Tzu Chi Research Articles

Relative validity and reproducibility of a quantitative FFQ for assessing nutrient intakes of vegetarians in Taiwan.

To assess the relative validity and reproducibility of the quantitative FFQ used in the Tzu Chi Health Study (TCHS). The reproducibility was evaluated by comparing the baseline FFQ with the 2-year follow-up FFQ. The validity was evaluated by comparing the baseline FFQ with 3 d dietary records and biomarkers (serum folate and vitamin B12). Median comparison, cross-classification and Spearman correlation with and without energy adjustment and deattenuation for day-to-day variation were assessed. TCHS is a prospective cohort containing a high proportion of true vegetarians and part-time vegetarians (regularly consuming a vegetarian diet without completely avoiding meat). Subsets of 103, seventy-eight and 1528 TCHS participants were included in the reproducibility, dietary record-validity and biomarker-validity studies, respectively. Correlations assessing the reproducibility for repeat administrations of the FFQ were in the range of 0·46-0·65 for macronutrients and 0·35-0·67 for micronutrients; the average same quartile agreement was 40%. The correlation between FFQ and biomarkers was 0·41 for both vitamin B12 and folate. Moderate to good correlations between the baseline FFQ and dietary records were found for energy, protein, carbohydrate, saturated and monounsaturated fat, fibre, vitamin C, vitamin A, K, Ca, Mg, P, Fe and Zn (average crude correlation: 0·47 (range: 0·37-0·66); average energy-adjusted correlation: 0·43 (range: 0·38-0·55); average energy-adjusted deattenuated correlation: 0·50 (range: 0·44-0·66)) with same quartile agreement rate of 39% (range: 35-45%), while misclassification to the extreme quartile was rare (average: 4% (range: 0-6%)). The FFQ is a reliable and valid tool to rank relative intake of major nutrients for TCHS participants.

Taiwan's Tzu Chi as Engaged Buddhism: Origins, Organization, Appeal and Social Impact. By Yu‐ShuangYao. Leiden: Global Oriental, 2012. Pp. xx + 243. Hardcover, $90.00.

Taiwan's Tzu Chi as Engaged Buddhism: Origins, Organization, Appeal and Social Impact. By Yu‐ShuangYao. Leiden: Global Oriental, 2012. Pp. xx + 243. Hardcover, $90.00.

Perivascular adipose tissue modulates neurogenic vasorelaxation in rat mesenteric arteries

We have demonstrated that palmitic acid methyl ester (PAME) is the major perivascular adipose tissue (PVAT)‐derived relaxing factor. PAME also was shown to inhibit nicotinic acetylcholine receptor (nAChR)‐mediated inward currents on the superior cervical ganglionic neurons. The present study, therefore, was designed to determine if PAME released from the PVAT inhibited nicotine‐induced neurogenic relaxation of isolated endothelium‐denuded small mesenteric arterial (sMA) rings of 8‐week old male Sprague‐Dawley rats. In tissue bath myography study, nicotine (100 μM) induced small, basal relaxation in sMA rings with PVAT. The relaxation was significantly enhanced in arteries without PVAT. Transmural nerve stimulation (TNS) also elicited tetrodotoxin‐sensitive relaxation of sMA rings with or without PVAT. The relaxations in both ring preparations, however, were not significantly different. In sMA preparations with PVAT, TNS‐elicited relaxation or nicotine‐induced small, basal relaxation was not significantly affected by 4‐propargylglycine (10 mM, an inhibitor for H2S synthesis). These results suggest that PVAT, most likely via release of PAME but not H2S, modulates the neurogenic control of the sMA tone. (supported by Tzu Chi Univ & Foundation, NSC and NHRI of Taiwan).

