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Chi-Ling Wu,1 Oswald Ndi Nfor,1 Disline Manli Tantoh,1,2 Wen-Yu Lu,1 Yung-Po Liaw1– 3 1Department of Public Health, Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan; 2Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan; 3Institute of Medicine, Chung Shan Medical University, Taichung City, TaiwanCorrespondence: Yung-Po Liaw, Department of Public Health and Institute of Public Health, Chung Shan Medical University, No.110 Sec. 1 Jianguo N.Road, Taichung City, Taiwan, Tel +886436097501, Fax +886423248179, Email Liawyp@csmu.edu.twPurpose: Osteoporosis is a degenerative disease that affects women and men of all races. We studied the association between body mass index (BMI), rs2908004 polymorphism of the WNT16 gene, and osteoporosis using data from Taiwan Biobank (TWB).Patients and Methods: We analyzed data from 10,942 subjects aged 30 to 70. We defined osteoporosis based on a mean T-score of − 2.5 and below in the hip. Body mass index was classified following the guidelines of the Health Promotion Administration. Imputation was carried out using the IMPUTE2 (v2.3.1) program. Multiple logistic regression was used for analysis. The odds ratios (ORs) and 95% confidence interval (CI) for osteoporosis were determined.Results: In the multivariate regression model, variant rs2908004 had a significant association with osteoporosis. That is, the rs2908004-GA+AA genotype was associated with lower osteoporosis risk than the GG genotype (OR, 0.651; 95% CI = 0.544 to 0.780). Compared to normal-weight, underweight was significantly associated with a higher risk of osteoporosis (OR, 6.517; 95% CI = 4.624 to 9.186) while overweight and obesity were protective (OR, 0.176; 95% CI = 0.140 to 0.221 and 0.057; 95% CI = 0.039 to 0.083, respectively). There was an interaction between rs2908004 and BMI (p = 0.0148). Subgroup analyses (using rs2908004-GG/normal-weight as the reference group) indicated ORs of 7.66 (95% CI = 5.153 to 11.394) in the rs2908004-GG/underweight group and 3.002 (95% CI = 1.509 to 5.974) in the rs2908004-GA+AA/underweight group (95% CI = 1.509 to 5.974). Odds ratios were substantially lower in rs2908004-GG/obese, rs2908004-GG/overweight, GA+AA/normal-weight, rs2908004-GA+AA/overweight, and rs2908004-GA+AA/obese groups, respectively.Conclusion: According to our study, underweight was associated with an increased risk of osteoporosis irrespective of WNT16 rs2908004 genotypes, while overweight and obesity were associated with a lower risk.Keywords: bone health, SNP, osteoporosis, anthropometric measures

To observe the effect of electroacupuncture (EA) combined with caudal epidural injection on subjective pain, walking capability, lumbar flexibility and muscle strength in patients with lumbar disc hernia (LDH).Sixty LDH patients were randomly allocated to the control group and the research group. The patients of the control group received ultrasound guided caudal epidural injection, and those of the research group received EA combined with ultrasound guided caudal epidural injection. Bilateral Jiaji (EX-B2) and adjunct points Guanyuanshu (BL26), Shenshu (BL23), Chengfu (BL36), Huantiao (GB30), Zhibian (BL54), etc. on the affected side were stimulated with EA (2 Hz/16 Hz, 5-8 mA) for 30 min each time, once every other day for 4 weeks, with 2 days' rest between every two weeks. The patients' pain was evaluated by using visual analogue scale (VAS), walking capability assessed by timed-up and go (TUG) test (time of walking back and forth in 3 m distance), lumbar flexibility (range of motion, ROM) detected by using an inclinometer and the strength of the lumbar flexor and extensor determined by using a push-pull dynamometer.After the treatment, self-comparison showed that the VAS score and TUG-measured time in both groups were significantly decreased (For patients with LDH, EA combined with caudal epidural injection can alleviate pain, improve the walking capability, lumbar flexibility and strength of the lumbar extensor, and the therapeutic effect of the combined treatment is significantly better than that of simple caudal epidural injection.

