Molecular Epidemiology of Integron-Associated Antimicrobial Gene Cassettes in the Clinical Isolates of Acinetobacter baumannii from Northern Taiwan

Ming-Feng Lin,Ming- Li Liou,Chi-Chao Tu,Hui-Wen Yeh,Chung-YuLan 대한진단검사의학회 2013 Annals of Laboratory Medicine Vol.33 No.4

Background: The aims of this study were to understand the molecular epidemiology of integron-associated gene cassettes in Acinetobacter baumannii across four hospitals in northern Taiwan and to clarify the relationship between the presence of integrons and antibiotic-resistant phenotypes. Methods: Sixty-five A. baumannii isolates, collected from the patients of four regional hospitals in northern Taiwan in 2009, were tested for the presence of integrons and their associated gene cassettes. The susceptibility difference between integron-positive and integron-negative A. baumannii strains was analyzed. Antibiotic-resistant phenotypes among A. baumannii with different types of gene cassette array combinations were also compared. Results: Around 72% of the A. baumannii isolates carried class 1 integrase genes. Despite this, only three gene cassette arrays were found in the integrons. Integron-positive strains were significantly more resistant to all the tested antibiotics than the integrase-negative strains. All the four types of A. baumannii with different gene cassette array combinations were multidrug-resistant in nature. Gene cassette array aacA4-catB8-aadA1 existed in all the integron-positive A. baumannii isolates. Repetitive-sequence-based PCR (rep-PCR)results revealed the prevalence of one major cluster of imipenem-resistant A. baumannii strains (84%) in the four regional hospitals. Conclusions: The presence of integrons with associated antimicrobial resistance gene cassettes can be used as a representative marker of multidrug resistance in A. baumannii. Some prevalent gene cassette arrays may exist among epidemiologically unrelated A. baumannii strains.

Economic Burden of High-Responding Inhibitors in Patients with Hemophilia A in Taiwan

Tsu-Chiang Tu,Shin-Nan Cheng,Jye-Daa Chen,Thau-Ming Cham,Mei-Ing Chung 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.2

Purpose: Hemophilia A (HA) is the most common X-linked inherited bleeding disorder. In some patients with HA, particularly those with severe HA, replacement therapy results in the production of high-responding clotting factor VIII inhibitors. The economic burden of this complication is the highest reported for a chronic disease. Our aim was to investigate the direct medical expenditure burden of high-responding inhibitors in patients with HA. Materials and Methods: A retrospective study was conducted using the National Health Insurance Research Database,utilizing data covering the period of 2004-2007. Results: In total, 638 males with HA¸ including 37 patients with high-responding inhibitors were evaluated. Over 99% of the annual median medical expenditure was attributable to the cost of clotting factor concentrates (CFCs) in patients with high-responding inhibitors. The annual median expenditure related to CFCs of the total medical care and outpatient care were US$170611 and US$141982, respectively, and were 4.6- and 4.3-fold higher in these patients during the study period, respectively. In patients with high-responding inhibitors, the median hospitalization expenditure and daily hospitalization cost with or without surgical procedures were 3.0- and 2.4-fold higher, respectively, and 4.3 and 5.6-fold higher, respectively. Conclusion: Our data reveal higher medical expenditures burden for patients with HA and high-responding inhibitors in Taiwan. Future research is encouraged to evaluate the impact of this burden on patient quality of life.

Prevalence, Incidence, and Factor Concentrate Usage Trends of Hemophiliacs in Taiwan

Tsu-Chiang Tu,Wen-Shyong Liou,Tsui-Yun Chou,Tsung-Kun Lin,Chuan-Fang Lee,Jye-Daa Chen,Thau-Ming Cham,Mei-Ing Chung 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.2

