Distribution of corneal and ocular spherical aberrations in eyes with cataract in the Taiwanese population

AbstractPurposeTo investigate the distribution of corneal and ocular spherical aberrations (SAs) in eyes with cataract in the Taiwanese population.MethodsCorneal and ocular SAs were measured in the central 6-mm optical zone using wavefront aberrometry. Axial length (AL) and keratometry (K) were also evaluated in each eye.ResultsA total of 413 eyes in 234 patients were analyzed. The mean age of the patients was 66.8 ± 10.64 years. The mean AL and K values were 24.32 mm and 44.08 D, respectively. The mean corneal SA was 0.307 ± 0.135 μm and ocular SA was −0.042 ± 0.487 μm. Ocular and corneal SAs were significantly correlated (r2 = 0.04, p < 0.001). Corneal and ocular SAs were not significantly correlated with K (p = 0.096 and p = 0.634, respectively), but were significantly correlated with AL (p < 0.001). Multilinear regression showed that corneal SAs and age were the dependent variables that predicted ocular SAs (r2 = 0.143, F = 13.65, p < 0.01), especially in patients who were aged > 50 years, for whom a strongly significant positive correlation was found (r2 = 0.102, F = 11.10, p < 0.001).ConclusionCorneal and ocular SAs varied among cataract patients and correlated with AL. After 50 years of age, ocular SAs increased significantly because of an increase in internal (lenticular) SAs. Corneal SAs in Taiwanese patients were larger than those in Japanese patients and similar to those in Chinese and Malaysian populations. Preoperative measurement of wavefront aberrations is necessary to select which aspherical intraocular lenses are most suitable for achieving better postoperative visual quality

San-Huang-Xie-Xin-Tang Prevents Rat Hearts from Ischemia/Reperfusion-Induced Apoptosis through eNOS and MAPK Pathways

San-Huang-Xie-Xin-Tang (SHXT) is a traditional Chinese medication consisting of three herbs, namely Coptidis rhizome, Scutellariae radix and Rhei rhizome. This study aimed to examine the cardioprotective effects of SHXT in a rat model of acute myocardial apoptosis induced by ischemia/reperfusion (I/R). Vehicle (intravenous saline) or SHXT (intravenous or oral) was administered prior to I/R (occlusion of left coronary artery for 45 min followed by reperfusion for 2 h). In the vehicle group, myocardial I/R caused myocardial infarction with increased plasma cardiac enzymes, severe arrhythmia and mortality. Myocardial apoptosis was induced by I/R as evidenced by DNA ladder and Bcl-2/Bax ratio. In the SHXT group, we found that SHXT significantly reduced plasma levels of cardiac enzymes, arrhythmia scores (from 5 ± 1 to 2 ± 1, P < .01) and mortality rate (from 53 to 0%, P < .01). In addition, pretreatment with intravenous SHXT reduced the infarct size dose-dependently when compared with the vehicle group (10 mg kg−1: 14.0 ± 0.2 versus 44.5 ± 5.0%, and 30 mg kg−1: 6.2 ± 1.2% versus 44.5 ± 5.0%, both P < .01). Similarly, oral administration of SHXT reduced the infarct size dose-dependently. Furthermore, SHXT markedly decreased the apoptosis induced by I/R with increased Bcl-2/Bax ratio. Finally, we found that SHXT counteracted the I/R-induced downstream signaling, resulting in increased myocardial eNOS expression and plasma nitrite, and decreased activation of ERK1/2, p38 and JNK. These data suggest that SHXT has cardioprotective effects against I/R-induced apoptosis, and that these effects are mediated, at least in part, by eNOS and MAPK pathways

Transmission of acute infectious illness among cases of Kawasaki disease and their household members

