Liver Disease Screening and Hepatitis C Virus Elimination in Taiwan Rural Indigenous Townships: Village-By-Village Screening and Linking to Outreach Hepatology Care.

Medical resources are limited for hepatitis C virus (HCV) elimination in rural indigenous areas of Taiwan. This study aimed to investigate liver disease risk and conduct a HCV elimination program in two rural indigenous townships. A program of village-by-village screening tests was conducted including hepatitis B virus surface antigen (HBsAg), antibody to HCV (anti-HCV) and gamma-glutamyl transferase (GGT), linking to outreach hepatology care at two indigenous townships (Laiyi and Mudan). Adult residents were invited to join this program. One hepatology specialist assessed liver disease risk, provided HCV treatment counselling and initiated direct acting antivirals (DAA) at an outreach hepatology clinic in primary health centers. A total of 3503 residents attended this program with a screening coverage of 73.5%. The prevalence of HBsAg, anti-HCV, and high GGT level was 8.2%, 10.0% and 19.5%, respectively. Laiyi had significantly higher prevalence of anti-HCV than Mudan. While males had significantly higher prevalence of HBsAg and high GGT in both townships, females in Laiyi had higher anti-HCV prevalence. HBsAg and high GGT prevalence peaked at 40-59 years of age and anti-HCV prevalence increased significantly with age. Two hundred and sixty-three residents visited the outreach hepatology clinic for HCV treatment evaluation, with 121 (46%) residents having active HCV, while 116 received DAA, with 111 (95.7%) achieving HCV elimination. For rural indigenous townships in southern Taiwan, HCV infection and alcohol consumption were two major liver disease risks. While HCV infection was predominant in old females, chronic hepatitis B virus infection and habitual alcohol consumptions predominated in middle-aged males. HCV elimination was achieved by the village-by-village screening model and linked to outreach hepatology care.

Rapid Control of a SARS-CoV-2 B.1.617.2 (Delta) Variant COVID-19 Community Outbreak: The Successful Experience in Pingtung County of Taiwan.

The Severe Acute Respiratory Syndrome-associated Coronavirus 2 (SARS-CoV-2) was an outbreak in December, 2019 and rapidly spread to the world. All variants of SARS-CoV-2, including the globally and currently dominant Delta variant (Delta-SARS-CoV-2), caused severe disease and mortality. Among all variants, Delta-SARS-CoV-2 had the highest transmissibility, growth rate, and secondary attack rate than other variants except for the new variant of Omicron that still exists with many unknown effects. In Taiwan, the pandemic Delta-SARS-CoV-2 began in Pingtung from 14 June 2021 and ceased at 11 July 2021. Seventeen patients were infected by Delta-SARS-CoV-2 and 1 person died during the Pingtung outbreak. The Public Health Bureau of Pingtung County Government stopped the Delta-SARS-CoV-2 outbreak within 1 month through measures such as epidemic investigation, rapid gene sequencing, rapidly expanding isolation, expanded screening of the Delta-SARS-CoV-2 antigen for people who lived in regional villages, and indirect intervention, including rapid vaccination, short lockdown period, and travel restrictions. Indirect environmental factors, such as low levels of air pollution, tropic weather in the summer season, and rural areas might have accelerated the ability to control the Delta-SARS-CoV-2 spread. This successful experience might be recommended as a successful formula for the unvaccinated or insufficiently vaccinated regions.

Toxicity assessment of electrochemical advanced oxidation process-treated groundwater from a gas station with petrochemical contamination.

