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Objectives: To evaluate the associations between cardiovascular disease (CVD) risk burden (estimated by the World Health Organization (WHO) algorithm) and cognitive impairments (e.g., incident dementia, global and domain-specific impairments) among CVD-, dementia- and disability-free, community-dwelling middle-aged and older adults during an 8-year follow-up. Design: A community-based longitudinal cohort study. Setting: Yuanshan township in Yi-Lan County, Taiwan. Participants: A total of 889 community-dwelling residents aged 50 years or older. Measurements: Age, sex, educational level, employment status, alcohol status, body mass index, physical activity, gait speed, depressive symptoms, WHO region-specific CVD risk scores (10-year CV risk, low: <10% vs. moderate-to-high: ≥ 10%), Chinese version of the Mini-Mental State Examination (MMSE), verbal memory by the delay-free recall in the Chinese Version Verbal Learning Test (CVVLT), language function by the Boston Naming Test and the category (animal) Verbal Fluency Test, visuospatial function by the Taylor Complex Figure Test, executive function by the digit backward and the Clock Drawing Test. Results: Compared to those with low CVD risk, middle-aged and older adults with moderate-to-high CVD risk were at greater risk for cognitive impairments with respect to the MMSE (adjusted odds ratio (aOR) 1.60 [95% confidence interval (CI) 1.19–2.15], P=0.002), verbal memory (aOR 1.97 [1.43-2.70], P< 0.001) and language (aOR 1.99 [1.46–2.70], P< 0.001), as well as incident dementia (aOR 2.40 [1.33–4.33], P=0.004). After adjusting for all covariates, CVD risk was not associated with other domains of cognitive impairment. Conclusions: Among healthy, community-dwelling, middle-aged and older adults, those with moderate-to-high cardiovascular risk burden were significantly associated with incident dementia and global and domain-specific cognitive impairments (verbal memory and language), which suggests the existence of a relationship between early cognitive deficits and CVD risk burden. Further studies are needed to elucidate the pathophysiological mechanism of the link between CVD risk burden and cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: International guidelines on clinical staging of gastric cancer recommend the use of chest CT for the detection of pulmonary metastases. This study assessed the clinical value of routine chest CT in the staging of gastric cancer. Methods: This retrospective study included patients identified from the gastric cancer registry of Chang Gung Memorial Hospital, Linkou, Taiwan. All patients who underwent clinical staging between 2008 and 2014 were included. The pattern, site and number of metastases at initial presentation and after surgery with curative intent were evaluated. Pulmonary metastases were defined as multiple small round pulmonary nodules with a random distribution or of variable size. Results: Some 1669 patients were included, of whom 478 (28·6 per cent) had metastatic disease at clinical presentation. The majority of metastases were to the peritoneum (75·7 per cent of patients) or liver (30·5 per cent), and only 27 patients (5·6 per cent) had pulmonary metastases at presentation, none of which were isolated to the lung. Of these 27 patients, 11 had primary lesions located at the cardia/fundus. In 19 patients the lung metastases were also detected on the staging chest X‐ray. After surgery there were 196 cancer recurrences. Some 15 patients (7·6 per cent) had lung metastasis and this was not the only site of metastases in any patient. The prevalence of lung metastasis at presentation of the disease and after surgery was 1·6 and 1·5 per cent respectively. Conclusion: This study does not support the routine use of chest CT for staging of gastric cancer as isolated pulmonary metastasis in the absence of other metastatic sites could not be detected. [ABSTRACT FROM AUTHOR]

The interpretation of modern river apatite fission track (AFT) data of Taiwan by Resentini et al. (2020) presents some fundamental inaccuracies that call in question the main conclusions of the paper. The study aims at approximating source rock cooling histories by analysing erosional products, but ignores existing bedrock data in their maps and discussions. The allegedly "new" southern extension of the AFT reset zone is largely unconstrained by the presented data and ignores the local geology and stratigraphy of individual drainage basins. Notably, low grain counts (median=9) and catchment with various geological provinces, including orogenic derived sediments, question the significance of the dataset to characterise "single geological domains" as explained in the paper. Overall, the new data do not provide discriminating evidence for an earlier collision in the north of the island and thus do not support a southwardly propagation of collision. [ABSTRACT FROM AUTHOR]