Background/purposeKawasaki disease (KD) is a disease of unknown cause and the causative agent is most likely to be infectious in nature. To investigate the household transmission pattern of infectious illness and etiology, we thus initiated a prospective case and household study.MethodsWe enrolled KD cases and their household members from February 2004 to September 2008. The KD cases and their household members accepted questionnaire-based interviews of the contact history, signs of infection, and symptoms to check whether clusters of infectious illness occurred.ResultsA total of 142 KD cases and 561 household members were enrolled. Among the 142 KD cases, 136 cases (96%) were typical KD, and six (4%) were atypical KD. Of the 561 household members, 17% were siblings, 46% were parents, 18% were grandparents, and the others were cousins or babysitters. Prior to the onset of their KD illness, 66% (94/142) KD cases had contact with ill household members. On the same day of the onset of KD cases' illness, 4% (6/142) KD cases had household members with illness. After KD cases' disease onset, 70% (100/142) KD cases had at least one other family member with illness. Overall, 61% (343/561) of all the household members had acute infectious illness during KD cases' acute stage, and 92% (130/142) of the families had clusters of infectious illness.ConclusionA total of 66% KD cases had positive contact with ill household members prior to their disease onset and 92% of families had clusters of infectious illness, so KD is strongly associated with infections

Establishment of a Knock-In Mouse Model with the SLC26A4 c.919-2A>G Mutation and Characterization of Its Pathology

Recessive mutations in the SLC26A4 gene are a common cause of hereditary hearing impairment worldwide. Previous studies have demonstrated that different SLC26A4 mutations may have different pathogenetic mechanisms. In the present study, we established a knock-in mouse model (i.e., Slc26a4tm1Dontuh/tm1Dontuh mice) homozygous for the c.919-2A>G mutation, which is a common mutation in East Asians. Mice were then subjected to audiologic assessment, a battery of vestibular evaluations, and inner ear morphological studies. All Slc26a4tm1Dontuh/tm1Dontuh mice revealed profound hearing loss, whereas 46% mice demonstrated pronounced head tilting and circling behaviors. There was a significant difference in the vestibular performance between wild-type and Slc26a4tm1Dontuh/tm1Dontuh mice, especially those exhibiting circling behavior. Inner ear morphological examination of Slc26a4tm1Dontuh/tm1Dontuh mice revealed an enlarged endolymphatic duct, vestibular aqueduct and sac, atrophy of stria vascularis, deformity of otoconia in the vestibular organs, consistent degeneration of cochlear hair cells, and variable degeneration of vestibular hair cells. Audiologic and inner ear morphological features of Slc26a4tm1Dontuh/tm1Dontuh mice were reminiscent of those observed in humans. These features were also similar to those previously reported in both knock-out Slc26a4−/− mice and Slc26a4loop/loop mice with the Slc26a4 p.S408F mutation, albeit the severity of vestibular hair cell degeneration appeared different among the three mouse strains

Associations between Arsenic in Drinking Water and Pterygium in Southwestern Taiwan

[[abstract]]BACKGROUND: Pterygium is a fibrovascular growth of the bulbar conjunctiva and underlying subconjunctival tissue that may cause blindness. The mechanism of pterygium formation is not yet fully understood, but pterygium has some tumorlike features. OBJECTIVES: The objective of this study was to evaluate the association between arsenic exposure through drinking water and the occurrence of pterygium in southwestern Taiwan. METHODS: We recruited participants > 40 years of age from three villages in the arseniasis-endemic area in southwestern Taiwan (exposure villages) and four neighboring nonendemic villages (comparison villages). Each participant received an eye examination and a questionnaire interview. Photographs taken of both eyes were later graded by an ophthalmologist to determine pterygium status. RESULTS: We included 223 participants from the exposure villages and 160 from the comparison villages. The prevalence of pterygium was higher in the exposure villages across an age groups in both sexes and increased with cumulative arsenic exposure. We found a significant association between cumulative arsenic exposure and the prevalence of pterygium. After adjusting for age, sex, working under sunlight, and working in sandy environments, we found that cumulative arsenic exposure of 0.1-15.0 mg/L-year and >= 15.1 mg/L-year were associated with increased risks of developing pterygium. The adjusted odds ratios were 2.04 [95% confidence interval (CI), 1.04-3.99] and 2.88 (95% CI, 1.42-5.83), respectively. CONCLUSIONS: Chronic exposure to arsenic in drinking water was related to the occurrence of pterygium, and the association was still observed after adjusting for exposures to sunlight and sandy environments

Fifteen-Year Population Attributable Fractions and Causal Pies of Risk Factors for Newly Developed Hepatocellular Carcinomas in 11,801 Men in Taiwan

