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background and Purpose: Painful sensations are recently reported to be a non-motor feature of Parkinson's disease (PD). The non-steroidal anti-inflammatory drug ibuprofen is a common painkiller and was reported to be associated with a decreased risk of PD. The aim of the present study was to examine the relationship amongst preceding pain symptoms, use of ibuprofen and risk of PD in a nationwide population-based cohort., Methods: The data of participants who were free of PD at baseline were obtained from two large National Health Interview Surveys (NHIS) in Taiwan, conducted in 2001 and 2005. The information regarding pain status included severity and location of pain. Information regarding pain status, use of ibuprofen, comorbidity of depression and PD-associated risk/protective behaviors was adjusted using proportional hazards models., Results: Amongst 33 388 participants, 32 cases of incident PD were identified after a mean follow-up of 3 years. After adjusting for the use of ibuprofen and other PD risk factors, subjects with preceding pain symptoms had a higher incidence of PD than those without pain at baseline, and the hazard ratio was 1.79 (95% CI: 0.71-4.51, P = 0.21) for mild pain and 2.88 (95% CI: 1.05-7.86, P = 0.04) for moderate or severe pain. The PD risk increased by 34% with each additional increment in pain score [hazard ratio = 1.34 (1.03-1.75), P = 0.03], showing a dose-response relationship., Conclusions: These findings support the hypothesis that pain is associated with PD in the pre-motor stage of the disease. Further research is needed to clarify the role of sensory system involvement in the pre-motor phase of PD., (© 2013 The Author(s) European Journal of Neurology © 2013 EFNS.)

Background: Obesity, in the either kidney donor or the recipient, has been related to worse graft function. The aim of this study was to compare long-term graft outcomes of living-related kidney recipients regarding the donor-to-recipient body mass index (BMI) ratio., Methods: From November 2002 to November 2010, 62 consecutive living-related kidney transplantations were performed at our center. Donor and recipient BMIs were categorized by Taiwan's national standard using dividing values of 18.5, 24, and 27 kg/m(2) to divide subjects into donor-to-recipient BMI categories. These with the same BMI category as their donors were defined as the same-BMI group (group 0); recipients with a lower BMI category than their donors were defined as the large-to-small group (group 1); and those with a higher BMI category than their donors were defined as the small-to-large group (group 2). Baseline parameters and posttransplantation follow-up data were analyzed according to this grouping., Results: Of the 57 recipients followed regularly at our hospital (mean follow-up 48.9 months), 21 (36.8.1%) were in group 0; 26 (45.6%) in group 1, and 10 (17.6%) in group 2. The baseline parameters were similar among these groups. The overall graft survival rates were 81.0% in group 0, 76.9% in group 1, and 90.0% in group 2. The rejection-free graft survival rates were 81.0%, 65.4%, and 90.0%, respectively. By Kaplan-Meier analysis, group 1 showed worse rejection-free graft survival than group 0 or group 2 (log-rank P = .046)., Conclusions: Living-related recipients of kidneys from donors with a higher BMI showed lower long-term graft survival, which might suggest that petite recipients may need time to compensate adequate blood flow for the relative large graft, thus carrying a higher chance of rejection and worse graft outcomes., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to explore the relationship between optimism and life satisfaction among patients with end-stage renal disease who decide to wait or not to wait for kidney transplantation. This cross-sectional, correlation design study was performed from July 2007 to June 2008. Subjects were recruited by purposive sampling in the clinics of kidney transplantation, renal disease, hemodialysis, and peritoneal dialysis. Three hundred fifty questionnaires were distributed, we analyzed the 335 returned including 196 subjects in the waiting group and 139 in the non-waiting group. Parameters included patient basic information, optimism, and life satisfaction scales. Data were analyzed by independent t-student's, chi-square, Pearson correlation, and stepwise multiple regression tests. The subjects in both the waiting and non-waiting groups reported moderate levels of life satisfaction; whereas, the latter reported a greater life satisfaction in general. All participants had good optimism that was positively related to their life satisfaction. Other factors of optimism, age, work ability, waiting transplantation or not, and marriage status were also significantly associated with life satisfaction., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

The purpose of this study is to develop a decision analysis model based on the influence diagram and estimate the benefits receiving of influenza vaccination. We collected more than 300,000 samples of elders aged over 65 years in Taiwan and then analyzed the health expenditure of the elders with and without influenza vaccination. We incorporate clinical results and the knowledge of physicians by an influence diagram. We divided our samples into four different age groups and the results showed that the total healthcare expenses for receiving influenza vaccination are more than the expenses for not receiving influenza vaccination for all age groups, we found there is a trend that the difference decreases if the age is older. We performed the one-way sensitivity analysis and Monde Carlo sensitivity analysis further and the results showed that the expected health expenditure is mostly sensitive to the hospitalization under the different condition.