Intravesical Botulinum Toxin A Injections Do Not Benefit Patients with Ulcer Type Interstitial Cystitis

Background: Ulcer type and non-ulcer type interstitial cystitis/bladder pain syndromes (IC/BPS) are considered different disease entities. Thus, intravesical botulinum toxin A (BoNT-A) treatment outcomes could differ for each entity. Objectives: To evaluate and compare the treatment outcomes of BoNT-A injections for treatment of each IC/BPS type. Study Design: Prospective interventional study. Setting: Tertiary medical center affiliated with Buddhist Tzu Chi General Hospital and Tzu Chi University, Taiwan. Methods: Forty-four consecutive patients with IC/BPS for whom conventional treatments failed were prospectively enrolled in this study. Patients were classified as having ulcer (n = 10) or non-ulcer (n = 30) IC/BPS based on their previous cystoscopic findings. Intervention: All patients received 4 sets of intravesical BoNT-A injections (100 U in 40 suburothelial injections) every 6 months. The primary end-point was the global response assessment (GRA) 6 months after the fourth set of BoNT-A injections. Secondary end-points included the O’Leary-Sant score (OSS) including symptom indexes (ICSI) and problem indexes (ICPI), visual analog scale (VAS) pain score, voiding diary, and urodynamics variables. Results: After 4 sets of BoNT-A injections, 15 patients with non-ulcer IC/BPS had GRA scores ≥ 2, while the other 15 had GRA scores < 2. All 10 patients with ulcer IC/BPS had GRA scores < 2 at the study end-point (treatment failure). At baseline, patients with ulcer IC/BPS had significantly higher daytime frequency, nocturia, smaller functional bladder capacity, smaller voided volume, greater VAS, smaller maximal bladder capacity, and greater glomerulation grade than did patients with non-ulcer IC/BPS. After 4 sets of BoNT-A injections, patients with non-ulcer IC/BPS and GRA scores ≥ 2 or < 2 all had significantly decreased ICSI, ICPI, OSS, VAS pain scores, frequency episodes, and increased functional bladder capacity. However, patients with ulcer IC/BPS showed no significant change in any clinical or urodynamic variable. After failure of repeated BoNT-A injections, all 10 patients with ulcer IC/ BPS underwent transurethral electrocauterization of their ulcers, which resulted in immediate pain relief. Limitations: Lack of a control arm in this study. Conclusion: Repeated intravesical BoNT-A injections provided effective treatment outcomes at the end-point in half of the patients with non-ulcer IC/BPS, but did not benefit any patient with ulcer type IC/BPS. Ulcer type IC/BPS should be treated as a different disease than non-ulcer IC/BPS. Institutional Review: This study was approved by the Institutional Review Board of the Tzu-chi General Hospital (TCGH 100-06). Key words: Botulinum toxin, interstitial cystitis, bladder pain syndrome, intravesical treatment, Hunner’s ulcer

Culture-Centered Engagement With Delivery of Health Services: Co-Constructing Meanings of Health in the Tzu Chi Foundation Through Buddhist Philosophy

The shift in health communication scholarship from the narrow focus on curing to the complexly intertwined spaces of health, illness, healing, and curing attends to the dynamic cultural contexts within which meanings and practices are negotiated, directing scholarship toward alternative spaces of health care delivery. This study utilized the culture-centered approach as a theoretical lens for providing a discursive space for understanding meanings of health constituted in the practices of the Tzu Chi Foundation, an organization that offers biomedical services within the larger philosophical understandings of Buddhism with 10 million members in over 50 different countries. The emerging perspective promotes non-biomedical meanings of health through selfless giving and assistance founded in Buddhist principles, simultaneously seeking purity of the mind, body, and soul holistically. Through the negotiation of the principles driving Buddhist philosophy and the principles that shape biomedical health care delivery, this study seeks to understand the interpretive frames that circulate among foundation staff and care recipients.