Background: Previous studies have indicated the issue of delay treatment in patients diagnosed as oral cancer in population-based screening because oral cancer patients often lack the knowledge to understand rapid progress of oral cancer. Aim: To evaluate the impact of delay in treatment on the survival of oral cancer detected by screening. Methods: We enrolled residences aged 18 years or older with cigarette smoking and/or betel quid chewing who attended Nationwide Oral Cancer Screening program between 2004 and 2009. Cases with prior history of oral cancer were excluded. Demographic characteristics, oral habits, time of delay in treatment after screening and cancer stage were collected. The survival status of oral cancer was ascertained by following up this cohort until the end of 2012. Results: A total of 6353 oral cancers were detected by screening with a median of 19 (interquartile range 12 to 29) days for treatment. Oral cancer with earlier clinical stage had less delay in treatment (P < 0.01) while gender, age, and diagnostic year had no difference in delay. In univariate analysis, older age (hazard ratio, HR = 1.01), clinical stage (HR = 1.96 for stage II, 3.13 for stage III, 6.42 for stage IV as compared with stage I), and delay in treatment after screening longer than 3 weeks (HR = 1.11) or 6 weeks (HR = 1.64) were highly associated with worse prognosis. In multivariate analysis, delay in treatment more than 6 weeks (HR = 1.34, 95% CI 1.21-1.48) led to poor survival of oral cancer. Conclusion: Subjects with cigarette smoking and/or betel quid chewing who attended oral cancer screening and were detected as oral cancer patients should be advised to undergo treatment no more than 6 weeks. [ABSTRACT FROM AUTHOR]

Hourly measurements of wave data for 10–14 years from four field stations were analyzed to evaluate wave energy resource characteristics in medium wave power potential coastal waters of northeast Taiwan. Spectral parameters, resource index, and constitutive energy periods were discussed. Time series of water surface displacement in each hour for three consecutive years at two stations were first adopted to obtain period transferring coefficient C ep of 0.86–0.87 for JONSWAP's peak enhancement factor γ of 1.5–1.6. The derived average wave energy scatter maps characterized indices of monthly and seasonal variations and highlighted the effects of typhoon and higher potentials by monsoons with increasing waves from NE. Comparisons with previous numerical simulations on sites offshore northeastern coasts pointed out slightly higher energy potentials at present field stations suggesting field measurements being vital for resource assessment. From energy scatter maps of two representative geographical zones, 15 and 16 top-ranked bin conditions were selected to display concentrations on constitutive energy periods from 6 s to 10 s. Similar selections were applied to foreign energy resources in Pacific and Atlantic coastal waters to show major energy potentials at higher latitudes concentrated on constitutive period ranges by 2 s longer. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of Adult T-cell leukaemia/lymphoma (ATL) in non-endemic regions is challenging., Aim: This study analyses the clinicopathologic features and diagnostic processes of ATL patients in Taiwan., Methods: ATL patients diagnosed and treated at Taipei Veterans General Hospital from 1998 through 2010 were retrospectively identified. The diagnosis of ATL was confirmed by in situ detection of human T-cell leukaemia virus type 1 (HTLV-1) when necessary. Patients' data were reviewed and analysed., Results: Fourteen ATL patients were identified, among whom six (42.9%) had an antecedent diagnosis of other malignant lymphomas before the ATL diagnosis, including two diagnosed with Hodgkin disease (HD), one with peripheral T-cell lymphoma, two with chronic lymphocytic leukaemia and one with angioimmunoblastic T-cell lymphoma. Of the 14 patients, eight (57%) were subclassified as the acute type, three (21.4%) as the lymphoma type, and three (21.4%) as the chronic type ATL. Five of six (83.3%) patients with initial non-ATL misdiagnosis were diagnosed with non-acute type ATL. In particular, a patient with an antecedent diagnosis of HD presented with typical Reed-Sternberg (RS)-like cells harbouring Epstein-Barr virus genomes in affected lymph nodes. The patient progressed to acute type ATL 3 years after the initial diagnosis, and HTLV-1 genomes were identified in the previous RS-like cells., Conclusion: In non-endemic areas, such as Taiwan, ATL, particularly the non-acute type, may mimic other lymphomas and easily be misdiagnosed. HTLV-1 serology should be routinely screened in all malignant lymphoma patients. In situ detection of HTLV-1 is helpful in cases with diagnostic dilemmas., (© 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.)