Development of hepatocellular carcinoma (HCC) is a multi-factorial process. Chronic infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are important risk factors of HCC. Host factors, such as alcohol drinking, may also play a role. This study aims to provide a synthesis view on the development of HCC by examining multiple risk factors jointly and collectively. Causal-pie modeling technique was applied to analyze a cohort of 11,801 male residents (followed up for 15 years) in Taiwan, during which a total of 298 incident HCC cases were ascertained. The rate ratios adjusted by age were further modeled by an additive Poisson regression. Population attributable fractions (PAFs) and causal-pie weights (CPWs) were calculated. A PAF indicates the magnitude of case-load reduction under a particular intervention scenario, whereas a CPW for a particular class of causal pies represents the proportion of HCC cases attributable to that class. Using PAF we observed a chance to reduce around 60% HCC risk moving from no HBV-related intervention to the total elimination of the virus. An additional ∼15% (or ∼5%) reduction can be expected, if the HBV-related intervention is coupled with an HCV-related intervention (or an anti-drinking campaign). Eight classes of causal pies were found to be significant, including four dose-response classes of HBV (total CPW=52.7%), one independent-effect class of HCV (CPW=14.4%), one HBV-alcohol interaction class (CPW=4.2%), one HBV-HCV interaction class (CPW=1.7%), and one all-unknown class (CPW=27.0%). Causal-pie modeling for HCC helps clarify the relative importance of each viral and host factor, as well as their interactions

Oncologic impact of delay between diagnosis and radical nephroureterectomy

PurposeThis study aimed to evaluate the oncological outcome of delayed surgical wait time from the diagnosis of upper tract urothelial carcinoma (UTUC) to radical nephroureterectomy (RNU).MethodsIn this multicenter retrospective study, medical records were collected between 1988 and 2021 from 18 participating Taiwanese hospitals under the Taiwan UTUC Collaboration Group. Patients were dichotomized into the early (≤90 days) and late (&gt;90 days) surgical wait-time groups. Overall survival, disease-free survival, and bladder recurrence-free survival were calculated using the Kaplan–Meier method and multivariate Cox regression analysis. Multivariate analysis was performed using stepwise linear regression.ResultsOf the 1251 patients, 1181 (94.4%) were classifed into the early surgical wait-time group and 70 (5.6%) into the late surgical wait-time group. The median surgical wait time was 21 days, and the median follow-up was 59.5 months. Our study showed delay-time more than 90 days appeared to be associated with worse overall survival (hazard ratio [HR] 1.974, 95% confidence interval [CI] 1.166−3.343, p = 0.011), and disease-free survival (HR 1.997, 95% CI 1.137−3.507, p = 0.016). This remained as an independent prognostic factor after other confounding factors were adjusted. Age, ECOG performance status, Charlson Comorbidity Index (CCI), surgical margin, tumor location and adjuvant systemic therapy were independent prognostic factors for overall survival. Tumor location and adjuvant systemic therapy were also independent prognostic factors for disease-free survival.ConclusionsFor patients with UTUC undergoing RNU, the surgical wait time should be minimized to less than 90 days. Prolonged delay times may be associated with poor overall and disease-free survival

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health. © 2014 Elsevier Ltd

The Influence of Dietary Protein on Lipid Metabolism in The Chick

71 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1972.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

Economic Evaluation of Conjugate Vaccines against Pneumococcal Infection in Taiwan