The growth of a Taiwanese Buddhist association in China: Soft power and institutional learning

This article looks at Ciji (Tzu Chi), a Taiwanese Buddhist charity which has been active in China since 1991. Ciji’s presence in China is all the more remarkable in view of outbreaks of crises in relations across the Taiwan Strait as well as the religious nature of the organization. The article first addresses the issue of Taiwan’s soft power in its relations with China and suggests the possibility that Ciji’s activities in Taiwan have shown China the benefits of a liberal policy towards religion in that charitable activities carried out by religious organizations complement the government’s social policies. The second section chronicles Ciji’s presence in China since 1991 and shows that local governments have their own reasons for welcoming Ciji’s volunteers. The third section compares and contrasts state approaches in China and Taiwan with respect to the provision of social services by religious organizations and notes that even if local governments in China are learning about the benefits of a more open policy in their dealings with Ciji, the central government has not adopted the liberal approach of the Taiwanese government in the regulation of religion.

Recognition of HLA-A*11:01-B*51:01-C*14:02-DRB1*11:01-DQB1*03:13 and HLA-A*02-B*40-C*03:77-DRB1*14 haplotypes restricted to Taiwanese

ObjectiveIn the Tzu Chi Taiwanese Bone Marrow Donor Registry individuals carrying the human leukocyte antigen (HLA)-C*03:77 allele and -DQB1*03:13 allele were registered. Here we report the confirmed DNA sequences of C*03:77 and DQB1*03:13 and the probable HLA haplotypes deduced in association with C*03:77 (i.e., HLA-A*02-B*40-C*03:77) and DQB1*03:13 (i.e., HLA-A*11:01-B*51:01-C*14:02-DRB1*11:01-DQB1*03:13) in Taiwanese. Materials and MethodsA sequence-based typing (SBT) method was used to confirm the low incidence alleles observed. Polymerase chain reaction was carried out to amplify exons 2 and 3 of the HLA-C locus with group-specific primer sets. For HLA-DQB1 allelic typing, six group-specific primer sets were used in the SBT procedure. Amplicons were sequenced using the Big Dye Terminator Cycle Sequencing Ready Reaction Kit (versions 3.1; Applied Biosystems, Foster City, CA, USA) in both directions according to the manufacturer's protocols. ResultsWe confirmed the DNA sequence of C*03:77, which is identical to the sequence of C*03:04:01:01 in exons 2 and 3 except for the nucleotide at position 527 (A→T). The nucleotide substitution caused an amino acid replacement at residue (codon) 152 (E→V). Similarly, our SBT confirmed that the DNA sequence of DQB1*03:13 is analogous to the sequence of DQB1*03:01:01:01 in exons 2 and 3, except for the nucleotide at residue 296 (T→A). The nucleotide variation caused one amino acid exchange at residue (codon) 67 (V→D). ConclusionsThe Taiwanese ethnicity of our donors identified in this study completes the ethnicity background for C*03:77 and DQB1*03:13 alleles listed on the IMGT/HLA Database and provides a strategy for marrow donor registry search coordinators to screen for unrelated HLA matched hematopoietic stem cell donors for blood disease patients bearing C*03:77 or DQB1*03:13.

Body Mass Index and Colorectal Hyperplastic Polyps

1 School of Medicine, China Medical University, Taichung, Taiwan 2 Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan 3 Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan 4 Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan 5 Department of Health Care Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan 6 These two authors contributed equally to this work Correspondence: Kuan-Fu Liao, Department of Internal Medicine, Taichung Tzu Chi General Hospital, No. 66, Section 1, Fongsing Road, Tanzi District, Taichung City, 427, Taiwan. E-mail: [email protected] This letter underwent AJG editorial review.