Background: The Milan criteria are used to select candidates with small hepatocellular carcinoma (HCC) for liver transplantation. Due to severe shortage of donors, majority of patients within the Milan criteria need to seek alternative treatments., Aim: To propose a prognostic model for these patients undergoing non-transplant therapies., Methods: A total of 1106 HCC patients, who were within the Milan criteria and received non-transplant therapies were retrospectively analysed. Patients were randomly assigned to the derivation and validation set according to treatments. A prognostic model was constructed from independent predictors of survival identified in the multivariate Cox model of the derivation set and was confirmed in the validation set., Results: In the Cox model, serum bilirubin ≥1.5 mg/dL [risk ratio (RR): 1.525, P = 0.016], α-fetoprotein (AFP) ≥100 ng/mL (RR: 1.728, P < 0.001), mild ascites (RR: 1.705, P = 0.025) and moderate/severe ascites (RR: 4.163, P < 0.001) were independent predictors of poor survival in the derivation set (n = 553). A prognostic model with a total of 0-4 points was derived with the sum of three variables: 1 point each for bilirubin ≥1.5 mg/dL, AFP ≥100 ng/mL and mild ascites, and 2 points for moderate/severe ascites. This scoring system accurately predicted the survival in the validation set (n = 553; P < 0.001). The model consistently discriminated the survival in patients stratified by curative and noncurative treatments (both P values <0.001)., Conclusion: The newly proposed prognostic scoring model, based on serum bilirubin and AFP level, and severity of ascites, is informative to predict the survival in non-transplant HCC patients within the Milan criteria., (© 2012 Blackwell Publishing Ltd.)

Background: Published studies of prevalence of depression in old age in Taiwan have yielded equivocal results., Aims: To study the prevalence of depressive disorders among community-dwelling elderly; further, to assess socio-demographic correlates and life events in relation to depression., Method: A randomised sample of 1500 subjects aged 65 and over was selected from three communities. Research psychiatrists conducted all assessments using the Geriatric Mental State Schedule. The diagnosis of depression was made with the GMS-AGECAT (Automated Geriatric Examination for Computerised Assisted Taxonomy); data on life events were collected with the Taiwanese version of the Life Events and Difficulties Schedule., Results: One-month prevalence of psychiatric disorders was 37.7%, with 15.3% depressive neurosis and 5.9% major depression. A high risk of depressive disorders was found among widows with a low educational level living in the urban community, and among those with physical illnesses., Conclusions: Contrary to most previous reports, we found that the prevalence of depressive disorders among the elderly in the community in Taiwan is high and comparable to rates reported in some studies of UK samples.

Objectives: To determine whether tea consumption and intake of other beverages increases bladder cancer risk., Methods: A case-control study was conducted in Kaohsiung, Taiwan between August 1996 and June 1997. Index patients studied were consecutive patients with histologically confirmed, newly diagnosed bladder cancer in two major hospitals. For each patient, 4 controls were selected from patients with non-neoplastic and nonurologic diseases undergoing surgical operations in the same hospital and individually matched by sex, age, and date of admission. Using a structured questionnaire, a trained interviewer interviewed 40 patients and 160 controls. Conditional logistic regression analysis adjusting for ethnicity, family history, and smoking status and matching variables were used to estimate the odds ratio (OR) and 95% confidence interval (CI)., Results: Tea consumption overall was associated with increased bladder cancer risk (OR 3.29, 95% CI 1.34 to 8.05). Compared with non-tea drinkers, the odds ratios of bladder cancer for oolong tea drinkers was 3.00 (95% CI 1.20 to 7.47); for non-oolong tea drinkers (black and/or other green tea), it was 14.86 (95% CI 2.13 to 103.83). The risk was greater among those who began to drink tea before age 40 (OR 9.50, 95% CI 2.39 to 37.75) and those who had been drinking tea for more than 30 years (OR 17.75, 95% CI 3.00 to 105.17). Coffee, tap water, and alcohol consumption were associated with a slightly increased risk, and both soy juice and rice juice consumption were associated with reduced risk; none of these odds ratio estimates were statistically significant, however., Conclusions: Our results suggest that tea consumption is associated with an increased risk of bladder cancer.

Our preliminary results show the telemedicine system is successful. It does fulfill the 3 goals we set earlier. However, for such a system to be cost effective, the communication cost need to be cut further. In fact, video is not required at all time. We are hoping to establish criteria and operational procedure for use of video. Also some sort of standard should be set up for evaluation of the quality of telemedicine.

The aim of this study was to examine the practicality of the modified isometric strength tests to predict the maximum acceptable weight of lift (MAWL) of Chinese men. The modified strength tests allow the participant to pull on the load cell in front of the body and to apply force in a functional free posture. Both the modified and the standard strength data of each participant were used as predictors for the MAWLs. The prediction models were constructed and evaluated under task conditions of two lifting ranges, two box sizes, and three lifting frequencies. To realize the effect of modifications, testing posture was recorded and the joint angles were calculated. A stepwise multiple regression analysis indicated that modified composite strength (MCS), chest circumference, and acromial height accounted for 86% to 91% of the variance. Because the strength of the upper extremity body was also recruited in the test, the weak upper extremity strength of the Chinese participants would therefore be better reflected. Evidence for the existence of a close match between MAWL and MCS values, as well as the task conditions for its existence, suggest that a simple isometric strength measure is a good predictor for the MAWL.