Electrochemical advanced oxidation process (EAOP) is known for its efficient and fast degradation of organic pollutants in polluted water treatment. In this study, the EAOP using a boron-doped diamond (BDD) anode was applied to treat two-season groundwater samples collected from four sampling wells (GS1 to GS4) with petrochemical contaminants including methyl tert-butyl ether (MTBE), benzene, toluene, chlorobenzene, total organic compounds (TOC), and total petroleum hydrocarbons (TPH) at a gas station in southern Taiwan. Moreover, toxicity tests (ATP, p53, and NF-κB bioassays) were performed to evaluate the biological responses of raw and EAOP-treated groundwater. Results show that the concentrations of chlorobenzene before and after EAOP treatment were all below its method detection limit. High degradation efficiencies were observed for MTBE (100%), benzene (100%), toluene (100%, except that of GS2 in the first season), TPH (94-97%, except that of GS4 in the first season), and TOC (85-99%). Cell viability for both the raw groundwater (81.2 ± 13.5%) and EAOP-treated samples (84.7 ± 11.7%) as detected using the ATP bioassay showed no significant difference (p = 0.715). A mean reduction in the DNA damage (739 to 165 ng DOX-equivalency L-1 (ng DOX-EQ. L-1)) and inflammatory response levels (460 to 157 ng TNFα-equivalency L-1 (ng TNFα-EQ. L-1)) were observed for EAOP-treated samples subjected to p53 and NF-κB bioassays. Overall, the significances of the average degradation efficiency, DNA damage, and inflammatory response before and after groundwater with EAOP treatment was observed to be significant (p < 0.05). p53 and NF-κB bioassays might be applied to assess ecotoxic risk in the environment.

Residue Levels of Organochlorine Pesticides in Breast Milk and Its Associations with Cord Blood Thyroid Hormones and the Offspring's Neurodevelopment.

Previous studies have demonstrated that organochlorine pesticide (OCP) exposure has a negative impact on the neurological function of infants. Only a few reports have investigated the thyroid and growth hormones and their relationship to neurodevelopment after human exposure to OCPs, especially in the case of infants. Our goal was to determine whether breastmilk OCP residues were associated with negative impacts and/or alterations in the neurodevelopment of infants among specific southern Taiwanese mother-breastfed infant pairs. Our subjects (n = 55 pairs) were recruited from southern Taiwan between 2007 and 2010. The thyroid and growth hormone levels in the cord blood samples collected after childbirth were determined. The breastmilk was gathered within one month after childbirth for the determination of OCP levels using a high-resolution gas chromatograph with mass spectrometry, and the neurodevelopment of 10-12-month-old infants was examined using the Bayley Scales of Infant and Toddler Development®, Third Edition (Bayley-III). It was observed that 4,4'-dichlorodiphenyl-dichloroethylene (4,4'-DDE) (mean = 10.3 ng/g lipid) was the most predominant OCP compound in the breastmilk samples. At higher concentrations (>75th percentile), specific OCPs were associated with significantly lower levels of thyroid and growth hormones than at lower concentrations (<75th percentile). Significantly higher odds ratios (ORs) were observed for binary cognitive (OR = 8.09, p = 0.025 for 4,4'-DDT), language (OR = 11.9, p = 0.013 for 4,4'-DDT) and social-emotional (OR = 6.06, p = 0.01 for trans-CHL) composite scores for specific OCPs belonging to the lower exposure group as compared to the higher OCP exposure group. The five domain Bayley-III infant neurodevelopment outcomes were negatively associated with specific OCPs in the breast milk samples based on the redundancy analysis (RDA) test. Bayley-III scales, which include cognitive, language, motor, social-emotional, and adaptive behavior scales, could be predicted by 4,4'-DDT, endrin, endosulfan I, heptachlor, or heptachlor epoxide using multivariate linear regression models with adjustment for maternal age, pre-pregnant BMI, parity, and infant gender. In conclusion, although our study showed that postnatal exposure to breast milk OCPs may be associated with infant neurodevelopmental outcomes and that prenatal exposure, if extrapolated from breastmilk levels, is associated with changes in thyroid and growth hormones that may have effects on neurodevelopment, these associations are only suggestive; thus, further studies are recommended for confirmation.

Dust levels of polybrominated diphenyl ethers (PBDEs) and polybrominated dibenzo-p-dioxins/furans (PBDD/Fs) in the Taiwanese elementary school classrooms: Assessment of the risk to school-age children.