Background: Transitional cell carcinomas (TCC) have been reported to be the most common post-renal transplantation malignancy in Taiwan; they are considered to be related to the use of herbal drugs. However, in 2004, hepatocellular carcinoma (HCC) was the most prevalent malignancy at our institute. We therefore extended our observations through 2006 to include a larger renal transplant cohort., Materials and Methods: Patients were given an immunosuppressive regimen consisting of either cyclosporine or FK 506, mycophenolate mofetil, and copticosteroid. Critical diagnostic follow-up procedures were performed trimonthly. Aggressive surgical procedures were performed when operable cancers were found. Immunosuppressants were reduced thereafter to prevent recurrence., Results: Among 663 patients, 55 developed 58 malignancies which were diagnosed after a mean of 70 months posttransplantation. Among these 55 patients, 25 died. HCC accounted for 22 malignancies, followed by 15 cases of TCC, and 8 cases of posttransplantation lymphoproliferative disorder (PTLD). Fifteen known hepatitis B carriers received lamivudine therapy; none had recurrences and only 2 acquired HCC. These 2 patients are still living, whereas the remaining 20 subjects with HCC are deceased. Of the 37 patients who received anti-CD25 induction therapy, none displayed PTLD., Conclusions: HCC remains the most common post-renal transplantation malignancy in northern Taiwan. The high rates of hepatitis B and C endemic to Taiwan and the prevalence of hepatitis C virus (HCV) genotype 1b infections in northern Taiwan may explain this finding. Frequent alpha-fetoprotein measurements and liver ultrasonograms are recommended for early detection of HCC among Taiwanese renal transplant recipients. Anti-CD25 induction therapy appears to be helpful to prevent the development of PTLD among Taiwanese renal transplant recipients.

Background: A drug regimen including a calcineurin inhibitor (cyclosporine or tacrolimus) and prednisone has been the mainstay of maintenance immunosuppression in our renal transplant recipients for more than 10 years. After the introduction of mycophenolate mofetil (MMF), a new, potent immunosuppressant that may reduce the incidence of late rejection in renal transplant recipients, the immunosuppressive protocol in some recipients was changed to an MMF-based regimen. We sought to ascertain whether the addition of MMF lead to greater susceptibility to infectious complications., Patients and Methods: Between May 1991 and November 2002, all renal transplant recipients who received a two-drug regimen initially for more than 6 months were changed to an MMF-based regimen. The study includes patients with functional grafts for more than 6 months thereafter. Differences in the incidence, etiology, and outcome of infections were compared during the non-MMF versus the MMF periods., Results: Eighty patients of mean age of 38.6 years (range 13 to 69) included 43 men and 37 women. The mean daily MMF dose was 663 mg/patient (range 250 to 1500 mg). The mean follow-up time of non-MMF period and MMF periods were 3.4 and 2.1 years, respectively. The overall incidence of infections in the two periods was similar (0.2 infections/patient in the non-MMF period and 0.25 infections/patient in the MMF period, P = .57). No mortality was associated with these infectious complications. In conclusion, addition of MMF, a more potent immunosuppressive protocol, did not increase the incidence of infections in stable renal transplant recipients initially treated with a two-drug regimen.

Introduction: Renal transplantation has been advocated as the treatment of choice for end-stage renal disease. Organ transplantation increases the incidence of cancer through unclear mechanisms. A literature review showed that the most common neoplasms are of skin origin, which are uncommon in Eastern people. We reviewed cancer patterns in our renal transplant series., Materials and Methods: From July 1981 to December 2002, among 560 renal transplantations performed in this hospital, we retrospectively surveyed cancer incidence, types, and usage of immunosuppressants., Results: Twenty nine cancer cases 5.18% (incidence) included hepatocellular carcinoma (HCC) as the highest mortality rate (9 of 13 cases). Eight of these 13 cases were hepatitis B carriers. All four hepatitis C carriers expired three of them with unresectable multinodular tumors at diagnosis in Posttransplantation lymphoproliferative disorder (PTLD) was the second most common cancer (seven cases); all but one survived with reduced doses of or changes in immunosuppressants. No skin cancer other than four Kaposi's sarcomas with skin manifestations was detected in our series., Discussions: HCC was the main cancer in our series. Accepting hepatitis B carriers as candidates for renal recipients and donors may be one of the causes. PTLD was the second most common cancer, while there were no skin cancers.

