Effectiveness of Booster and Influenza Vaccines against COVID-19 among Healthcare Workers, Taiwan.

Among previously uninfected healthcare workers in Taiwan, mRNA COVID-19 booster vaccine was associated with lower odds of COVID-19 after primary recombinant vaccine. Symptom-triggered testing revealed that tetravalent influenza vaccine was associated with higher odds of SARS-CoV-2 infection. COVID-19 vaccination continues to be most effective against SARS-CoV-2.

Cardiac adaptation to exercise training in health and disease.

The heart is the primary pump that circulates blood through the entire cardiovascular system, serving many important functions in the body. Exercise training provides favorable anatomical and physiological changes that reduce the risk of heart disease and failure. Compared with pathological cardiac hypertrophy, exercise-induced physiological cardiac hypertrophy leads to an improvement in heart function. Exercise-induced cardiac remodeling is associated with gene regulatory mechanisms and cellular signaling pathways underlying cellular, molecular, and metabolic adaptations. Exercise training also promotes mitochondrial biogenesis and oxidative capacity leading to a decrease in cardiovascular disease. In this review, we summarized the exercise-induced adaptation in cardiac structure and function to understand cellular and molecular signaling pathways and mechanisms in preclinical and clinical trials.

Pediatric parapneumonic effusion before and after national pneumococcal vaccination programs in Taiwan.

BACKGROUND: Reports on the effectiveness of pneumococcal conjugate vaccines (PCVs) on pediatric parapneumonic effusion are limited. We report the changes in cases and etiologies of pediatric parapneumonic effusion in a children's hospital before and after national PCV13 vaccination programs. METHODS: We screened medical records of children 0-18 years admitted to the National Taiwan University Hospital with diagnoses of lobar pneumonia and parapneumonic effusion between 2008 and 2017. Patients with effusion analyses were included. Results of blood, pleural fluid, and respiratory specimens surveyed as standard care were analyzed. RESULTS: Diagnostic testing revealed at least a pathogen in 85% of 202 children with lobar pneumonia and parapneumonic effusion. After national PCV13 immunization, pneumococcal empyema decreased by 72% among 2- to 5-year olds. Mycoplasma pneumoniae was the second most common etiology. There were marked differences in effusion characteristics, metabolic, and respiratory parameters between children infected with pneumococcus and M. pneumoniae. CONCLUSION: The effectiveness of the national PCV13 immunization programs on pneumococcal empyema was evident and remained substantial after 4 years in Taiwan. Continuous surveillance is important to monitor the emergence of other pathogens including non-PCV serotypes and M. pneumoniae.

Method for identification of rigid domains and hinge residues in proteins based on exhaustive enumeration.

Many proteins undergo large-scale motions where relatively rigid domains move against each other. The identification of rigid domains, as well as the hinge residues important for their relative movements, is important for various applications including flexible docking simulations. In this work, we develop a method for protein rigid domain identification based on an exhaustive enumeration of maximal rigid domains, the rigid domains not fully contained within other domains. The computation is performed by mapping the problem to that of finding maximal cliques in a graph. A minimal set of rigid domains are then selected, which cover most of the protein with minimal overlap. In contrast to the results of existing methods that partition a protein into non-overlapping domains using approximate algorithms, the rigid domains obtained from exact enumeration naturally contain overlapping regions, which correspond to the hinges of the inter-domain bending motion. The performance of the algorithm is demonstrated on several proteins.

Clinical progression of asynchronous cutaneous lesions in a patient with locally acquired mpox infection.

We present one of the earliest domestic mpox cases in Taiwan, highlighting the asynchronous and atypical progression of cutaneous lesions which could pose significant diagnostic challenges for clinicians.

CoVnita, an end-to-end privacy-preserving framework for SARS-CoV-2 classification.

Classification of viral strains is essential in monitoring and managing the COVID-19 pandemic, but patient privacy and data security concerns often limit the extent of the open sharing of full viral genome sequencing data. We propose a framework called CoVnita, that supports private training of a classification model and secure inference with the same model. Using genomic sequences from eight common SARS-CoV-2 strains, we simulated scenarios where the data was distributed across multiple data providers. Our framework produces a private federated model, over 8 parties, with a classification AUROC of 0.99, given a privacy budget of [Formula: see text]. The roundtrip time, from encryption to decryption, took a total of 0.298 s, with an amortized time of 74.5 ms per sample.