Elementary school classroom dust is an important source of exposure to polybrominated dibenzo-p-dioxins/furans and diphenyl ethers (PBDD/DF/DEs) for school-age children. Our goal is thus to investigate concentrations of PBDD/DF/DEs in elementary school classroom dust to further assess the impact on school-age children via ingestion. The dust from classrooms, including both normal (NR) and computer classrooms (CR), was collected from six urban and four rural schools. Fourteen PBDEs and twelve PBDD/Fs were measured using high-resolution gas-chromatography/high-resolution mass-spectrometry. The mean levels of Σ14PBDEs in NR and CR dust from the urban classrooms were 370 and 2510ng/g and those whose dust from the rural classrooms were 464 and 1780ng/g. The means of ΣPBDD/Fs were 0.0401ng-WHO2005-TEQ/g (concentration: 4.72ng/g) in urban NR dust, 0.0636ng-WHO2005-TEQ/g (7.51ng/g) in urban CR dust, 0.0281ng-WHO2005TEQ/g (3.60ng/g) in rural NR dust, and 0.0474ng-WHO2005TEQ/g (6.28ng/g) in rural CR dust. The PBDEs pattern in NR dust was quite different from that in CR dust, but the PBDD/Fs patterns in NR and CR dust were similar. A linearly significant correlation coefficient (n=20, r=0.862, p<0.001) was found between ΣPBDEs and ΣPBDD/Fs in NR and CR dust, indicating that the PBDEs and PBDD/Fs in the dust may be from the same sources in the elementary school classrooms. This study assessed the risks (daily intake and cancer and non-cancer risks) of PBDEs and PBDD/Fs for the children from the classroom dust, and the calculated risk values did not exceed the related thresholds. With regard to the exposure scenarios for school-age children in an indoor environment, the results suggest that they might ingest more dust PBDD/DF/DEs in their homes than in the schools. In conclusion, the exposure of Taiwanese elementary school children to PBDD/DF/DEs via indoor dust was with a safe range based on our findings.

Intracranial Inflammatory Myofibroblastic Tumor with Sarcomatous Local Recurrence.

CASE DESCRIPTION: A 20-year-old woman presented with a rare intracranial inflammatory myofibroblastic tumor (IMT) manifesting as headache and insomnia. Magnetic resonance imaging showed a tumorous lesion with heterogeneous enhancement at the right temporal lobe, as well as perifocal edema with midline shift. The tumor was totally resected with the margin free. Pathologic examination showed IMT with myofibroblastic cells admixed with collagen fibers. Sarcomatous change in morphology was observed in tumor recurrence within 7 months. CONCLUSIONS: Surgical resection and whole brain radiation are recommended in patients with IMT.

An AhR-Luciferase Adenovirus Infection System for Rapid Screening of Dioxins in Soils.

Our goal was to develop a fast-screening method for measuring dioxin levels in soils. The adenovirus (Ad)-dioxin-responsive (DR) bioassay system (AdEasy-6XDRE-TATA-Luc) combined with a fast-cleanup system was examined under conventional conditions (i.e., with incubation at 37°C) and three alternative conditions [incubation at 37°C with addition of phorbol-12-myristate-13-acetate (PMA), incubation at 33°C, and incubation at 33°C with addition of PMA]. The best conditions for carrying out the Ad-DR bioassay was 33°C and no addition of PMA. The background level of soil dioxins determined by the chemical assay [6.49 ng I-TEQ/kg dry weight (dw)] was well correlated (Pearson's r = 0.873, p < 0.001) with that by the Ad-DR bioassay [expressed in ng bioanalytical equivalents (BEQ) 81.1 ng BEQ/kg dw] (n = 17). When surveyed in contaminated soil samples (n = 114) from industrial areas by the Ad-DR bioassay, dioxin levels were 117, 102, 98.5, and 112 ng BEQ/kg dw, respectively, in northern, central, southern, and eastern Taiwan.

Use of a highly sensitive recombinant hepatoma cell method to determine dioxin concentrations in samples of fish and crab from a hotspot area.