Background: Acute rejection is the major cause of graft loss in renal transplantation. Sirolimus (rapamycin) inhibits the effects of cytokines on T and B cells; therefore, it provides prophylaxis against acute renal rejection. This open-label trial assessed the incidence of biopsy-confirmed acute rejection episodes, variation in renal function, as well as graft and patient survival rates up to 12 months posttransplantation when using sirolimus in combination with cyclosporine and prednisolone as immunosuppressants., Methods: Ten kidney transplant recipients received sirolimus 2 mg daily after a 6-mg loading dose. Doses were then adjusted to keep the whole-blood trough level between 5 and 20 mg/mL. All patients received sirolimus in combination with cyclosporine and prednisolone., Results: At 12 months after renal transplantation, the graft and patient survival rates were 90% and 90%, respectively. One patient died at 2 months due to sepsis with a functioning graft. The mean serum creatinine levels at 1, 3, and 6 months were 1.59 mg/dL, 1.71 mg/dL, and 1.65 ml/dL, respectively. There was no biopsy-confirmed acute rejection episode within 12 months., Conclusions: Sirolimus in combination with cyclosporine and prednisolone significantly protected kidney transplant recipients from acute rejection for up to 1 year of follow-up.

Background: The long-term use of methamphetamine (MAMP) can result in psychosis but it is not clear why some individuals develop psychotic symptoms, while others use MAMP regularly over long periods and remain unscathed. We set out to characterize MAMP users and to examine the relationship of pre-morbid personality, pre-morbid social function and other psychiatric disorders to MAMP psychosis., Method: Four hundred and forty-five amphetamine users were recruited from a psychiatric hospital and a detention centre in Taipei, and were assessed with the Diagnostic Interview for Genetic Studies (DIGS). Their parents were interviewed with the Premorbid Schizoid and Schizotypal Traits (PSST) and the Premorbid Social Adjustment (PSA) schedules. Pre-morbid characteristics and psychiatric co-morbidity were compared between the MAMP users with a lifetime diagnosis of MAMP psychosis and those without., Results: The MAMP users with psychosis presented a clinical picture which mimicked the positive symptoms of schizophrenia: 85% had auditory hallucinations; 71% persecutory delusions; 63% delusions of reference. Compared with their non-psychotic counterparts, these MAMP users were younger at first MAMP use, used larger amounts of MAMP, had a significantly higher mean PSST score, and higher rates of major depressive disorder, alcohol dependence and antisocial personality disorder., Conclusions: Earlier and larger use of MAMP was associated with increased risk of psychosis. Our data are also compatible with the view that pre-morbid schizoid/schizotypal personality predisposes MAMP users to develop psychosis, and that the greater the personality vulnerability, the longer the psychosis will persist.

The phylogegraphic pattern of Cycas taitungensis, an endemic species with two remaining populations in Taiwan, was investigated based on genetic variability and phylogeny of the atpB-rbcL noncoding spacer of chloroplast DNA (cpDNA) and the ribosomal DNA (rDNA) internal transcribed spacer (ITS) of mitochondrial DNA (mtDNA). High levels of genetic variation at both organelle loci, due to frequent intramolecular recombination, and low levels of genetic differentiation were detected in the relict gymnosperm. The apportionment of genetic variation within and between populations agreed with a migrant-pool model, which describes a migratory pattern with colonists recruited from a random sample of earlier existing populations. Phylogenies obtained from cpDNA and mtDNA were discordant according to neighbour-joining analyses. In total four chlorotypes (clades I-IV) and five mitotypes (clades A-E) were identified based on minimum spanning networks of each locus. Significant linkage disequilibrium in mitotype-chlorotype associations excluded the possibility of the recurrent homoplasious mutations as the major force causing phylogenetic inconsistency. The most abundant chlorotype I was associated with all mitotypes and the most abundant mitotype C with all chlorotypes; no combinations of rare mitotypes with rare chlorotypes were found. According to nested clade analyses, such nonrandom associations may be ascribed to relative ages among alleles associated with the geological history through which cycads evolved. Nested in networks as interior nodes coupled with wide geographical distribution, the most dominant cytotypes of CI and EI may represent ancestral haplotypes of C. taitungensis with a possible long existence prior to the Pleistocene glacial maximum. In contrast, rare chlorotypes and mitotypes with restricted and patchy distribution may have relatively recent origins. Newly evolved genetic elements of mtDNA, with a low frequency, were likely to be associated with the dominant chlorotype, and vice versa, resulting in the nonrandom mitotype-chlorotype associations. Paraphyly of CI and EI cytotypes, leading to the low level of genetic differentiation between cycad populations, indicated a short period for isolation, which allowed low possibilities of the attainment of coalescence at polymorphic ancestral alleles.