Determining the Definitive Time Criterion for Postherpetic Neuralgia Using Infrared Thermographic Imaging.

INTRODUCTION: The time criteria used in many studies of postherpetic neuralgia (PHN) are arbitrary and do not have supporting evidence. Therefore, this study sought to determine the definite time criterion for PHN by analyzing the skin temperature to estimate the time point when zoster-induced skin inflammatory reaction ends. METHODS: Infrared thermography was used to measure the difference in skin temperature between the affected and unaffected areas (ΔTemp) in the craniocervical and thoracic regions of patients with herpes zoster (HZ). Because the ΔTemp changes from a positive value to zero when the skin is no longer inflamed, a ΔTemp ≤ 0 was defined as the end of skin inflammation, and this time point was considered the starting point for PHN. This cutoff time point was estimated using receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 503 patients were included in this study. The ROC curve analysis showed that the time point when the ΔTemp was ≤ 0 occurred at 12 weeks after HZ onset (95% confidence interval 11-15 weeks, area under the ROC curve 0.901). Using this time point as the time criterion of PHN, the sensitivity, specificity, and classification accuracy were 0.807, 0.905, and 0.871, respectively. CONCLUSIONS: The transition of skin temperature from warm to cold occurs 12 weeks after HZ onset, which implies the end of local inflammation. Therefore, PHN associated with pathophysiologic change may be defined as 12 weeks after the skin rash. This finding provides a theoretical basis for the timing definition of PHN.

Characteristics of children and adolescents presenting to the emergency department with self-inflicted injury: Retrospective analysis of two teaching hospitals.

BACKGROUND: Data on Taiwanese adolescents with self-inflicted injuries are limited. We describe the epidemiology of children and adolescents visiting the emergency department for self-inflicted injuries in two geographically distinct teaching hospitals. METHODS: Medical records of children 0-18 years old who visited the emergency department of Taipei Tzu Chi Hospital and Chi Mei Medical Center, Tainan between 2016 and 2019 coded with relevant diagnoses were reviewed. Visits with documented self-inflicted injury were included. RESULTS: During the 4-year period, 62 children made 74 emergency visits for self-inflicted injury. A total of 88% of visits were made by children with a psychiatric diagnosis, with depressive disorders being the most common (57%). Interpersonal relationship issue was cited as a trigger for self-harm in 49% of visits. Adjusted for annual visit volumes, self-harm visits per 10,000 pediatric emergency visits increased nearly 5 fold between 2016 and 2019, with the most prominent increase in the final year. Poisoning was the most common mechanism of injury and was frequently used by females, as compared to males who tended to jump from heights. Up to 96% of adolescents with previous self-harm seen at the emergency department had sought psychiatric help in the past year. Urban-rural inequity in mental health resource utilization was observed. CONCLUSIONS: Visits to the emergency department for self-inflicted injuries among children and adolescents increased, most remarkably in 2019, for both hospitals. Intentional poisoning with prescription and over-the-counter medications was the most common method. There was a high prevalence of psychiatric disorders in our study population. As the emergency department is likely the first point of medical contact for such visits, emergency personnel should be trained appropriately on managing such patients.

Characteristics, contacts, and relative risk of SARS-CoV-2 infection among children during school closures.