Purpose Hemophilia A and B (HA, HB) are the most common X-linked inherited bleeding disorders. The introduction of factor concentrates has allowed for control of the lifelong chronic disease. However, no studies have been published regarding the epidemiology of hemophilia in Taiwan. Our aim was to determine the prevalence, incidence, and mortality rate, as well as trends in the use of factor concentrates, in individuals with hemophilia in Taiwan. Materials and Methods A retrospective study was conducted using the National Health Insurance Research Database between 1997 and 2007. Results We identified 988 males with hemophilia (HA : HB ratio=5.4 : 1). The mean prevalence per 100000 males was 6.7±0.1 for HA and 1.2±0.1 for HB. The estimated mean annual incidence per live male birth was 1 in 10752 for HA and 1 in 47619 for HB. Standardized mortality ratios for males with hemophilia (all severities) or severe hemophilia were 1.3- and 2.1-fold higher than that of the general male population, respectively. Mean factor VIII (FVIII) and factor IX (FIX) usage was 1.5003±0.4029 and 0.3126±0.0904 international units (IUs) per capita, respectively. Mean FVIII and FIX usage per patient with hemophilia (all severities) or severe hemophilia was 44027±11532 and 72341±17298, respectively, and 49407±13015 and 74369±18411 IUs per person with HA or HB, respectively. Conclusion Our data revealed epidemiologic and factor concentrate usage trends in males with hemophilia in Taiwan, highlighting a need for improvements in the mandatory National Health Insurance registry. A better-designed, patient-centered registry system would enable more detailed patient information collection and analysis, improving subsequent care.

Prevalence, Incidence, and Factor Concentrate Usage Trends of Hemophiliacs in Taiwan

Tsu-Chiang Tu,Wen-Shyong Liou,Tsui-Yun Chou,Tsung-Kun Lin,Chuan-Fang Lee,Jye-Daa Chen,Thau-Ming Cham,Mei-Ing Chung 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.1

Purpose: Hemophilia A and B (HA, HB) are the most common X-linked inherited bleeding disorders. The introduction of factor concentrates has allowed for control of the lifelong chronic disease. However, no studies have been published regarding the epidemiology of hemophilia in Taiwan. Our aim was to determine the prevalence, incidence, and mortality rate, as well as trends in the use of factor concentrates,in individuals with hemophilia in Taiwan. Materials and Methods: A retrospective study was conducted using the National Health Insurance Research Database between 1997 and 2007. Results: We identified 988 males with hemophilia (HA : HB ratio=5.4 : 1). The mean prevalence per 100000 males was 6.7±0.1 for HA and 1.2±0.1 for HB. The estimated mean annual incidence per live male birth was 1 in 10752 for HA and 1 in 47619 for HB. Standardized mortality ratios for males with hemophilia (all severities) or severe hemophilia were 1.3- and 2.1-fold higher than that of the general male population, respectively. Mean factor VIII (FVIII) and factor IX (FIX) usage was 1.5003±0.4029 and 0.3126±0.0904 international units (IUs) per capita, respectively. Mean FVIII and FIX usage per patient with hemophilia (all severities) or severe hemophilia was 44027±11532 and 72341±17298, respectively, and 49407±13015 and 74369±18411 IUs per person with HA or HB, respectively. Conclusion: Our data revealed epidemiologic and factor concentrate usage trends in males with hemophilia in Taiwan, highlighting a need for improvements in the mandatory National Health Insurance registry. A better-designed, patient-centered registry system would enable more detailed patient information collection and analysis, improving subsequent care.

Novel application of Influenza A virus-inoculated chorioallantoic membrane to characterize a NP-specific monoclonal antibody for immunohistochemistry assaying

Yang-Chang Tu,Kuang-Yu Chen,Chung-Kung Chen,Ming-Chu Cheng,Shu-Hwae Lee,Ivan-Chen Cheng 대한수의학회 2019 Journal of Veterinary Science Vol.20 No.1

Monoclonal antibodies (MAbs) are widely applied in disease diagnoses. Herein, we report a MAb, WF-4, against Influenza A virus nucleoprotein (NP), its broad response with Influenza A virus, and its application in an immunohistochemistry (IHC) assay. WF-4 was screened by immunofluorescence assay (IFA). The results showed that its reactivity with baculovirus-expressed full-length recombinant NP (rNP) in Western blot (WB), indicating its IHC applicability. Fifteen Influenza A virus (reference subtypes H1 to H15) infected chicken embryonated chorioallantoic membranes (CAM), fixed by formalin, were all detectable in the WF-4-based IHC assay. Also, the reactivity of the IHC test with NP from experimentally inoculated H6N1 and from all recent outbreaks of H5 subtype avian Influenza A virus (AIV) field cases in Taiwan showed positive results. Our data indicate that CAM, a by-product of Influenza A virus preparation, is helpful for Influenza A virus-specific MAb characterization, and that the WF-4 MAb recognizes conserved and linear epitopes of Influenza A virus NP. Therefore, WF-4 is capable of detecting NP antigens via IHC and may be suitable for developing various tests for diagnosis of Influenza A virus and, especially, AIV infection.

