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Background People in Taiwan enjoy comprehensive National Health Insurance coverage. However, under the global budget constraint, hospitals encounter enormous challenges. This study was designed to examine Taiwan medical centers' efficiency and factors that influence it. Methods We obtained data from open sources of government routine publications and hospitals disclosed by law to the National Health Insurance Administration, Ministry of Health and Welfare, Taiwan. The dynamic data envelopment analysis ( DDEA) model was adopted to estimate all medical centers' efficiencies during 2015–2018. Beta regression models were used to model the efficiency level obtained from the DDEA model. We applied an input-oriented approach under both the constant returns-to-scale (CRS) and variable returns-to-scale (VRS) assumptions to estimate efficiency. Results The findings indicated that 68.4% (13 of 19) of medical centers were inefficient according to scale efficiency. The mean efficiency scores of all medical centers during 2015–2018 under the CRS, VRS, and Scale were 0.85, 0.930, and 0.95,respectively. Regression results showed that an increase in the population less than 14 years of age, assets, nurse-patient ratio and bed occupancy rate could increase medical centers' efficiency. The rate of emergency return within 3-day and patient self-pay revenues were associated significantly with reduced hospital efficiency ( p  < 0.05). The result also showed that the foundation owns medical center has the highest efficiency than other ownership hospitals. Conclusions The study results provide information for hospital managers to consider ways they could adjust available resources to achieve high efficiency.

This study estimates the efficiency of 19 tertiary hospitals in Taiwan using a two-stage analysis of Data Envelopment Analysis (DEA) and TOBIT regression. It is a retrospective panel-data study and includes all the tertiary hospitals in Taiwan. The data were sourced from open information hospitals legally required to disclose to the National Health Insurance (NHI) Administration, Ministry of Health and Welfare. The variables, including five inputs (total hospital beds, total physicians, gross equipment, fixed assets net value, the rate of emergency transfer in-patient stay over 48 h) and six outputs (surplus or deficit of appropriation, length of stay, the total relative value units [RVUs] for outpatient services, total RVUs for inpatient services, self-pay income, modified EBITDA) were adopted into the Charnes, Cooper and Rhodes (CCR) and Banker, Charnes and Cooper (BCC) model. In the CCR model, the technical efficiency (TE) from 2015–2018 increases annually, and the average efficiency of all tertiary hospitals is 96.0%. In the BCC model, the highest pure technical efficiency (PTE) was in 2018 and the average efficiency of all medical centers is 99.1%. The average scale efficiency of all medical centers was 96.8% in the BBC model, meaning investment can be reduced by 3.2% and the current production level can be maintained with a fixed return to scale. Correlation coefficient analysis shows that all variables are correlated positively; the highest was the number of beds and the number of days in hospital (r = 0.988). The results show that TE in the CCR model was similar to PTE in the BCC model in four years. The difference analysis shows that more hospitals must improve regarding surplus or deficit of appropriation, modified EBITDA, and self-pay income. TOBIT regression reveals that the higher the bed-occupancy rate and turnover rate of fixed assets, the higher the TE; and the higher number of hospital beds per 100,000 people and turnover rate of fixed assets, the higher the PTE. DEA and TOBIT regression are used to analyze the other factors that affect medical center efficiency, and different categories of hospitals are chosen to assess whether different years or different types of medical centers affect operational performance. This study provides reference values for the improvable directions of relevant large hospitals’ inefficiency decision-making units through reference group analysis and slack variable analysis.

Aims: The purposes of this study were (1) to compare body composition, physical function, and quality of life (QOL) between patients after coronary artery bypass grafting (CABG) with and without chronic kidney disease (CKD) and (2) to analyze the factors associated with physical function and QOL domains in these patients. Methods: Thirty male post-CABG patients with CKD and 30 matched controls were recruited. All subjects underwent dual-energy X-ray absorptiometry for body composition evaluation. Physical function tests included the grip strength test, 30-second chair stand test (30CST), and 6-min walk test (6MWT). Physical activity and QOL were assessed using the long form of the International Physical Activity Questionnaire and the World Health Organization Quality of Life Instrument (WHOQOL)-BREF, respectively. Results: Post-CABG patients with CKD exhibited a lower arm lean mass and higher percent leg fat mass than those without CKD (p < 0.05). The patients with CKD also had lower 30CST scores, 6MWT distances, and QOL domain of social relationships scores than those without CKD after adjusting for covariates (p < 0.05). If NYHA class was considered in the model, NYHA class became the most important factor associated with 6MWT distances (β = -0.647, p < 0.001) and the QOL domains of psychological health (β = -0.285, p = 0.027) and environment (β = -0.406, p = 0.001). Conclusion: Post-CABG patients with CKD had worse body composition, physical function, and QOL than those without CKD, and this might be associated with a worse NYHA class.