背景: 台灣現有兩種不同設計之新型肺炎鏈球菌接合性疫苗能有效預防肺炎鏈球菌相關疾病，全國新生兒公費肺炎鏈球菌接種計劃審議中，惟缺乏適當之疫苗經濟評估。 目的 藉由「成本效果分析」評估於新生兒全面接種不同之新型肺炎鏈球菌接合性疫苗(PCV10及PCV13)對國內肺炎鏈球菌感染相關疾病的影響。. 方法 使用馬可夫決策分析建構經濟評估模型藉以評估三種不同的疫苗接種策略：「不施打新型肺炎鏈球菌接合性疫苗」、「全面接種PCV10疫苗」以及「全面接種PCV13疫苗」。 本研究使用「全人口」模型進行分析以符合實際施打疫苗之情境。並藉由健保資料庫及已發表之相關文獻蒐集國內肺炎鏈球菌感染相關疾病各種的參數，如不同的肺炎鏈球菌疾病(侵襲性肺炎鏈球菌感染、中耳炎及肺炎)的國人發病率、疾病相關的合併症以及後遺症、疫苗價格、疫苗保護效果及群體免疫力、直接以及間接醫療成本等等進行「成本效果分析」。在進行完「基本案例分析」後，我們再使用「敏感度分析」、「機率性敏感度分析」以及「情境模擬分析」等方式測試初步分析後所得結果的證據強度，同時分析其他替代性疫苗接種政策之成本效果比，以期求得客觀的分析結果。. 結果 由「全人口」模型進行分析，發現在「成本效果分析」方面顯示相較於「接種PCV10 疫苗」或「完全不接種疫苗」兩種策略而言，「全面接種PCV13疫苗」為最具經濟效益之疫苗接種政策，且其成本效果分析結論為「節省成本」的。而「敏感度分析」的結果顯示「折現率」，「單純性肺炎住院的間接成本」，「接合性疫苗對肺炎及中耳炎的群體免疫力」等三種變相為最重要之影響因子。而在「機率性敏感度分析」分析則發現即便考量及變動各種因子的分布，其結果仍顯示為「全面接種PCV13疫苗」為最具經濟效益的策略。而「情境模擬分析」結果則顯示除全面嬰兒疫苗接種之外，即便是在一歲及兩歲孩童追加接種疫苗，其成本效益分析仍顯示「全面接種PCV13」 為最為「節省成本」之預防接種策略。 結論 由「全人口」模型之「成本效果分析」可知，「全面接種PCV13疫苗」為一具「節省成本」效果之健康政策。即便除了出生嬰兒外，擴大於5歲以下幼兒全面進行補接種仍為一極具經濟效益之政策。為涵蓋抗藥性之肺炎鏈球菌19A血清型菌株及依據本經濟評估之結果，「全面接種PCV13」應為新型肺炎鏈球菌接合性疫苗之優先選擇。預期本論文經濟評估的結果能為衛生政策制定者提供科學上的證據，協助其決定全面嬰幼兒接種新型肺炎鏈球菌接合性疫苗時的決策參考。Background Two newly designed pneumococcal conjugate vaccines are scheduled included in nationwide immunization program in Taiwan. However, evidence from cost-effectiveness analysis is still poorly understood. Objectives To investigate the impact of universal immunization (PCV10 & PCV13) on both health and economic outcomes of pneumococcal diseases in Taiwan. Methods We designed a Markov decision analytic model to investigate three vaccination strategies: no vaccination, universally vaccinated with PCV10 and PCV13. Both population cohort and birth cohort models were simulated. The parameters, such as incidences of various pneumococcal diseases, disease specific complications and sequelaes, vaccine cost, vaccine efficacy and herd immunity, direct and indirect medical costs in Taiwan were assigned for base-case simulation. Sensitivity analysis, probabilistic analysis and scenario analysis were performed for testing the robustness of our conclusion. Results With population model, the CEA result showed PCV13 dominated both PCV10 and no vaccination, and was “cost saving”. Univariate sensitivity analysis showed the discount rate, herd immunity of PCV13 for simple pneumococcal pneumonia admission, indirect cost of pneumococcal admission and outpatients are most influential parameters. The probabilistic analysis also showed PCV13, when compared with both PCV10 and no vaccination strategy, was “cost-saving” after considering the uncertainty of variables. The “PCV13 vaccination for infants with catch-up program of children under the age of 5 years” is as “cost-saving” as the infantile vaccination program of PCV13. Conclusion The cost–effectiveness study of universal immunization of infants with PCV 13, even with extended vaccine coverage for children aged 1-4 years, is “cost saving” when compared with universal PCV10 immunization and no vaccination. Both the necessity of extending vaccine coverage of 19A and the cost-saving result of this study urged the commencement of universal infantile vaccination with PCV13. The results of this dissertation provide scientific evidence for health policy makers on deciding new PCV strategies for universal immunization for infants in Taiwan