Background The febrile infection-related epilepsy syndrome (FIRES) is a catastrophic epileptic encephalopathy which developed the refractory status epilepticus following or during a nonspecific febrile illness. To analyze the short-term and long-term outcome of FIRES in the children, we retrospectively analyzed the related data. Methods The motor outcome was evaluated by modified Rankin scale (mRS). Poor motor outcome was defined as a mRS score of 4 or higher at discharge. Significant motor decline was defined as the mRS difference more than 2 before hospital admission and at discharge. Results We totally enrolled 25 patients for analysis. Four patients were expired during hospitalization, and one patient was lost to follow-up after discharge. Therefore, a total 20 patients were finally analyzed. The age of disease onset ranged from 1.6 to 17.2 years (mean: 9.6 ± 4.4 years). Newly acquired epilepsy and cognitive deficit occurred in 100% and 61%, respectively. The duration of the anesthetic agents ranged from 7 to 149 days (mean: 34.2 ± 36.1 days). The duration of anesthetic agent usage (p = 0.011), refractory epilepsy (p = 0.003), and the use of ketogenic diet (p = 0.004) were significantly associated with the poor long-term motor outcome, and the number of anesthetic agents tended to be associated with the poor long-term motor outcome (p = 0.050). In-hospital mortality was 16%. Significant functional decline at discharge occurred in 100%. However, there was improvement in long-term follow-up. Conclusion The outcome of FIRES is poor with significant mortality and morbidities. Refractory epilepsy with cognitive deficit in survived cases is common, but improvement is possible.

Pang-Li Liu,1 Ming-Yi Hsu,2,3 Chao-Chin Hu,4 Disline Manli Tantoh,5,6 Wen-Yu Lu,6 Oswald Ndi Nfor,6 Yung-Po Liaw5,6 1Department of Medical Sociology and Social Work, Chung Shan Medical University, Taichung, 40201, Taiwan; 2Department of Nursing, Chung Shan Medical University, Taichung, 40201, Taiwan; 3Department of Nursing, Chung Shan Medical University Hospital, Taichung, 40201, Taiwan; 4Department of Medical Applied Chemistry, Chung Shan Medical University, Taichung, 40201, Taiwan; 5Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, 40201, Taiwan; 6Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, 40201, TaiwanCorrespondence: Yung-Po Liaw; Oswald Ndi Nfor Tel +886-932-532-370Fax +886-266-369-260Email Liawyp@csmu.edu.tw; nforoswald2@yahoo.comObjective: This study aimed to investigate the association of age and sex with metabolic syndrome (MS) in Taiwanese adults.Methods: We extracted information of 4307 men and 4783 women aged 30– 70 from the Taiwan Biobank.Results: The interaction between age and sex on MS was significant (p-value = 0.0001). After stratification by sex, men and women aged 50– 70 years (reference: 30≤age< 50 years) had a higher risk of MS. The odds ratio (OR), 95% confidence interval (CI) was 2.316, 1.936– 2.772 in men and 3.101, 2.561– 3.754 in women. After stratification by age, men aged 50– 70 years had a lower risk of MS compared to women (OR, 95% CI = 0.713, 0.598– 0.851).Conclusion: The interaction between age and sex on MS was significant. Sex-wise, both men and women aged 50– 70 years had a higher likelihood of MS. Age-wise, men aged 50– 70 years had a lower risk of MS compared to women.Keywords: metabolic syndrome, age, sex, Taiwan Biobank

A fucosylated chondroitin sulfate was isolated from the body wall of sea cucumber Stichopus japonicus (FCSsj), whose structure was characterized by NMR spectroscopy and HILIC-FTMS. At the ratio of 1.00:0.26:0.65, three fucosyl residues were found: 2,4-disulfated-fucose (Fuc2,4S), 4-sulfated-fucose (Fuc4S) and 3,4-disulfated-fucose (Fuc3,4S), which were only linked to the O-3 of glucuronic acid residues (GlcA). Besides mono-fucosyl moieties, di-fucosyl branches, namely Fuc2,4Sα(1→3)Fuc4S, were also found to be attached to the O-3 of GlcA. The antidiabetic activity of FCSsj was evaluated using glucosamine induced insulin resistant (IR) Hep G2 cells in vitro. It was found that FCSsj significantly promoted the glucose uptake and glucose consumption of IR-Hep G2 cells in a dose-dependent manner, and could alleviate the cell damage. Furthermore, FCSsj could promote the glycogen synthesis in the glucosamine-induced IR-Hep G2 cells. These results provided a supplement for studying the antidiabetic activity of FCSsj.