BACKGROUND: Characteristics of children with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Taiwanese households is nascent. We sought to characterize SARS-CoV-2 infection, and estimate the relative risk of infection among children within households during school closures in Taipei and New Taipei City. METHODS: We reviewed consecutive children below 18 years presenting to our emergency department from May 18, 2021 to July 12, 2021 who underwent real-time reverse-transcription polymerase chain reaction (rRT-PCR) for SARS-CoV-2 from respiratory swabs. Demographics, symptoms, and contacts were captured from medical records. Household contact was defined as an individual with confirmed COVID-19 living in the same residence as the child. RESULTS: Among 56 children with SARS-CoV-2, twenty-five (45%) were male with mean age of 7.9 years. Symptoms were nonspecific, with 29% having fever, 32% having cough, and 48% were asymptomatic. The median cycle threshold (Ct) value of SARS-CoV-2 rRT-PCR was 25 (range 11-38). All 56 children reported 94 contacts with a COVID-19 patient, of which 99% were household contacts. The relative risk of infection was 8.5 (95% CI 5.0-14.7) for children whose parent(s) were COVID-19 patients, and 7.3 (95% CI 4.9-11.0) for children whose household grandparent(s) were patients, as compared to children without respective contacts. Children without COVID-19 contacts were all tested negative. CONCLUSIONS: During school closures in Taipei and New Taipei City, children with SARS-CoV-2 infection in our cohort had one or more COVID-19 contacts, mostly within their households. While diagnosing pediatric COVID-19 is challenging as children were often asymptomatic, those without contacts were likely uninfected.

Circulating pediatric respiratory pathogens in Taiwan during 2020: Dynamic change under low COVID-19 incidence.

BACKGROUND: In Taiwan, there were only 799 confirmed COVID-19 cases in 2020. The unique backdrop amidst a pandemic and promotion of nonpharmaceutical interventions generated some distinct changes in the epidemiology of common respiratory pathogens. In this study, we aimed to investigate the dynamic changes in respiratory pathogens in children during 2020. METHODS: We performed a retrospective cohort study at a tertiary hospital in southern Taiwan during 2020. Patients aged 0-18 years who visited the pediatric emergency department were enrolled. Children who presented with clinical symptoms (fever or respiratory illness) and received nasopharyngeal swabs for multiplex polymerase chain reaction (PCR) were included in our analysis. We also compared respiratory syncytial virus (RSV) trends from previous years by PCR and lateral flow immunochromatographic assays from 2017 to 2020. RESULTS: A total of 120 children were tested. The overall detection rate was 55%. With strengthened restrictions, the detection rate dropped from 70% to 30%. However, non-enveloped viruses (rhinovirus/enterovirus and adenovirus) were in constant circulation. Upon easing prevention measures, the detection rate remained above 60%, and an outbreak of an enveloped virus (RSV and parainfluenza virus) was noted. Compared with 2017-2019, the cyclical RSV epidemic was delayed, with a large surge in late 2020. CONCLUSIONS: We observed a constant circulation of non-enveloped viruses when strict nonpharmaceutical interventions were employed and a delayed surge of enveloped viruses during the easing of restrictions. Continuous surveillance and monitoring of the evolutionary dynamics of respiratory viruses is important, while easing restrictions requires balanced judgment.

Severe Mycoplasma pneumoniae infections with prolonged fever in a child: Delayed treatment is as important as macrolide resistance.

We report a 7-year-old girl who got Mycoplasma pneumoniae infection with prolonged fever. Macrolide was used on day 14 of illness but fever persisted with progressive lung consolidation. Oral prednisolone was administered on day 33 then fever subsided with dramatically clinical improvement (decreased CRP and resolution of lung consolidation). In this case, delayed effective antibiotic treatment with inflammation may be the major factor contributing to the fever rather than ongoing infection.

Streptococcus gallolyticus - A potentially neglected pathogen causing neonatal sepsis not covered by routine group B streptococcus screening.

We report 4 cases of neonatal sepsis caused by Streptococcus gallolyticus. The clinical course was quite similar to early-and late-onset group B streptococcus disease. None of the mothers had group B streptococcus (GBS) colonization on prenatal screening nor received intrapartum antibiotics. We proposed the sporadic distribution of S. gallolyticus sepsis among neonates was partly due to relatively low colonization rate in adults compared with GBS. Species determination of S. gallolyticus may not be available using conventional microbiological methods and may contribute to underestimation or misclassification. In our series, we highlighted the importance of S. gallolyticus as an important pathogen in neonatal sepsis deserving further surveillance.

Achieving GWAS with homomorphic encryption.