Both experimental and epidemiologic studies have linked a low dietary intake of selenium with an increased risk of cancer. The authors examined the association between plasma selenium levels and risk of hepatocellular carcinoma (HCC) among chronic carriers of hepatitis B and/or C virus in a cohort of 7,342 men in Taiwan who were recruited by personal interview and blood draw during 1988-1992. After these men were followed up for an average of 5.3 years, selenium levels in the stored plasma were measured by using hydride atomic absorption spectrometry for 69 incident HCC cases who were positive for hepatitis B surface antigen (HBsAg) and/or antibodies against hepatitis C virus (mostly HBsAg positive) and 139 matched, healthy controls who were HBsAg positive. Mean selenium levels were significantly lower in the HCC cases than in the HBsAg-positive controls (p = 0.01). Adjusted odds ratios of HCC for subjects in increasing quintiles of plasma selenium were 1.00, 0.52, 0.32, 0.19, and 0.62, respectively. The inverse association between plasma selenium levels and HCC was most striking among cigarette smokers and among subjects with low plasma levels of retinol or various carotenoids. There was no clear evidence for an interaction between selenium and alpha-tocopherol in relation to HCC risk.

This study was conducted to assess the role of carotenoid and glutathione S-transferase (GST) M1 and T1 genetic polymorphisms in the development of hepatocellular carcinoma (HCC). A total of 84 incident cases of HCC and 375 matched controls selected from a cohort of 7,342 men (4,841 chronic hepatitis B carriers and 2,501 noncarriers) who were recruited between 1988 and 1992 in Taiwan were studied. Neither GST M1/T1 polymorphisms nor plasma levels of various carotenoids were independently associated with HCC, but they modulated smoking- and/or drinking-related HCC risk. Cumulative exposure to tobacco smoke significantly increased HCC risk in a dose-dependent manner among subjects with low plasma beta-carotene levels (p for trend = 0.047) but not among those with high levels. A statistically significant effect of habitual alcohol drinking on HCC risk was observed only for those with low plasma levels of beta-carotene, alpha-carotene, or lycopene and for GST M1 null subjects. There was evidence suggesting an interaction between the GST M1/T1 genotype and certain carotenoids in HCC associated with smoking and drinking. The strongest effect of smoking and drinking was noted among GST M1 null subjects with low plasma levels of beta-carotene (smoking: adjusted odds ratio (OR) = 3.54, 95% confidence interval (CI) 1.06-11.83; drinking: OR = 8.28, 95% CI 2.40-28.61).

Background: In April 1997, an unusual pigmentary disorder was noticed by dermatologists in Taiwan. All patients had a history of using facial dressings with steamed leaves of Piper betle L. (Piperaceae)., Objective: Our purpose was to clarify the evolution and the origin of this unique leukomelanosis., Methods: Fifteen patients with an unusual pigmentary disorder, who visited our clinic in September and October 1997, were asked to complete a questionnaire designed to elicit the history related to the disorder. Eight of these 15 patients underwent skin biopsies: 6 on the mottled hyperpigmented area (group A) and 2 on the hypopigmented area (group B). All 8 specimens were prepared with hematoxylin-eosin, Masson-Fontana, and S-100 stains., Results: The results of the questionnaire revealed that these patients had all experienced a temporary erythematous reaction in the first few days of the use of the facial dressing, and 9 of them also complained of an accompanying stinging sensation. A bleaching effect became noticeable approximately 1 week to 1 month later. Eight patients reported that the hyperpigmentation and confetti-like hypopigmentation occurred after overexposure to the sun. In both groups, histopathologic examination revealed some melanophages in the dermis. Masson-Fontana staining of specimens from group A showed local interspersed depigmentation and hyperpigmentation in the basal epidermis and pigmentary incontinence in the dermis. This picture was different from the homogeneous depigmentation within basal epidermis in specimens from group B. In both groups, S-100 staining was negative for melanocytes in the depigmented area., Conclusion: The clinical course and histopathologic findings suggest that the evolution of this pigmentary disorder can be divided into 3 stages. The first stage is the immediate bleaching stage, when an irritant reaction is usually conspicuous. The second stage consists of prominent hyperpigmentation visible both grossly and microscopically. The final stage is characterized by confetti-like depigmentation. It may be induced by chemicals in the betel leaves such as phenol, catechol, and benzene derivatives, perhaps through inhibition of melanin synthesis or melanocytotoxicity.