Background DNA methylation of Cadherin 13 (CDH13), a tumor suppressor gene is associated with gene repression and carcinogenesis. We determined the relation of dietary fat and sex with CDH13 cg02263260 methylation in Taiwanese adults. Methods Data of 870 eligible participants (430 men and 440 women) between 30 and 70 years were obtained from the Taiwan Biobank (TWB) database. The association of dietary fat and sex with CDH13 cg02263260 methylation was determined using multiple linear regression. Results The association between sex and cg02263260 methylation was significant: beta-coefficient (β) = 0.00532; 95% confidence interval (CI) = 0.00195–0.00868. Moreover, the interaction between sex and dietary fat on cg02263260 methylation was significant (P-value = 0.0145). After stratification by sex, the association of dietary fat with cg02263260 methylation was significant only in women. Specifically, high dietary fat was positively associated with cg02263260 methylation in women (β = 0.00597; 95% CI = 0.00061–0.01133) and the test for trend was significant (P-value = 0.0283). Conclusion High fat intake was significantly associated with higher cg02263260 methylation in women and the test for trend was significant. These findings suggest that the association of fat intake and CDH13 cg02263260 might vary by sex and CDH13 cg02263260 methylation levels in women might increase as fat intake increases.

New diseases are emerging as the environment changes, so drug manufacturers are always on the lookout for new resources to develop effective and safe drugs. In recent years, many bioactive substances have been produced in the marine environment, which represents an alternative resource for new drugs used to combat major diseases such as cancer or inflammation. Many marine-derived medicinal substances are in preclinical or early stage of clinical development, and some marine drugs have been put on the market, such as ET743 (Yondelis®). This review presents the sources, activities, mechanisms of action and syntheses of bioactive substances based on marine natural products in clinical trials and on the market, which is helpful to understand the progress of drug research by application of marine natural products.

Background Polycyclic aromatic hydrocarbon (PAH)-rich substances like cigarette smoke and PM2.5 induce aryl hydrocarbon receptor (AHR)-mediated aryl hydrocarbon receptor repressor (AHRR) methylation. AHRR cg05575921 and coagulation factor II (thrombin) receptor-like 3 (F2RL3) cg03636183 methylation patterns are well-established biomarkers for smoking. Even though AHRR cg05575921 methylation has recently been associated with PM2.5, the interaction between smoking and PM2.5 on AHRR methylation is yet to be fully explored. We evaluated AHRR and F2RL3 CpG sites to identify potential significant markers in relation to PM2.5 and smoking in Taiwanese adults. Methods DNA methylation and smoking data of 948 participants aged 30–70 years were obtained from the Taiwan Biobank Database (2008–2015), while PM2.5 data were obtained from the Air Quality Monitoring Database (2006–2011). Results Smoking and PM2.5 were independently associated with hypomethylation (lower levels) of AHRR cg05575921, AHRR cg23576855, F2RL3 cg03636183, and F2LR3 cg21911711 after multiple-comparison correction (Bonferroni P β = − 0.03909, P P smoking P 2.5. After adjusting for F2RL3 cg03636183, smoking and PM2.5 remained significantly associated with cg05575921 hypomethylation: β − 0.02221, P P smoking P = 0.0120 for PM2.5. After stratification by sex, smoking and PM2.5 remained associated (P β = − 0.04274, − 0.17700, and − 0.00163 for former smoking, current smoking, and PM2.5, respectively) and women (β = − 0.01937, − 0.17255, and − 0.00105 for former smoking, current smoking, and PM2.5, respectively). After stratification by residential area, former and current smoking remained associated (P β = − 0.03918 and − 0.17536, respectively (P-trendsmoking P β = − 0.01356 and − 0.01970, respectively (P-trendarea Conclusion Smoking and PM2.5 were independently associated with hypomethylation of cg05575921, cg23576855, cg03636183, and cg21911711. The most hypomethylated CpG site was cg05575921 and its association with smoking and PM2.5 was dose-dependent.