Professionals’ experiences and attitudes toward use of Traditional Chinese Medicine in hospice palliative inpatient care units: A multicenter survey in Taiwan

Yu-Jia Lin,Hsiao-Ting Chang,Ming-Hwai Lin,Ru-Yih Chen,Ping-Jen Chen,Wen-Yuan Lin,Jyh-Gang Hsieh,Ying-Wei Wang,Chung-Chieh Hu,Yi-Sheng Liou,Tai-Yuan Chiu,Chun-Yi Tu,Yi-Jen Wang,Bo-Ren Cheng,Tzeng-Ji Ch 한국한의학연구원 2021 Integrative Medicine Research Vol.10 No.2

Background: Medical staff may have difficulties in using conventional medicine to manage symptoms among terminally ill patients, including adverse effects of the treatment. Traditional Chinese medicine (TCM) is regarded as a complementary or alternative medicine, and has been increasingly used in the field of palliative medicine in recent years. This study aimed to investigate the experiences of and attitudes toward using TCM among palliative care professionals, and to provide preliminary information about its use in palliative care. Methods: This was a cross-sectional survey study conducted in eight inpatient hospice wards in Taiwan between December 2014 and February 2016. The questionnaire was self-administered, and was analyzed with descriptive statistics including Pearson’s Chi-square test and Fisher’s exact test. Results: A total of 251 palliative care professionals responded to the questionnaire, of whom 89.7% and 88.9% believed that the use of TCM could improve the physical symptoms and quality of life in terminally ill patients, respectively. Overall, 59.8%, of respondents suggested that TCM had rare side effects, and 58.2% were worried that TCM could affect the liver and kidney function of patients. In total, 89.7% and 88.0% of professionals agreed there were no suitable clinical practice guidelines and educational programs, respectively, for TCM use in palliative care. Conclusions: Most of the respondents agreed there was insufficient knowledge, skills-training, and continuing education on the use of TCM in terminally ill patients in Taiwan. These results show that to address patient safety considerations, guidelines about use of TCM in palliative care should be established.

Slide Session : OS-CAD-06 ; Cardiology : Erythrocytosis Increased One-Year Mortality in Patients with St-Segment Elevation Myocardial Infarction Un-dergoing Primary Percutaneous Coronary Intervention

( Cheng Wei Liu ),( Yi Ching Lin ),( Chung Ming Tu ),( Pen Chih Liao ),( Kuan Change Chen ),( Yen Wen Wu ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Anemia is associated with poor prognosis in patients with ST-segment elevation myocardial infarction(STEMI). However, it is unclear that erythrocytosis has protective effect in these populations. Hence, we conducted a retrospective cohort study to examine the relationship between erythrocytosis and mortality in patients with STEMI undergoing primary percutaneous coronary intervention (PCI ). Materials and Methods: We screened 1,156 consecutive patients with STEMI undergoing primary PCI in a single center during Feb 2007 and January 2012. There were 201 missing data for door-to-balloon time and 4 missing data for hemoglobin. Of 951 analyzable patients, they were divided into anemia (Hemoglobin<13.0mg/dl in men or <12.0mg/dl in women), normal hemoglobin, and erythrocytosis (hemoglobin =16.0mg/dl in men or =15.0mg/dl in women) groups. The study end point was one-year mortality. Results: There were 148, 535, and 268 patients in anemia, normal hemoglobin, and erythrocytosis groups, respectively. Patients in the anemia group were older and had lower body mass index than other two groups. There was more female, smokers, hypertension, and diabetes in the anemia group. One-year mortality rates were 16.2%, 6.5%, 2.6% (P<0.001) respectively. In univariate proportional hazards regression analysis, age, hemoglobin, total cholesterol, statin use, glycoprotein llb/llla inhibitor use, and TIMI risk score were associated with 1-year mortality in three groups. After adjustment for potential confounders, hemoglobin levels remained an independent predictor of one-year mortality in both anemia (hazard ratio 0.697, 95% CI 0.528-0.960) and erythrocytosis group (hazard ratio 3.129, 95% CI 1.1.474-6.642). Conclusions: Patients with STEMI and anemia had the worst outcomes than normal hemoglobin and erythrocytosis groups. Expectedly, hemoglobin had the protective effect on prognosis in anemia group. However, a hemoglobin level was an independent risk factor of one-year mortality in those with erythrocytosis.