A new and easy fast-screening test (the Ad-DR (adenoviral vector-dioxin response) bioassay) for dioxins in biological samples from highly dioxin-contaminated areas was developed. The aryl-hydrocarbon-receptor (AhR) reporter system was utilized to transport a dioxin-responsive-element (DRE) via an adenovirus vector into rat hepatoma (H4IIE) cells before each experiment; these DRE-H4IIE cells were utilized in the Ad-DR bioassay. Biological extracts were simultaneously analyzed by the Ad-DR bioassay and high resolution gas chromatography/high resolution mass spectrometry (HRGC/HRMS). A good correlation was found between the results of the HRGC/HRMS assay and those of the Ad-DR bioassay (R(2) = 0.920, p < 0.001). The bio-analytical equivalent (BEQ) value found in fish or crab caught in the abandoned pentachlorophenol plant (AP) was extremely high compared with the BEQ in fish or crab caught in two rivers nearby this abandoned plant. Dioxins were more heavily bioaccumulated in fish viscera than in fish muscles or in the whole fish. Two-way analysis of variance tests identified the significant effects of fish collection site, fish or crab tissue sample and the interaction between them on dioxin levels in the tissues of these aquatic animals. In conclusion, the Ad-DR bioassay is a useful tool to determine dioxin levels in samples of fish and crab. Compared with fish tissues, where a sample is taken (in the PCP plant or nearby rivers) is the most important factor to determine bioaccumulation of dioxins in fish.

Cord blood levels of thyroid hormones and IGF-1 weakly correlate with breast milk levels of PBDEs in Taiwan.

In vivo studies indicate that prenatal or neonatal exposure of rodents to polybrominated diphenyl ethers (PBDEs) disrupts thyroid hormone balance, but few studies have reported an association of PBDEs and insulin-like growth factor 1 (IGF-1). The goal was to examine whether PBDEs exposure affects the levels of thyroid hormones and IGF-1 in cord blood. Study participants were healthy pregnant women recruited from the general population in central Taiwan between 2000 and 2001 and in southern Taiwan from 2007 to 2009. One-hundred-forty-nine breast milk samples (n=149), which were collected within one month after delivery, were analyzed using a high resolution gas chromatograph equipped with a high resolution mass spectrometer. The average and median levels of breast milk Σ(14)PBDEs were 5.34 and 3.38 ng/g lipid in 2000-2001 and 5.22 and 3.13 ng/g lipid in 2007-2009, respectively. In general, levels of PBDE congeners were very low in this study population and not significantly different between the years 2000-2001 and 2007-2009. Breast milk Σ(14)PBDEs were not significantly correlated with thyroid hormones and IGF-1 in cord blood. After examining multiple stepwise linear regression models with adjustment for maternal age, pre-pregnancy body mass index (BMI), parity, gestational age, and region (namely, central and southern Taiwan), we found that log of T4 in cord blood was significantly but slightly correlated with higher BDE-154 (B=0.113, p=0.017) in breast milk. The log of FT4 concentration was significantly related to a decrease in the log of BDE-99 level (B=-0.137, p=0.043) and an increase in the log of BDE-154 level (B=0.158, p=0.008). Meanwhile, the log of IGF-1 level was also significantly linked to an increase in the log of BDE-196 level (B=0.532, p=0.028) and decrease in the log of BDE-85 level (B=-0.235, p=0.018). Few epidemiological studies report an association between PBDEs exposure and IGF-1. Based on our findings, further in vivo and epidemiological studies are encouraged and needed to explore associations between PBDEs exposure and levels of thyroid hormones and IGF-1.

Neurodevelopment of infants with prenatal exposure to polybrominated diphenyl ethers.

The study aimed to examine the impact of prenatal exposure to polybrominated diphenyl ethers (PBDEs) on infant neurodevelopment. PBDEs levels in 36 cord blood samples were analyzed with a high-resolution-gas-chromatograph/high-resolution-mass-spectrometer and infant neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. The mean and median of Σ(11)PBDEs were 6.63 and 4.63 ng/g lipid, respectively. As compared to the lower PBDEs group (Σ(11)PBDEs < 4.63 ng/g lipid), the higher PBDEs group (Σ(11)PBDEs > 4.63 ng/g lipid) had a significantly higher actual odds ratio (OR = 1.13, p < 0.05) of the cognition score as well as a lower odds ratio (OR = 0.904, p < 0.01) of the adaptive behavior score, suggesting that prenatal PBDEs exposure may potentially affect infant neurodevelopment.

Impact of non-occupational exposure to polybrominated diphenyl ethers on menstruation characteristics of reproductive-age females.

