Background/Purpose: The Yami inhabit Lanyu Island and are the smallest and most primitive aboriginal tribe in Taiwan. Lanyu Island is a closed environment and little information is available on the prevalence of Helicobacter pylori infection there. This study aimed to establish the prevalence of H. pylori infection in high-school students on Lanyu Island and its risk factors and effect on growth. Methods: A cross-sectional population-based study was conducted among high-school students to determine the prevalence of H. pylori infection by using the 13C urea breath test. A questionnaire was administered to the recruited population. Relevant personal and socioeconomic data for risk factors of infection were collected. Body height and weight of the recruited adolescents in relation to H. pylori infection were analyzed. Results: A total of 106 high-school students (55 boys and 51 girls), with a mean age of 14.3 +/- 1.4 years were enrolled. The overall prevalence of H. pylori infection was 54.7%. Those residing in Dongcing village had the highest rate of H. pylori infection (73.3%). There was no difference in the prevalence of H. pylori infection according to sex, ethnicity, socioeconomic level or parental education. Sixty-two students (54.8%) were completely asymptomatic and the others had at least one gastrointestinal symptom. H. pylori infection was asymptomatic in 56.8% and symptomatic in 53.2% of students. There was no significant difference between infected and uninfected children with regard to body weight, height and body mass index. Conclusion: The prevalence of H. pylori infection is high among high-school students on Lanyu Island. There is no evidence that infection is related to growth failure.

Human immunodeficiency virus type 1 (HIV-1) circulating recombinant form (CRF) 07_BC strain has caused serious outbreaks among injection drug users in Taiwan since 2004. The objective of this study was to conduct a molecular epidemiological study of HCV genotypes in intravenous drug users in Taiwan. Blood samples and questionnaires from 591 intravenous drug users infected with HIV-1 were collected nationwide. In total, 180 samples were selected for HCV genotyping using multiplex PCR and phylogenetic analysis of the core, E1 and NS5B regions. The Inno-Lipa assay was used to confirm multiple infections with different genotypes. Eighty percent had a single infection with subtype 1b being the most common subtype (24%), 12% had double infections and two had triple infections. In addition, three recombinant forms (RFs)-2a1a, 3a1b, and 2b6w were identified. Phylogenetic analyses showed that the 3a, 6a, and 6n strains were clustered with strains present in Thailand and mainland China. Full-length sequence analysis showed that two 6w strains shared 89.4-90.2% sequence homology with the 6(r) strain from the Guangdong Province, China. Bootscan analysis revealed that the recombination breakpoint of RF_2b6w was located at the NS2-NS3 junction. In summary, the distribution of HCV genotypes among Taiwanese intravenous drug users was complex and more than 12% of the drug users were infected with more than one genotype of HCV. J. Med. Virol. 82:57-68, 2010.(c) 2009 Wiley-Liss, Inc.

BACKGROUND: Ventriculostomy-associated infections are a serious complication of external ventricular drains. The objective of this study was to analyze the clinical features of and risk factors for such infections. METHODS: We retrospectively collected demographic and clinical data on patients with indwelling ventriculostomy catheters hospitalized in a teaching hospital from July 2001 to June 2006, comparing those with and without ventriculostomy-associated infections. RESULTS: A total of 197 drains (2910 catheter-days) placed in 155 patients were studied. Infections developed in 28 of the 197 (14.2%) drains. The duration from insertion to infection ranged from 7 to 36 days. The cut-off point of duration from insertion to infection was 15.5 days. Re-insertion because of catheter malfunction carried a high risk of infection (p<0.001). Patients with infections had a longer intensive care unit stay (p=0.001), longer duration of catheterization (p=0.002), and a higher incidence of concurrent sepsis (p=0.018), urinary tract infection (p=0.011) and pneumonia (p=0.004). Gram-negative bacilli were the leading pathogens (84%); Pseudomonas aeruginosa was the most common isolate. Polymicrobial infections occurred later than monomicrobial infections (p=0.003). CONCLUSIONS: Repeated insertion and longer duration of drains are major risk factors for ventriculostomy-associated infections.