Discrepancy of Cytogenetic Analysis in Western and Eastern Taiwan

This study aimed at investigating the results of second-trimester amniocyte karyotyping in western and eastern Taiwan, and identifying any regional differences in the prevalence of fetal chromosomal anomalies. From 2004 to 2009, pregnant women who underwent amniocentesis in their second trimester at three hospitals in western Taiwan and at four hospitals in eastern Taiwan were included. All the cytogenetic analyses of cultured amniocytes were performed in the cytogenetics laboratory of the Genetic Counseling Center of Hualien Buddhist Tzu Chi General Hospital. We used the chi-square test, Student t test, and Mann-Whitney U test to evaluate the variants of clinical indications, amniocyte karyotyping results, and prevalence and types of chromosomal anomalies in western and eastern Taiwan. During the study period, 3573 samples, 1990 (55.7%) from western Taiwan and 1583 (44.3%) from eastern Taiwan, were collected and analyzed. The main indication for amniocyte karyotyping was advanced maternal age (69.0% in western Taiwan, 67.1% in eastern Taiwan). The detection rates of chromosomal anomalies by amniocyte karyotyping in eastern Taiwan (45/1582, 2.8%) did not differ significantly from that in western Taiwan (42/1989, 2.1%) (p=1.58). Mothers who had abnormal ultrasound findings and histories of familial hereditary diseases or chromosomal anomalies had higher detection rates of chromosomal anomalies (9.3% and 7.2%, respectively). The detection rate of autosomal anomalies was higher in eastern Taiwan (93.3% vs. 78.6%, p=0.046), but the detection rate of sex-linked chromosomal anomalies was higher in western Taiwan (21.4% vs. 6.7%, p=0.046). We demonstrated regional differences in second-trimester amniocyte karyotyping results and established a database of common chromosomal anomalies that could be useful for genetic counseling, especially in eastern Taiwan.

Yao, Yu-shuang : Taiwan's Tzu Chi as Engaged Buddhism: Origins, Organization, Appeal and Social Impact

It is many years since I have enjoyed an academic book so much as this one, or benefited so much from reading it. I had the good fortune to be invited by Global Oriental to read a manuscript submitted to them for publication. Since I do not know Chinese, and have no specialist knowledge of Chinese religion, I was disinclined to accept; but I was moved to do so by being told that the author, who lived in Taiwan, had spent nearly ten years looking for a publisher for this, her first book in English. For once, my virtue has been rewarded.

Taiwan’s Tzu Chi as Engaged Buddhism: Origins, Organization, Appeal and Social Impact by Yu-Shuang Yao (review)

Taiwan’s Tzu Chi as Engaged Buddhism: Origins, Organization, Appeal and Social Impact by Yu-Shuang Yao (review)

A Kind of D-Amino Acid Oxidase Inhibitor, Sodium Benzoate, Might Relieve Panic Symptoms in a First-Episode, Drug-Naïve Panic-Disorder Patient

A Kind of D-Amino Acid Oxidase Inhibitor, Sodium Benzoate, Might Relieve Panic Symptoms in a First-Episode, Drug-Naïve Panic-Disorder Patient

Superior antidepressant effect occurring 1 month after rTMS: add-on rTMS for subjects with medication-resistant depression

Depression is a major psychiatric disorder. The standard treatment for depression is antidepressant medication, but the responses to antidepressant treatment are only partial, even poor, among 30%–45% of patients. Refractory depression is defined as depression that does not respond to antidepressant therapy after 4 weeks of use. There is evidence that repetitive transcranial magnetic stimulation (rTMS) may exert effects in treating psychiatric disorder through moderating focal neuronal functions. High-frequency rTMS on the left prefrontal area and low-frequency rTMS on the right prefrontal area were shown to be effective in alleviating depressive symptoms. Given the statistically significant antidepressant effectiveness noted, the clinical application of rTMS as a depression treatment warrants further studies. Application of rTMS as an add-on therapy would be a practical research model. High-frequency (5–20 Hz) rTMS over the left dorsolateral prefrontal cortex was found to have a significant effect on medication-resistant depression. In the present study, we not only measured the acute antidepressant effect of rTMS during treatment and immediately after its completion but also evaluated participants 1 month after completion of the treatment protocol. Study participants were divided into two groups: an active rTMS group (n = 10) and a sham group (n = 10). The active rTMS group was defined as participants who received the rTMS protocol, and the sham group was defined as participants who received a sham rTMS procedure. A significant Hamilton Depression Rating Scale score reduction was observed in both groups after the fifth and tenth treatments. However, those in the active rTMS group maintained their improvement as measured one month after completion of the rTMS protocol. Participants who received active rTMS were more likely to have persistent improvement in depression scores than participants who received sham rTMS.