Background and objectives: High-density lipoprotein cholesterol (HDL-C) is important for improving risk estimates of atherosclerotic cardiovascular disease. We investigated the effect of omnivore and diverse vegetarian diets in connection with exercise on HDL-C. Materials and Methods: Historical data of 9588 biobank participants (4025 exercisers and 5563 non-exercisers) aged 30&ndash, 70 years were categorized as omnivores (n = 8589), former vegetarians (n = 544), lacto-ovo vegetarians (n = 417), and strict vegetarians (n = 38). We used multiple linear regression for analyses. Results: HDL-C levels were higher in exercisers compared to non-exercisers. Compared with omnivores, strict vegetarians had decreased levels of HDL-C (&beta, = &minus, 5.705, p = 0.001) followed by lacto-ovo vegetarians (&beta, 3.900, p &lt, 0.001) and former vegetarians (&beta, 0.329, p = 0.475). The test for trend was significant (p &lt, 0.001). After categorization by exercise modalities, the &beta, value was &minus, 13.984 for strict vegetarians, &minus, 4.419 for lacto-ovo vegetarians, and &minus, 1.864 for former vegetarians, respectively (p &lt, 0.05). There was an interaction between diet and exercise (p = 0.009). Omnivores who exercised regularly had significantly higher HDL-C, whereas strict vegetarians who exercised regularly had significantly lower HDL-C. Conclusions: In summary, strict vegetarian diets in conjunction with regular exercise might not serve as healthful behaviors to be implemented in everyday life considering the negative impact on HDL-C.

Both refractory convulsive status epilepticus (SE) and super-refractory SE are medical emergencies. However, there are limited data on super-refractory SE in children. Thus, this study focuses on characterizing the demographics, outcomes, and prognostic factors for super-refractory SE in children.This study was a retrospective analysis of super-refractory SE treated in a tertiary referral center in Taiwan. The functional outcome was evaluated by modified Rankin scale (mRS). Significant functional decline was defined as an mRS difference (before hospital admission and at discharge) of more than 2. The variates and the follow-up mRS values were then analyzed statistically.We enrolled 134 patients with 191 episodes of convulsive SE and identified 30 patients with 38 episodes of convulsive super-refractory SE. The incidence of convulsive super-refractory SE in the group with SE was 19.9%, and the age ranged from 2.5 months to 17 years. In-hospital mortality was 13.3%, which was much lower than that of adult cohorts. Newly acquired epilepsy and cognitive deficit occurred in 100% and 88.5%, respectively. Newly acquired epilepsy, as a sequel of super-refractory SE, was observed in all 18 patients (100%) who survived and had no history of epilepsy. Significant functional decline (mRS difference of more than 2) at discharge occurred in 76.7%. Poor functional outcome was associated with acute symptomatic etiology (P 0.001) and the number of anesthetic agents (P = 0.002). The functional outcome improved after 1 year of follow-up in our population.Super-refractory SE is associated with significant morbidity and mortality in children. However, the in-hospital mortality rate is much lower compared with adults. The functional outcome in children is associated with acute symptomatic etiology and the number of anesthetic agents and may improve after long-term follow-up.

The Mean Shift is an algorithm which is a non-parametric probability density gradient estimation. It can be widely applied to the moving target tracking. This paper presents a target tracking method of mean shift based on SOPC. Through designing the parallel algorithm of the system, to take into account the cost of FPGA hardware and complexity of the model, we improve the real-time of the target tracking. Meanwhile, through modeling based on DSP Builder, instead of preparing FPGA hardware description language code, we reduce system designing complexity and improve the designing efficiency of the electronic system . The results show that the real-time of the target tracking is proportional to the Parallelism of design, and the system can meet with the real-time of high-speed visual tracking.

An 11-year-old boy was referred to our hospital for near syncope. He was generally healthy before. On physical examination, his consciousness was clear, and there was no focal neurological deficit. The heart beat was irregular. ECG showed atrial flutter with variable ventricular response (Figure 1A). Cardiomegaly was noted on chest x-ray, with cardiac apex pointing toward the left side (Figure 1B). However, the transthoracic echocardiography showed that the location of presumed cardiac apex on chest x-ray was actually occupied by an extremely dilated left atrium (LA). The cardiac apex was pointed toward the right side of the chest. Mild to moderate mitral valve regurgitation was found, but the morphology and opening of both mitral leaflets appeared normal. Computed tomography confirmed the diagnosis of a giant LA aneurysm with rightward shift of the cardiac apex (Figure 1C and 1D). The …