BACKGROUND: One way of investigating how genes affect human traits would be with a genome-wide association study (GWAS). Genetic markers, known as single-nucleotide polymorphism (SNP), are used in GWAS. This raises privacy and security concerns as these genetic markers can be used to identify individuals uniquely. This problem is further exacerbated by a large number of SNPs needed, which produce reliable results at a higher risk of compromising the privacy of participants. METHODS: We describe a method using homomorphic encryption (HE) to perform GWAS in a secure and private setting. This work is based on a proposed algorithm. Our solution mainly involves homomorphically encrypted matrix operations and suitable approximations that adapts the semi-parallel GWAS algorithm for HE. We leverage upon the complex space of the CKKS encryption scheme to increase the number of SNPs that can be packed within a ciphertext. We have also developed a cache module that manages ciphertexts, reducing the memory footprint. RESULTS: We have implemented our solution over two HE open source libraries, HEAAN and SEAL. Our best implementation took 24.70 minutes for a dataset with 245 samples, over 4 covariates and 10643 SNPs. CONCLUSIONS: We demonstrate that it is possible to achieve GWAS with homomorphic encryption with suitable approximations.

Use of d-galactose to regulate biofilm growth of oral streptococci.

In the oral microbial community, commensals can compete with pathogens and reduce their colonization in the oral cavity. A substance that can inhibit harmful bacteria and enrich beneficial bacteria is required to maintain oral health. The purpose of this study was to examine the effect of d-galactose on the biofilm formation of the cariogenic bacteria Streptococcus mutans and oral commensal streptococci and to evaluate their use in solution and in paste form. Biofilms of S. mutans, Streptococcus oralis, and Streptococcus mitis were formed on saliva-coated glass slips in the absence or presence of d-galactose and evaluated by staining with 1 % crystal violet. d-Galactose significantly inhibited the biofilm formation of S. mutans at concentrations ranging from 2 µM to 200 mM but increased the biofilm formation of S. oralis and S. mitis at concentrations of 2-200 mM. d-Galactose significantly inhibited three glucosyltransferase genes, gtfB, gtfC, and gtfD. The effect of d-galactose in the form of solution and paste was evaluated using bovine teeth. Pretreatment with 100 mM d-galactose on bovine teeth resulted in significantly reduced S. mutans biofilm formation. Our results suggest that d-galactose can be a candidate substance for the development of oral hygiene products to prevent caries by inhibiting the biofilm formation of S. mutans and simultaneously increasing the biofilm formation of commensal oral streptococci.

Highly ordered self-assembly of 1D nanoparticles in phospholipids driven by curvature and electrostatic interaction.

Self-assembly of 1D nanoparticles such as carbon nanotubes or nanorods into highly ordered superstructures using various interactions has been of great interest as a route toward materials with new functionalities. However, the phase behavior of 1D nanoparticles interacting with surrounding materials, which is the key information to design self-assembled superstructures, has not been fully exploited yet. Here, we report for the first time a new phase diagram of negatively charged 1D nanoparticle and cationic liposome (CLs) complexes in water that exhibit three different highly ordered phases, intercalated lamellar, doubly intercalated lamellar, and centered rectangular phases, depending on particle curvature and electrostatic interactions. The new phase diagram can be used to understand and design new highly ordered self-assemblies of 1D nanoparticles in soft matter, which provide new functionalities.

Human parvovirus B19 infection in patients with or without underlying diseases.

BACKGROUND/PURPOSE: The clinical presentations of parvovirus B19 in patients with underlying diseases have greater diversity than previously healthy patients. We retrospectively identified patients with polymerase chain reaction (PCR)-confirmed parvovirus B19 infection in attempt to describe its clinical features especially in these populations. METHODS: From 2009 to 2018, patients with real-time PCR-confirmed parvovirus B19 infection were collected. Comparisons were done between previously healthy patients and patients with preexisting diseases, as well as patients with high (>5.5 × 105 copies/mL sera) and low viral loads. RESULTS: Parvovirus B19 DNA was detected in 31 patients. Fourteen (45%) patients had underlying diseases, including six (19%) with immunologic diseases, five (16%) with hematologic diseases, and three (10%) with cardiopulmonary diseases. Only seven (23%) patients received an initial impression of erythema infectiosum prior to positive PCR. A higher proportion of patients with underlying diseases presented with fatigue and pallor, and suffered from tachycardia and hepatosplenomegaly compared to previously healthy patients. Among patients with a high viral load, a substantial proportion were of older age, suffered fatigue, and anemia. There was a trend of patients with immunologic comorbidity having a higher viral load. CONCLUSION: The classical parvovirus B19 manifestations were less frequently observed in patients with a preexisting disease compared with previously healthy patients. Depending on host factors, the symptoms of parvovirus B19 infection can be multifaceted.