Extracorporeal shock wave therapy (ESWT) is becoming a popular method for the treatment of musculoskeletal disorders. We herein report a case of Achilles tendon rupture possibly related to ESWT. A 49-year-old female was treated with a calcaneal osteotomy due to Haglund’s disease on the right. However, she developed chronic calcific Achilles tendinopathy postoperatively, and during the following 2 year period after surgery she received various non-steroidal anti-inflammatory drugs and one injection of corticosteroids. She was subsequently treated with extracorporeal shock wave therapy (ESWT), but persistent pain, local swelling and redness over posterior right ankle were noted. Two months after ESWT she experienced an Achilles tendon tear and received Achilles tendon reconstruction. While ESWT is generally considered safe, physicians should be aware of potential major complications.

Aerobic fitness is among the various aspects of rheumatoid arthritis (RA) patients' lives that may deteriorate as a result of the disease and, in doing so, influence patient attitudes toward their own general health. This cross-sectional study examined (1) relationships between patients' aerobic fitness and general health perceptions, (2) relationships between functional aerobic impairment and general health perceptions, (3) the impact of body mass index (BMI) on RA patients' cardiopulmonary functioning. Sixty-six RA patients (ten male and 56 female adults) participated in this study. Following maximum graded exercise tolerance testing to determine their subsequent aerobic fitness, they completed a version of the World Health Organization Quality of Life brief form (WHOQOL-BREF, short form) questionnaire. The one sample t test determined differences between the RA group and the reference data. We used Spearman's correlation analyses to assess the associations between variables of the WHOQOL-BREF questionnaire and patients' aerobic fitness. VO₂ peak was on average 92.00% ± 13.37% and 77.93% ± 20.24% of that predicted for age-matched men and women, respectively. The female patients' BMI was significantly lower than that of the reference data (P < 0.0001). Spearman's correlation coefficient demonstrated a significant association between WHOQOL-BREF scores and VO₂ peak in the physical (P = 0.002; mobility, work) and psychological (P = 0.009; self-esteem, body image, and negative feelings) domains for the female patients. It also demonstrated a significant association between the WHOQOL-BREF scores and functional aerobic impairment in the physical (P = 0.006; energy, mobility, activity), psychological (P = 0.008; self-esteem and body images), and environment (P = 0.035; finance, service) domains for the female patients. Our results indicated that impaired aerobic fitness, combined with poor physical and psychological well-being, influenced midlife transition in Taiwanese RA women.

The Tatun volcano group is located adjacent to the Taipei metropolitan area in northern Taiwan and was a result of episodic volcanisms between 2.8 and 0.2 Ma. Earthquake data collected over the last 30 years are analyzed to explore seismicity patterns and their associated mechanisms of faulting in the area. Using a Joint Hypocenter Determination (JHD) method, a few sequences of relocated earthquake hypocenters are tightly clustered; these seemed to be blurry in the original catalog locations. Numerous earthquakes, previously unnoticed and not reported in the CWB catalog, have been identified from careful examination of the continuous recordings of a nearby broadband seismic station. These newly identified earthquakes show similarities in waveforms and arrival time differences between direct P- and S-waves indicating that their hypocenter locations are very close to each other and their source mechanisms are similar. A relatively high b-value of 1.22 is obtained from the analysis of crustal earthquakes (depth < 30 km) in the region, which may suggest that clustered local seismicity in the Tatun volcanic region probably resulted from subsurface hydrothermal or volcano-related activities. Focal mechanism solutions determined in this study are dominated by normal faulting. Thus, these earthquake clusters are most probably associated with hydrothermal/magmatic activities in a back-arc extensional environment.