Polybrominated diphenyl ethers (PBDEs) have documented effects on thyroid functions and rodent behavior in vivo. Epidemiological studies, however, have revealed only limited information about associations between PBDE exposure and menstruation characteristics. Our goal was to examine whether high breast milk PBDE levels in reproductive-age females lead to interference with menstruation characteristics. We analyzed 15 PBDE congeners in 46 breast milk samples. Fifteen PBDE congeners (BDE-15, 28, 47, 49, 99, 100, 153, 154, 183, 196, 197, 203, 207, 208, and 209) were analyzed using a gas chromatograph equipped with a high resolution mass spectrometer. The mean sum of PBDEs (SigmaPBDEs) in breast milk was 3.42 ng/g lipid. Women's age at menarche was not correlated with breast milk PBDE levels. Increased BDE-208 and 209 levels were significantly associated with the prolonged length of average and the longest menstrual cycle independent of age, pre-pregnant BMI, and parity. Higher concentrations of SigmaPBDEs and the higher brominated PBDEs from BDE-183 to 209, except 197, were significantly linked to women whose menstruation periods were still coming irregularly at the sampling time. Age-adjusted odds ratios (ORs) of BDE-153, 183, 207, 208, and SigmaPBDEs were significantly higher in women with length of average menstrual cycle >32 days, compared to the control. Women whose menstruation periods still came irregularly when they were 18 years old had higher age-adjusted ORs of BDE-207, 208, 209, and SigmaPBDEs than those whose periods came regularly at the same age. Although SigmaPBDEs and certain higher brominated PBDEs appear to have potential to prolong length of average menstrual cycle and delay the age when menstruation periods begin coming regularly, these findings are not conclusive because our sample size is small and more scientific evidence is needed.

Effects of arecoline on adipogenesis, lipolysis, and glucose uptake of adipocytes-A possible role of betel-quid chewing in metabolic syndrome.

To investigate the possible involvement of betel-quid chewing in adipocyte dysfunction, we determined the effects of arecoline, a major alkaloid in areca nuts, on adipogenic differentiation (adipogenesis), lipolysis, and glucose uptake by fat cells. Using mouse 3T3-L1 preadipocytes, we showed that arecoline inhibited adipogenesis as determined by oil droplet formation and adipogenic marker gene expression. The effects of arecoline on lipolysis of differentiated 3T3-L1 adipocytes were determined by the glycerol release assay, indicating that arecoline induced lipolysis in an adenylyl cyclase-dependent manner. The diabetogenic effects of arecoline on differentiated 3T3-L1 adipocytes were evaluated by the glucose uptake assay, revealing that > or = 300 microM arecoline significantly attenuated insulin-induced glucose uptake; however, no marked effect on basal glucose uptake was detected. Moreover, using 94 subjects that were randomly selected from a health check-up, we determined the association of betel-quid chewing with hyperlipidemia and its related risk factors. Hyperlipidemia frequency and serum triglyceride levels of betel-quid chewers were significantly higher than those of non-betel-quid chewers. In this study, we demonstrated that arecoline inhibits adipogenic differentiation, induces adenylyl cyclase-dependent lipolysis, and interferes with insulin-induced glucose uptake. Arecoline-induced fat cell dysfunction may lead to hyperlipidemia and hyperglycemia/insulin-resistance. These findings provide the first in vitro evidence of betel-quid chewing modulation of adipose cell metabolism that could contribute to the explanation of the association of this habit with metabolic syndrome disorders.

Concentrations of polybrominated diphenyl ethers in breast milk correlated to maternal age, education level, and occupational exposure.

The aim of the present study is to determine whether levels of polybrominated diphenyl ethers in breast milk in the general population are associated with demographic parameters, socioeconomic status, lifestyle factors, and occupational exposure. Forty-six participants are randomly selected from healthy women recruited between April 2007 and April 2008 from local hospitals in southern Taiwan. Thirty PBDE isomers in breast milk are analyzed using a gas chromatograph with a high resolution mass spectrometer. The mean+/-standard deviation of Sigma PBDEs in breast milk is 3.59+/-1.07 ng/g lipid. Our current value of Sigma PBDEs in breast milk is 0.7-fold lower compared to the past value in our previous study between 2000 and 2001. Higher levels of Sigma PBDEs might be significantly associated with older maternal age and maternal age of the present study is between 22 and 42 years old. Levels of Sigma PBDEs and certain PBDEs in breast milk are not correlated with maternal pre-pregnant BMI (Body mass index), parity, and lipid contents of breast milk. The Sigma PBDEs level in breast milk is lower in more educated women after controlling for age and pre-pregnancy BMI in our subjects. The main factors associated with Sigma PBDEs in breast milk are age and education level among the binary variables of demographic, socioeconomic, and lifestyle characteristics in this report. The exploratory relationships are found between PBDEs in breast milk and age, education level, or occupational exposure due to small sampling size.