Cotton pledget packing versus topical spray for nasal preparation: merits and demerits are answered by a strict randomized controlled trial

We read with interest the article ‘‘Preparation of nose for nasal endoscopy: cotton pledget packing versus topical spray. A prospective randomized blinded study’’ by Mishra et al. [1] because they have found similar results as we did [2]. Although Mishra et al. claimed that there is no randomized study comparing cotton pledget packing versus topical spray before, we actually performed a randomized controlled study (RCT) in our endoscopy suite 2 years ago [2]. We have published a novel method of nasal anesthesia named cotton-tipped applicator primed gauze pledgetting (CTGP) which was found to be superior to the endoscopicguided aerosolized spray (EGAS) in reducing nasal pain during anesthesia and transnasal insertion, unpleasant taste of anesthesia, throat pain after examination, gagging episodes, and overall tolerance [2]. The RCT conducted by Mishra et al. did not show any data following the CONSORT guideline [3] regarding how sample size was determined, method used to generate the random allocation sequence, statistical methods used to compare groups for primary outcome(s), no flow of participants through each stage, and no baseline demographic and clinical characteristics of each group. As the authors pointed out in the discussion section, the concentration of anesthetic/decongestant agents used for 50 patients in Group A (a cotton pledget soaked in 4 % lignocaine and xylometazoline nasal drops) was different from those used for another 50 patients in Group B (instilled xylometazoline nasal drops and 10 % lignocaine spray). The 10 % lignocaine would definitely induce strong mucosal irritation but its higher concentration did not achieve improved anesthetic effects. This interventional bias (and probably selection bias) in this study is associated with the study design from the beginning. In fact, they could have controlled the study conditions to be as similar as possible in both groups (for example, using same concentration of anesthetic/decongestant agents). Furthermore, 8 out of 50 patients in Group A had mucosal trauma or bleeding during cotton pledget packing but none of the 50 patients in group B suffered from this side effect (16 % vs 0 %, p = 0.01). On the contrary, as shown in our study, none of the 103 patients who received gauze pledgetting had nasal bleeding, whereas only 2 patients who received topical spray had epistaxis [2]. This discrepancy was attributable to how a cotton/gauze strip was delivered into the nasal cavity. In a strict RCT, the authors should also mention how they handled the trauma/ bleeding situation and the outcomes about this side effect. Although Mishra et al. did not mention how they delivered a cotton pledget into the nasal cavity, a pair of ENT forceps or biopsy forceps can induce nasal trauma or bleeding by an unstable doctor’s hand or in patients who are so nervous to move during the nasal preparation. We had abandoned using these rigid forceps and instead we use one ‘‘flexible’’ plastic shaft (not wood shaft) cotton-tipped applicator for delivering a soaked gauze strip and re-use the gauze strip immediately for packing when epistaxis occurs (Fig. 1). If the four patients who were anxious due to mild bleeding in C.-T. Hu (&) Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Graduate Institute of Clinical Medicine, School of Medicine, Tzu Chi University, No 707, Section 3, Chung Yang Road, Hualien 970, Taiwan e-mail: chitan.hu@msa.hinet.net

Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

BackgroundThere is increasing interest in balanced propofol sedation (BPS) titrated to moderate sedation (conscious sedation) for endoscopic procedures. However, few controlled studies on BPS targeted to deep sedation for diagnostic endoscopy were found. Alfentanil, a rapid and short-acting synthetic analog of fentanyl, appears to offer clinically significant advantages over fentanyl during outpatient anesthesia.It is reasonable to hypothesize that low dose of alfentanil used in BPS might also result in more rapid recovery as compared with fentanyl.MethodsA prospective, randomized and double-blinded clinical trial of alfentanil, midazolam and propofol versus fentanyl, midazolam and propofol in 272 outpatients undergoing diagnostic esophagogastroduodenal endoscopy (EGD) and colonoscopy for health examination were enrolled. Randomization was achieved by using the computer-generated random sequence. Each combination regimen was titrated to deep sedation. The recovery time, patient satisfaction, safety and the efficacy and cost benefit between groups were compared.Results260 participants were analyzed, 129 in alfentanil group and 131 in fentanyl group. There is no significant difference in sex, age, body weight, BMI and ASA distribution between two groups. Also, there is no significant difference in recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between two groups. Though deep sedation was targeted, all cardiopulmonary complications were minor and transient (10.8%, 28/260). No serious adverse events including the use of flumazenil, assisted ventilation, permanent injury or death, and temporary or permanent interruption of procedure were found in both groups. However, fentanyl is New Taiwan Dollar (NT$) 103 (approximate US$ 4) cheaper than alfentanil, leading to a significant difference in total cost between two groups.ConclusionsThis randomized, double-blinded clinical trial showed that there is no significant difference in the recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between the two most common sedation regimens for EGD and colonoscopy in our hospital. However, fentanyl is NT$103 (US$ 4) cheaper than alfentanil in each case.Trial registrationInstitutional Review Board of Buddhist Tzu Chi General Hospital (IRB097-18) and Chinese Clinical Trial Registry (ChiCTR-TRC-12002575)

Donor Toll-Like Receptor 9 Genetic Factors in Susceptibility to Acute Graft-Versus-Host Disease and Cytomegalovirus Infection After Related and Unrelated Hematopoietic Stem Cell Transplantation