We conducted an active, population-based laboratory surveillance study to evaluate the epidemiologic features of invasive pneumococcal disease (IPD) in Taiwan. Concurrently, nasopharyngeal colonization of Streptococcus pneumoniae was evaluated among 1128 healthy children aged </=5 years. The overall incidence was highest among children aged 2-4 years (15.6/100,000). Serotype 19A, which had never been reported in Taiwan previously, caused a substantial fraction of the invasive diseases (OR, 9.6; 95% CI, 3.1-29.4) among children aged 2-4 years. Comparing serotype distributions of the isolates from nasopharyngeal colonization among children aged </=5 years, serotypes 14 (OR, 17.3; 95% CI, 5.2-57.9) and 19A (OR, 14.9; 95% CI, 1.9-117) had the highest invasive potential. The study found that serotype 19A expanded in Taiwan, a country with a low 7-valent conjugate pneumococcal vaccine coverage. The 7-valent conjugate pneumococcal vaccines covered 73% of cases in children aged between 2 and 4 years, and 64.7% of cases in children aged <2 years. Among patients aged >/=65 years, the 23-valent pneumococcal polysaccharide vaccine covered 70.4% of cases. In the future, a broader pneumococcal vaccine is needed.

Fumarate, a four-carbon trans dicarboxylic acid, is the allosteric activator of the human mitochondrial NAD(P)(+)-dependent malic enzyme (m-NAD(P)-ME). In this paper, we discuss the effects of the structural analogues of fumarate on human m-NAD(P)-ME. Succinate, a dicarboxylic acid with a carbon-carbon single bond, can also activate the enzyme, but the activating effect of succinate is less than that of fumarate. Succinamide, a diamide of succinate, cannot activate the enzyme and is a poor active-site inhibitor. The cis isomer of fumarate, maleic acid, significantly inhibits the ME activity, suggesting that the trans configuration of fumarate is crucial for operating the allosteric regulation of the enzyme. Other dicarboxylic acids, including glutaconic acid, malonic acid and alpha-ketoglutarate, cannot activate the enzyme and inversely inhibit enzyme activity. Our data suggest that these structural analogues are mainly active-site inhibitors, although they may enter the allosteric site to inhibit the enzyme. Furthermore, these data also suggest that the dicarboxylic acid must be in a trans conformation for allosteric activation of the enzyme.

Abstract Tsai, M-L., Chang, K-Y., Chiang, C-S., Shu, W-Y., Weng, T-C., Chen, C. R., Huang, C-L., Lin, H-K. and Hsu, I. C. UVB Radiation Induces Persistent Activation of Ribosome and Oxidative Phosphorylation Pathways. Radiat. Res. 171, 716-724 (2009). Ultraviolet B (UVB) radiation has strong biological effects and modulates the expression of many genes. The major biological pathways affected by UVB radiation remain controversial. In this work, we used a loop-design microarray approach and applied rigorous statistical analyses to identify differentially regulated genes at 4, 8, 16 or 24 h after UVB irradiation. The most prominent biological categories in lists of differentially regulated gene sets were extracted by functional enrichment analysis. With this approach, we determined that genes participating in two prime cellular processes, the ribosome pathway and the oxidative phosphorylation pathway, were persistently activated after UVB irradiation. Mitochondrial activity assays confirmed increased activity for up to 24 h after UVB irradiation. These results suggest that the persistent activation of ribosome and oxidative phosphorylation pathways may have a key role in UVB-radiation-induced cellular responses. For the first time, the specific cellular pathways that respond to UVB radiation consistently and persistently can be delineated with confidence using a loop-design microarray approach and functional bioinformatics analysis. The results of this study offer further insight into UVB-radiation-induced stress responses.

The goal was to identify HLA-DQ8-bound beta cell epitopes important in the T cell response in autoimmune diabetes. We first identified HLA-DQ8 (DQA1*0301/DQB1*0302) beta cell epitopes using a computational approach and then related their identification to CD4 T cell responses. The computational program (TEA-DQ8) was adapted from one previously developed for identifying peptides bound to the I-A(g7) molecule and based on a library of naturally processed peptides bound to HLA-DQ8 molecules of antigen-presenting cells. We then examined experimentally the response of NOD.DQ8 mice immunized with peptides derived from the Zinc transporter 8 protein. Log-of-odds scores on peptides were experimentally validated as an indicator of peptide binding to HLA-DQ8 molecules. We also examined previously published data on diabetic autoantigens, including glutamic acid decarboxylase-65, insulin and insulinoma-associated antigen-2, all tested in NOD.DQ8 transgenic mice. In all examples, many peptides identified with a favorable binding motif generated an autoimmune T cell response, but importantly many did not. Moreover, some peptides with weak-binding motifs were immunogenic. These results indicate the benefits and limitations in predicting autoimmune T cell responses strictly from MHC-binding data. TEA-DQ8 performed significantly better than other prediction programs.