Lane detection is one of fundamental but critical problems for lane following system of Intelligent Vehicles. However, a robust and cost effective approach is still a deserve exploit issue. A novel and effective approach using a five steps scheme is presents. First, Canny detector is used to obtain edge map from the road image acquired from monocular camera mount on vehicle; Second, a matching process is conducted to normalize the potential candidates of road line or boundary; Third, a searching procession is utilized for reinforce potential road lines while degraded those impossible ones; Forth, a linking condition is investigated to further enhance the confidence of the potential lane lines; Finally, a K-means cluster based algorithm is employed to localize the lane lines, in this step, false edges will be rejection and only optimal lines will be accepted. Experimental results show that the proposed approach can achieve robust and effective localize the lane line in various bad road scenes, and has a better generalize capability with road types.

Absence epilepsy is an important epileptic syndrome in children. Multiscale entropy (MSE), an entropy-based method to measure dynamic complexity at multiple temporal scales, is helpful to disclose the information of brain connectivity. This study investigated the complexity of electroencephalogram (EEG) signals using MSE in children with absence epilepsy. In this research, EEG signals from 19 channels of the entire brain in 21 children aged 5-12 years with absence epilepsy were analyzed. The EEG signals of pre-ictal (before seizure) and ictal states (during seizure) were analyzed by sample entropy (SamEn) and MSE methods. Variations of complexity index (CI), which was calculated from MSE, from the pre-ictal to the ictal states were also analyzed. The entropy values in the pre-ictal state were significantly higher than those in the ictal state. The MSE revealed more differences in analysis compared to the SamEn. The occurrence of absence seizures decreased the CI in all channels. Changes in CI were also significantly greater in the frontal and central parts of the brain, indicating fronto-central cortical involvement of "cortico-thalamo-cortical network" in the occurrence of generalized spike and wave discharges during absence seizures. Moreover, higher sampling frequency was more sensitive in detecting functional changes in the ictal state. There was significantly higher correlation in ictal states in the same patient in different seizures but there were great differences in CI among different patients, indicating that CI changes were consistent in different absence seizures in the same patient but not from patient to patient. This implies that the brain stays in a homogeneous activation state during the absence seizures. In conclusion, MSE analysis is better than SamEn analysis to analyze complexity of EEG, and CI can be used to investigate the functional brain changes during absence seizures.

Fifty-eight patients with anorectal malformations were closely followed up for postoperative anorectal function. Constipation was noted shortly after anorectoplasty in 10 of 28 low anomalies (35.7%) treated with limited sagittal anorectoplasty (LSARP), in 18 of 25 high or intermediate anomalies (72.0%) treated with posterior sagittal anorectoplasty (PSARP), but in none of 5 high or intermediate anomalies treated with Rehbein's mucosa-stripping endorectal pull-through and anterior sagittal perineal anorectoplasty (R-ASAP). The constipation resolved mostly within 1-2 years after repair under conservative management, but persisted beyond 2 years after repair in 3/25 children with LSARP and 10/25 with PSARP. Anal soiling was noted in 1/23 (4.3%) LSARP and 6/22 (27.3%) PSARP patients, but normal anorectal function was attained in 20/23 LSARP (86.9%) and 11/12 PSARP patients (50.0%) by the time of toilet training. Manometric studies disclosed that the resting rectal pressure (RRP) was lower and the anorectal pressure gradient (ARPG) higher in the constipated than the non-constipated children, while the RRP was higher and the ARPG lower in the soiled than the non-soiled patients. The ARPG after R-ASPA was close to that of non-constipated and in between that of the constipated and soiled patients. The rectoanal sphincter inhibitory reflex was not related to defecation status or surgical procedures, but showed a tendency toward positive conversion with time or after exclusion of esctatic terminal bowel in the severely constipated. It is concluded that anorectal function in patients with repaired imperforate anus seems to be more affected by the extent of endopelvic dissection than by preservation of the terminal bowel or sphincter muscles.

We present the design of a logic query processor for linear recursive rules. Unlike the traditional methods which primarily use query information in query processing, our design makes use of both query information and program structure to achieve efficient query processing. The design of this processor consists of three major components: representation and classification, analysis, and compilation. The approach is to classify logic rules based on their structures and obtain quantitative information about the recursive expansions, and then combine the information with query instantiation to generate an efficient database program. This design suggests a sophisticated analysis phase before query processing. In return, it often yields a superior performance than other general processing strategies.