Abstract 1938 Background:Toll-like receptors (TLRs) are transmembrane proteins on the surface of immune cells that detect conserved molecular motifs known as “microbe-associated molecular patterns” from a variety of organisms. They interact with several adapter proteins to activate transcription factors, leading to the production of inflammatory cytokines and the activation of adaptive immunity. Current evidence suggests that common polymorphisms in TLR genes have been associated with the susceptibility to autoimmune disease and several infections, their association with outcomes after allogeneic hematopoietic stem cell transplantation (allo-HSCT) has yet to be explored. Methods:We unselectively included all patients undergoing allo-HSCT in our Bone Marrow Transplantation Center between January 2001 and March 2009 if donor and patient DNA were available. All the patients and their donors were from a homogeneous genetic background. We analyzed 10 single nucleotide polymorphisms (SNPs) in the TLR1gene (rs4833095 C/T, rs5743565 A/G), TLR2gene (rs11938228 A/C, rs3804099 C/T), TLR3 gene (rs3775291 A/G, rs3775296 G/T), TLR8gene (rs3764880 A/G, rs2159377 C/T) and TLR9 gene (rs352139 G/A, rs352140 C/T) in 2 independent cohorts. The initial cohort consisted of 138 pairs of patients and their unrelated donors (URDs). The second cohort consisted of 102 pairs of patients and their HLA-identical sibling donors. Results:(1) We found that two SNPs in donor side, TLR9 +1174 G/A (rs352139) and TLR9 +1635 C/T (rs352140), influenced the risk of aGVHD. The association was particularly strong in the URD transplantation cohort. Multivariate analysis confirmed that an unrelated donor with the TLR9 +1174 variant allele (A allele) was an independent risk factor for aGVHD (P= 0.009, RR= 3.123). In contrast, an unrelated donor with the TLR9 +1635 variant genotype (TT) was protective (P= 0.067, RR= 3.457). The same effect was observed in the sibling transplantation cohort, although the incidence of clinically significant aGVHD in this cohort was low overall and the association was not statistically significant. (2) Since cytomegalovirus (CMV) reactivation and disease continued to be important complications post-HSCT, and CMV infection is of special concern in the Chinese population. The incidence of asymptomatic infection is high. The episodes of major infection were focused on early CMV infection post-HSCT. Early CMV infection refers to antigenemia or disease with onset by day 100 after transplantation. In the present study cohorts, all patients and almost all donors were CMV seropositive (CMV-specific immune globulin G positive, CMV-IgG(+)) before HSCT and only one donor from the Taiwan Tzu Chi Stem Cells Center was CMV seronegative. All patients received CMV prophylaxis treatment and those experiencing pre-transplantation CMV recurrent infection received preemptive treatment. Of the total of 240 patients, 134 (55.8%) had experienced early CMV infection with a median onset of 27 days (range 2–64) post-HSCT. Patients who received stem cells from donors with the TLR9 +1635 variant genotype (TT) had a reduced incidence of grades II–IV aGVHD, however, they experienced early CMV infection more frequently than those with the wild-type genotype (CT or TT) in both the URD transplantation cohort (TT: 80% vs. CT or CC: 59.3%, Gray’s test p =0.02) and the sibling transplantation cohort (TT: 66.7% vs. CT or CC: 41.7%, Gray’s test p=0.03), although a higher incidence of early CMV infection was observed in the URD transplantation cohort (63% vs. 46%, Gray’s test p = 0.025). Multivariate analysis confirmed unrelated donors (p =0.046, RR = 1.438, 95%CI,1.007–2.053), patients experiencing recurrent CMV infection pre-transplantation (p = 0.004, RR = 0.597, 95%CI, 0.419–0.849) and donors with the TLR9 +1635 TT genotype (p=0.005, RR=0.561, 95%CI, 0.376–0.836) all contributed to the development of early CMV infection. Conclusion:There is increasing evidence for a role for TLR9 in the pathogenesis of aGVHD and viral infection. These result is the first report of donor TLR9 gene polymorphic features with the risk of aGVHD and early CMV infection, which are located within the promoter region and coding polymorphisms and may influence transcriptional regulation and the amino acid exchange of the TLR9 gene. Disclosures:No relevant conflicts of interest to declare.

Eye-Witnessing Great Giving — A Discussion of Organ Donation and Transplant Among Nurses

Objective: In Asia, Taiwan is pioneer in organ transplant, the first kidney transplants in 1968. From the Department of Health in September 1992 for the first time printed the official version of organ donation agreement card, organ donation for two decades, people have signed the organ donation consent card ratio of about 58.3 million people, 3.4 percent. The purpose of this study was to evaluate the view and insights on organ donation of nursing staff in Taiwan. Methods: A cross-sectional study was conducted with sampling of nursing staff from Tzu Chi six hospitals in Taiwan. There were 1359 nurses participated and completed the questionnaire survey. To discussion the nursing staff's views on organ donation. Results: In Tzu Chi six hospitals, 1,359 valid questionnaires were (1) working years: the proportion of 27.8% in five to ten years; (2) job title: first-line clinical nurses (71.1%); (3) units: general ward accounted for 31.6 percent, followed by acute and critical care unit (25.5%). The results were shown the nursing staff views on organ donation, agree that organ donation continues the positive meaning of life,accounted for 73.5%. There were signed the organ donation card accounted for 29.5%. Clearly, the signed card rate of nurses is higher than the general public(3.4%). The registration rate of organ donation wishes on the National Health Insurance IC card annotation accounted for 21.0%. Did not sign the organ donation card reason, “consideration” to 550 (the number of the total sample 40.5%), without considering the accounted for 13.6%, do not know this card accounted for 13.1%. For the reason of “consideration” were below: not thinking or receiver to donate concept, undecided, 42.4%, do not understand, do not have time to handle accounting for 35.3 percent, did not discuss with the family, family opposition, accounted for 20.9%. Conclusions: Tzu Chi medical system, uphold the compassion of the Dharma Master Cheng Ten called on Tzu Chi people agree with organ donation. Donation in recent years the trend towards more open, but the donation and transplantation between the number of supply and demand ratio, and persists to a great proportion of the poor. Analysis by the results of this questionnaire and look forward to allow nurses to have a correct concept of organ donation and transplantation, clinical encounter donation cases or required to undergo a transplant cases, to have the right care for common sense, and to establish a good atmosphere to help others, so that irreversible death turned into a continuation of the other side of love.