Cerebral sinovenous thrombosis. Neuroimaging diagnosis and clinical management.

SUMMARY: Cerebral sinovenous thrombosis (CSVT) is an uncommon disorder that affects the dural venous sinus and cerebral vein. In our study, thirty- four patients were examined. Pre and/or post contrast-enhanced CT was done in 28 patients. MRI studies were done in 24 patients. 2-D TOF MR venography (MRV) and contrast-enhanced MRV (CEMRV) were done in 19 cases. Digital subtraction angiography (DSA) was done in 18 patients. Sixteen patients received systemic intravenous heparinization, and 12 received endovascular thrombolytic treatment with urokinase combined with anticoagulant therapy. Neuroimages of CSVT can be acquired by direct visualization of the thrombus within the dural sinus or by parenchymal changes secondary to venous occlusion. As there are some pitfalls to MRI in the diagnosis of CSVT, the combination of MRI and MRV is now the gold standard in the diagnosis of CSVT. Usually, accuracy can be improved by applying 2-D TOF MRV and CE MRV. Furthermore, the source image of MRV is critical in differentiating between normal sinus variations and diseased ones. DSA is the best tool for demonstrating dynamic intracranial circulation in CSVT and mostly is used for endovascular treatment. Systemic intravenous anticoagulant therapy with heparin is accepted as a first line treatment. Except for clinical manifestations after systemic heparinization, abnormal MR findings of parenchymal change can be used to determine when to initiate thrombolytic treatment. Endovascular therapy can be finished at the antegrade flow within the dural sinus and continuous anticoagulation is sufficient to facilitate clinical improvement. Clinical suspicion and excellent neuroimaging are crucial in making the diagnosis of CSVT. Proper management with anticoagulants and/or endovascular thrombolytic therapy is mandatory in preventing propagation of the thrombosis and improving the clinical outcome.

CT angiography and MR angiography in the evaluation of carotid cavernous sinus fistula prior to embolization: a comparison of techniques.

BACKGROUND AND PURPOSE: This study compared CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA) in elucidating the size and location of carotid cavernous sinus fistulas (CCFs) before embolization treatment. METHODS: This was a retrospective study of 53 patients with angiographically confirmed CCF. All patients underwent pre- and postcontrast-enhanced CTA and DSA, and 50 patients also underwent MRA. Two neuroradiologists rated detectability of the fistula tract as "good," "moderate," or "poor" in source images obtained by using each procedure. The chi(2) test was used to compare the imaging modalities with respect to their ability to detect fistulas. RESULTS: CTA did not differ significantly from DSA (P = .155), and both CTA (P = .001) and DSA (P = .007) performed significantly better than MRA in the population as a whole. Differences in performance among the methods, however, depended upon the segmental location of the fistula along the internal carotid artery (ICA). CTA and MRA were similar in detection of CCFs in patients with a fistula at segment 3. CTA significantly outperformed MRA in patients with a fistula at segment 4, who accounted for approximately half of the population. CONCLUSIONS: CTA source imaging has proved itself as useful as DSA for detecting CCFs. Of the 2 noninvasive techniques, CTA performed better than MRA in the population as a whole and in most patients whose fistula was located at segment 4 or 5 of the ICA.

MR imaging of an infiltrating spinal epidural angiolipoma.

Infiltrating spinal epidural angiolipoma is an uncommon benign tumor composed of mature adipose elements admixed with abnormal blood vessel, which tends to invade the surrounding soft tissue and may potentially be mistaken for an aggressive tumor. In this report, we present the MR imaging findings of a pathologically proved infiltrating spinal epidural angiolipoma that appeared largely hypointense on T1-weighted images and enhanced strongly with IV injection of contrast medium, features that suggested a malignant tumor.