Clin Microbiol InfectAbstract Accurate molecular surveillance is important in monitoring the dynamics of Streptococcus pneumoniae. A prospective study was conducted to collect invasive isolates of S. pneumoniae from children for genetic analysis from January 2004 to December 2006 in Taiwan. PCRs were performed to detect the zmpC and zmpD genes, both encoding a metalloprotease virulence factor in pneumococci, among these invasive isolates. During the study period, 68 invasive isolates of S. pneumoniae were obtained for analysis. Serotype 14 was the most common type isolated from children with invasive disease and was significantly associated with pneumonia (OR 3.1; 95% CI] 1.1-8.8; p 0.035). Serotype 23F was significantly associated with bacteraemia (OR 7.5; 95% CI 1.8-31.3; p 0.006). The seven-valent conjugate vaccine covered 83.8% of invasive isolates, but non-vaccine serotypes were more frequently isolated from patients with underlying diseases than from patients without underlying diseases (p 0.007 by Fisher's exact test). Clonal complexes related to international clones Spain23F ST81, Spain6B ST95, England14 ST9, Taiwan19F ST236, Taiwan23F ST242 and Colombia23F ST338 accounted for 52.9% of invasive isolates. Dissemination of the penicillin-resistant clones ST876, ST46, ST76 and ST2889, which were first identified in Taiwan, was also found; 1.5% of these invasive isolates carried the zmpC gene, and 47.1% of these invasive isolates carried the zmpD gene. In conclusion, the spread of certain international clones and some domestic antibiotic-resistant clones resulted in invasive diseases among Taiwanese children.

Background: Postoperative pain and postoperative vomiting (POV) are both sources of distress in the postoperative period. Patient-controlled epidural analgesia (PCEA) is used in patients undergoing lower extremity surgery to improve postoperative quality but is accompanied by a certain incidence of vomiting. We wanted to determine the risk factors of POV in patients using PCEA with the aim of improving the quality of the postoperative period. Methods: We conducted a retrospective study to analyze the risk factors among patients using PCEA after lower-limb surgery under regional anesthesia. A total of 195 patients (91 males, 104 females) were enrolled. They were categorized into 2 groups: vomiting and non-vomiting. We found that female gender predominated in the vomiting group. Hence, we analyzed the female subgroup in order to find the risk factors of vomiting in the female PCEA population. Results: Female gender was the most significant factor related to vomiting (crude OR, 11.55; 95% CI, 4.88-27.33). From analysis of the female subgroup, puncture site (OR, 4.07; 95% CI, 1.41-11.79), catheter length in the epidural space (OR, 0.28; 95% CI, 0.16-0.50) and patient's height (OR, 1.07; 95% CI, 1.00-1.14) were also factors for vomiting, i.e. higher epidural catheter puncture site, shorter length in the epidural space, and greater height caused a higher incidence of POV. Conclusion: The most important risk factor for POV in patients using PCEA was female gender. Among the female subgroup, the risk factors for POV included higher epidural catheter puncture site, shorter length in the epidural space and greater body height.

Background/Purpose: Although evidence suggests that gastroesophageal reflux disease (GERD) may interrupt sleep, the effects of symptomatic and endoscopically diagnosed GERD remain elusive because the patient population is heterogeneous. Accordingly, we designed a cross-sectional study to assess their association. Methods: Consecutive participants in a routine health examination were enrolled. Definition and severity of erosive esophagitis were assessed using the Los Angeles classification system. Demographic data, reflux symptoms, sleep quality and duration, exercise amount, alcohol consumption, and smoking habits were recorded. Factors affecting sleep quality and sleep duration were revealed by a polytomous logistic regression analysis. Results: A total of 3663 participants were recruited. Subjects with reflux symptoms, female gender, higher body mass index, and regular use of hypnotics had poorer sleep quality. Exercise was associated with better sleep quality. Either symptomatically or endoscopically, GERD did not disturb sleep duration. Among the 3158 asymptomatic patients, those with erosive esophagitis were more likely to have poor sleep quality. The risk increased with the severity of erosive changes (p = 0.03). Conclusion: The present study highlights the adverse effect of gastroesophageal reflux on sleep, even in the absence of reflux symptoms. This finding has therapeutic implications in patients with silent erosive disease, and future trials are warranted.