The practicality of using restrained as well as standard isoinertial strength tests in predicting the maximum acceptable weight of lift (MAWL) of Chinese male subjects was examined using a restrained strength test, which allows the subject to pull on the load in front of the body and to apply force in a functional free posture. Prediction models were constructed and evaluated under task conditions of two lifting ranges, two box sizes, and three lifting frequencies. The following measurements were taken for each subject in each test: (1) the body posture and joint angles, and (2) electromyographic activities of the arm muscles (biceps brachii), back muscles (erector spinae), and leg muscles (rectus femoris). Results indicate that the restrained knuckle height isoinertial strength (RK) was related significantly to the MAWL for all tasks, and the correlation coefficients ranged from 0.42 to 0.69. A step-wise multiple regression analysis based on data from the 22 subjects showed that RK, chest circumference, and thigh length accounted for 90 to 94% of the variance. A validation effort on a different sample (N = 10) showed that the MAWLs can be predicted within an absolute mean (SD) error of 0.84 (3.30) kg. Percentages of muscle activation levels indicated that, other than strength from the erector spinae, the strongest contribution to the RK value was that of biceps brachii strength. Since the strength of the body's upper extremity was also recruited, the weak upper extremity strength of Chinese subjects was better reflected. Evidence for the existence of a close match between MAWL and RK values, and the conditions of the existence, suggest that RK is good predictor for the MAWL.

Objective: To investigate a possible interrelationship between obesity and the coagulation and fibrinolytic systems of ethnic Chinese., Design: The Cardiovascular Disease Risk Factor Two-Township Study, a longitudinal, prospective study in Taiwan, which focuses on the evolution of cardiovascular disease risk factors., Measurements: Haemostatic parameters measured in this study included prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, factor VIIc, factor VIIIc, antithrombin III and plasminogen., Results: Present data demonstrated that all haemostatic parameters show a dose-dependent change with body weight. PT and APTT shortened with increased body mass index (BMI). Fibrinogen, factor VIIc, factor VIIIc, plasminogen and antithrombin III increased with higher BMI., Conclusion: The present result shows that haemorrheological abnormalities do exist in obese subjects and this thrombophilic phenomenon sheds further light on the study of higher cardiovascular and cerebrovascular mortality and morbidity in the obese.

A postural analysis system was developed using a biomechanical approach to identify low back pain related working postures of nursing personnel. The Ovako Working Analysis System (OWAS) was modified for doing postural recording. Chaffin's biomechanical model was used to calculate the associated work stress on the L5/S1. The system was applied to examine the working postures of 64 nurses of 16 departments. The frequency distribution of the trunk showed 15.9% of the 8,629 observed postures were bending more than 15 degrees. Based on the calculated stress, 17.0% of the observed postures generated forces higher than the recommended action limit of the National Institute for Occupational Safety and Health (NIOSH). In addition to patient transfers, potentially health hazardous postures were identified in nursing tasks of inspection, nursing techniques, instrumentation, physical examination, taking inventory, and documentation.

The Eco RI fragment of hepatitis B virus (HBV) DNA isolated from human blood plasma Dane particles were inserted into plasmid pUC8 Eco RI site and transformed into E. coli JM103 host. Two recombinants pTWL1 and pTWL2 were found to carry 3.2 kbp fragment and proved to have HBV genome by Southern hybridization method. The 1.4 kbp Bam HI fragment which carried the hepatitis B viral surface antigen (HBsAg) gene, obtained via Bam HI digestion of Dane particles DNA which was made fully double stranded by endogenous DNA polymerase reaction, was also inserted into plasmid pUC8 Bam HI site. Four recombinant clones, pTWS1, pTWS2, pTWS3, and pTWS4 were found. Only one of the clones pTWS1 carried the HBsAg gene in a correct orientation with respect to the lac promoter sequence. The physical mapping of HBV DNA was performed with several restriction endonucleases. Our results indicated that the HBV DNA insert contains unique XbaI and HpaI cleavage sites and lacks the cleavage sites for the HindIII, SmaI, KpnI, SalI, and SstI endonucleases. The locations of Bam HI, BglII, and HincII endonucleases cleavage sites within the cloned HBV DNA of the pTWL1 plasmid were similar to that HBV DNA of adw and adw2 subtypes.