Between March 1984 and August 1994, 13 orthotopic liver transplantations were performed in 13 patients < or = 25 years of age. The indications included Wilson's disease (n = 7), biliary atresia (n = 4), choledochal cyst (n = 1) and hepatitis C cirrhosis (n = 1). Technical variants included full-size (n = 11), reduced-size (n = 1) and living-related (n = 1) liver transplantation. These recent technical innovations have offered an expanded donor pool for earlier transplantation, shorter waiting times and excellent quality grafts. Surgical complications occurred in six patients; all required additional surgery. Biliary complications were encountered more commonly in our earlier patients. Our actuarial patient and graft survival rate is 92% at 2 years. The long-term follow-up of our liver-transplanted Wilson's disease patients provides confirmatory evidence that orthotopic liver transplantation cures the underlying metabolic defect with complete normalization of biochemical abnormalities of copper metabolism, reversal of neurological impairments and the disappearance of Kayser-Fleischer corneal rings. The high rate of patient survival and excellent rehabilitation indicate that with prudent clinical judgement, liver transplantation can be achieved with an acceptable rate of morbidity, mortality and cost in a setting where manpower and donor organs are very limited.

The seroprevalence of the measles antibody in southern Taiwan 2 years after the launch of the two-dose measles elimination program was studied using serological surveillance. Sera from 868 healthy inhabitants were collected from January to December 1993. Measles IgG antibody was detected by enzyme-linked immunosorbent assay. Measles antibody was found in 82% of infants under 3 months of age, 26% of those between 4 and 9 months and 54% of those between 10 and 15 months of age. The most common reason for postponement of vaccination was due to concomitant illness during the scheduled vaccination period. The presence of measles antibody rose sharply in children over 15 months of age, reached 90% among preschool-aged children and was 93% in school-aged children. These data suggest that a high immunization coverage rate was achieved in children over 15 months of age (92%) and that a third measles immunization at age 12 is not necessary. Future strategies for measles control should aim at increasing the immunization coverage for children between 9 and 15 months of age.

In Kaohsiung City, dengue fever subsided for two years after the 1987-1988 epidemic. The main reason that it recurred was due to late diagnoses of the dengue fever in patients because of mild or atypical clinical presentations. The first patient contracted dengue fever from Thailand in mid-May, 1991. The disease then spread among his co-workers. Dengue fever was not suspected until the 9th patient contracted it in early July 1991. Through chain transmission, the epidemic spread in the community and even to other parts of Taiwan. There were 113 confirmed dengue cases in Kaohsiung City, and a total of 175 cases on the whole island during the 1991 epidemic. The clinical manifestations were mainly fever, body pain, dizziness, general weakness, and a skin rash. No instances of severe bleeding, shock or dengue hemorrhagic fever were found. Seven dengue 1 and three dengue 3 viruses were isolated from the sera of patients. We found that the clinical severity of the 1991 dengue epidemic was milder, and the viral isolation rate was lower, compared with the 1987-1988 epidemic, although these two outbreaks of dengue fever were both mostly due to dengue type 1. Genetic variation in the dengue virus may be the explanation. Clinically, about 35% of the patients were missed or not reported, although they were finally demonstrated to be dengue fever patients during a patient survey in the epidemic area. For early detection, viral surveys should be performed in new epidemic regions in addition to fixed-spot surveillance.(ABSTRACT TRUNCATED AT 250 WORDS)

Approximately 15 to 20% of the general population in Taiwan are chronic hepatitis B surface antigen (HBsAg) carriers. However, the incidence of hepatitis D virus (HDV) infection is low (5-8%) in patients with HBsAg-positive chronic liver diseases in this area. To evaluate the prevalence of hepatitis B virus (HBV) and HDV infection among drug abusers in Taiwan, serum samples were collected from 152 drug abusers at the Taipei Municipal Anti-Narcotic Institute and test for HBV and HDV markers. Of these, 24 (15.8%) were HBsAg positive, and only 15 (9.9%) were seronegative for all HBV markers. Of the 115 intravenous drug abusers, serum antibody to hepatitis D antigen (anti-HD) was positive in 78.9% of 19 persons who were HBsAg positive, and in 7.5% of 80 persons who were positive for antibody to HBsAg (anti-HBs). Anti-HD was not detected in the sera from all 37 nonintravenous drug abusers regardless of the status of their HBV markers. Also, none of 63 asymptomatic HBsAg carrier pregnant women or 23 patients with acute type B viral hepatitis had measurable anti-HD in their sera. Thus, the high frequency of HDV detected among Chinese HBsAg carrier intravenous drug abusers in Taiwan is similar to that reported in Western countries.