Risks of Nocturia in Patients with Chronic Kidney Disease—Do the Metabolic Syndrome and its Components Matter?

We evaluate the risk factors for nocturia in patients with chronic kidney disease, and determine whether the metabolic syndrome and its components aggravate nocturia in these patients. We enrolled patients with chronic kidney disease who had regular followup at nephrology clinics, and excluded from study those patients undergoing dialysis, and those with neurogenic bladder or active urinary tract infection. Patients were asked to complete a questionnaire including medical history, clinical parameters and times of nocturnal voids in the last month. Laboratory parameters were checked when the questionnaire was completed. Clinically significant nocturia was defined as voiding 2 or more times per night. The metabolic syndrome was defined according to the ATP III (National Cholesterol Education Program Adult Treatment Panel III) guidelines. Chronic kidney disease was divided into 5 stages (based on National Kidney Foundation guidelines). Multivariate logistic regression was used to evaluate the risk factors for clinically significant nocturia. A total of 202 men and 234 women were eligible for analysis (mean age 68.4 years). The prevalence rate of clinically significant nocturia in patients with chronic kidney disease was 64.0%. Statistically significant risk factors for clinically significant nocturia were patient age (OR 1.02, 95% CI 1.003-1.04) and chronic kidney disease stage (OR 1.47, 95% CI 1.19-1.81) but not gender. Although 53.9% of our patients with chronic kidney disease had the metabolic syndrome, the metabolic syndrome (adjusted OR 0.96, 95% CI 0.64-1.44) and its components had no significant correlations with clinically significant nocturia. Clinically significant nocturia is prevalent in patients with chronic kidney disease, and the severity increased with chronic kidney disease stage and patient age. Contrary to previous reports, the metabolic syndrome did not increase the risk of clinically significant nocturia in patients with chronic kidney disease.

The effects of calming music listening intervention on anxiety-related outcomes in college nursing students under stress

1Department of Nursing, Tzu Chi College of Technology, Taiwanese centre for evidence-based health care, Hualien, Taiwan, 2Department of Radiological Technology, Tzu Chi College of Technology, Hualien, Taiwan, 3Taipei Inner Connection Music Association, Taipei, Taiwan, 4Department of Physical Therapy, Tzu Chi College of Technology, Hualien, Taiwan, 5School of Health in Social Science, University of Edinburgh, UK

A Single-nucleotide Polymorphism of CCR6 (rs3093024) Is Associated with Susceptibility to Rheumatoid Arthritis But Not Ankylosing Spondylitis, in a Taiwanese Population: Table 1.

To the Editor: Rheumatoid arthritis (RA) is a common autoimmune disease with chronic inflammatory reactions in the synovial tissue and joint destruction. Genetic and environmental factors contribute to the development of RA1. Using genome-wide association analysis, Kochi, et al identified a single nucleotide polymorphism (rs3093024) in the CCR6 gene that was associated with the risk of rheumatoid arthritis2. Further, the genotype of CCR6 correlated with the concentration of interleukin 17 in the sera of subjects with RA2. We investigated whether the polymorphism of CCR6 is associated with susceptibility to RA in a Taiwanese population. A total of 1441 … Address correspondence to Dr. J.H. Yen or Dr. W.C. Chang, 100 Tzu Chi First Road, Kaohsiung City 807, Taiwan, Kaohsiung 701., E-mail: wcc{at}kmu.edu.tw or jehsye{at}kmu.edu.tw