Amyotrophic Lateral Sclerosis (ALS) is an adult-onset, neurodegenerative disorder characterized by loss of upper and lower motor neurons, leading to paralysis and death usually within 2-5 years. ALS is the most common motor neuron disease, with a prevalence of 5 in 100,000 individuals. At present, the etiology of disease remains unelucidated and there are no effective treatments for ALS. The most common form of familial ALS is linked to mutations in the antioxidant enzyme Cu/Zn superoxide dismutase-1 (SOD1). Transgenic mice expressing mutant SOD1 alleles develop late-onset motor neuron degeneration resembling ALS. Activated cellular and molecular components of the immune system are present in the central nervous system (CNS) of patients and mutant SOD 1 transgenic mice, but the role of neuro-inflammation in pathogenesis is not well characterized. This dissertation focuses on defining the activation and function of the immune system in the mutant SOD1G93A transgenic mouse model of ALS. Investigating the neuro-inflammatory response in the CNS, we found significant infiltration of adaptive immune CD4+ and CD8+ T cells during disease progression. Expression profiling of microglia revealed concurrent upregulation of dendritic cell receptors and neurotrophic factors. Spinal cord leukocytes secreted the Th2 cytokine, IL-4, which polarized microglia to a neuroprotective phenotype. On a T cell deficient background, mutant SOD1 disease phenotype was significantly accelerated. These data demonstrate a surprising, neuroprotective role for adaptive immunity in ALS. In mutant SOD1 spinal cord, we found upregulation of several components of the humoral complement system. To investigate the classical and lectin complement pathways, the mutant SOD 1 transgene was bred onto a C4 deficient background. Absence of C4 led to a specific decrease in microglia activation, but did not lead to a change in motor phenotype. Finally, we investigated the role of neuro-inflammation in the peripheral nervous system of mutant SOD1 mice. We found progressive infiltration and activation of macrophages, which is partially mediated by deposition of antibodies and complement. Therefore, inflammatory activation occurs throughout the nervous system of ALS transgenic mice and immunity modulates the response to motor neuron injury, leading to functional consequences for disease progression.

ObjectiveAlthough mass eradication of Helicobacter pylori has been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear.DesignMass eradication of H. pylori infection was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalent H. pylori infection. Test positives for the 13C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively.ResultsAfter six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates of H. pylori fell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI −14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate of H. pylori.ConclusionPopulation-based eradication of H. pylori has significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period.Trial registration number NCT00155389

There is currently no well-accepted consensus on the association between gut microbiota and the response to treatment of immune checkpoint inhibitors (ICIs) in patients with advanced cancer. Fecal samples were collected before ICI treatment. Gut microbiota was analyzed using 16 S ribosomal RNA sequencing. We investigated the relationship between the α-diversity of fecal microbiota and patients' clinical outcomes. Microbiota profiles from patients and healthy controls were determined. Pre-treatment serum was examined by cytokine array. We analyzed 74 patients, including 42 with melanoma, 8 with kidney cancer, 13 with lung cancer, and 11 with other cancers. Combination therapy of anti-PD1 and anti-CTLA-4 was used in 14 patients, and monotherapy in the rest. Clinical benefit was observed in 35 (47.3 %) cases, including 2 complete responses, 16 partial responses, and 17 stable diseases according to RECIST criteria. No significant difference in α-diversity was found between the benefiter and non-benefiter groups. However, patients with α-diversity within the range of our healthy control had a significantly longer median overall survival (18.9 months), compared to the abnormal group (8.2 months) (p = 0.041, hazard ratio = 0.546) for all patients. The microbiota composition of the benefiters was similar to that of healthy individuals. Furthermore, specific bacteria, such as Prevotella copri and Faecalibacterium prausnitzii, were associated with a favorable outcome. We also observed that serum IL-18 before treatment was significantly lower in the benefiters, compared to non-benefiters. The α-diversity of gut microbiota is positively correlated with more prolonged overall survival in cancer patients following ICI therapy.