D-Galactose as an autoinducer 2 inhibitor to control the biofilm formation of periodontopathogens.

Autoinducer 2 (AI-2) is a quorum sensing molecule to which bacteria respond to regulate various phenotypes, including virulence and biofilm formation. AI-2 plays an important role in the formation of a subgingival biofilm composed mostly of Gram-negative anaerobes, by which periodontitis is initiated. The aim of this study was to evaluate D-galactose as an inhibitor of AI-2 activity and thus of the biofilm formation of periodontopathogens. In a search for an AI-2 receptor of Fusobacterium nucleatum, D-galactose binding protein (Gbp, Gene ID FN1165) showed high sequence similarity with the ribose binding protein (RbsB), a known AI-2 receptor of Aggregatibacter actinomycetemcomitans. D-Galactose was evaluated for its inhibitory effect on the AI-2 activity of Vibrio harveyi BB152 and F. nucleatum, the major coaggregation bridge organism, which connects early colonizing commensals and late pathogenic colonizers in dental biofilms. The inhibitory effect of D-galactose on the biofilm formation of periodontopathogens was assessed by crystal violet staining and confocal laser scanning microscopy in the absence or presence of AI-2 and secreted molecules of F. nucleatum. D-Galactose significantly inhibited the AI-2 activity of V. harveyi and F. nucleatum. In addition, D-galactose markedly inhibited the biofilm formation of F. nucleatum, Porphyromonas gingivalis, and Tannerella forsythia induced by the AI-2 of F. nucleatum without affecting bacterial growth. Our results demonstrate that the Gbp may function as an AI-2 receptor and that galactose may be used for prevention of the biofilm formation of periodontopathogens by targeting AI-2 activity.

Surgical site infection after colorectal surgery according to the main anesthetic agent: a retrospective comparison between volatile anesthetics and propofol.

BACKGROUND: Anesthetic agents used for general anesthesia are emerging possible influential factors for surgical site infection (SSI). In this retrospective study, we evaluated the incidence of SSI after colorectal surgery according to the main anesthetic agents: volatile anesthetics vs. propofol. METHODS: A total 1,934 adult patients, who underwent elective colorectal surgery under general anesthesia between January 2011 and December 2013, were surveyed to evaluate the incidence of SSI: 1,519 using volatile anesthetics and 415 using propofol for main anesthetic agents. Patient, surgery, and anesthesia-related factors were investigated from all patients. Propensity-score matching was performed to reduce the risk of confounding and produced 390 patients in each group. RESULTS: Within the propensity-score matched groups, the incidence of SSI was higher in the volatile group compared with the propofol group (10 [2.6%] vs. 2 [0.5%], OR = 5.0 [95% CI = 1.1-2.8]). C-reactive protein was higher in the volatile group than in the propofol group (8.4 ± 5.6 vs. 7.1 ± 5.3 mg/dl, P = 0.001), and postoperative white blood cells count was higher in the volatile group than in the propofol group (9.2 ± 3.2 × 10(3)/µl vs. 8.6 ± 3.4 × 10(3)/µl, P = 0.041). CONCLUSIONS: The results of this study suggest that intravenous anesthesia may have beneficial effects for reducing SSI in colorectal surgery compared to volatile anesthesia.

Effect of Sulfurization Temperature on Solution-Processed Cu2ZnSnS4 Thin Films.

Cu2ZnSnS4 (CZTS) solar cells are attracting significant attention as an alternative to CIGS (Culn1-xGa(x)S2) solar cells because of the non-toxic and inexpensive constituent elements of CZTS. Recently, solution-based deposition methods are being developed because they have advantages such as suitability for use in large-area deposition, high-throughput manufacturing, and a very short energy payback time with drastically lower manufacturing costs. In this work, we fabricated solution-based CZTS thin films and investigated them in order to observe the effects of sulfurization temperature on CZTS thin films. We confirmed the grain size, morphology, chemical composition, crystallinity, and electrical properties of CZTS thin films depending on various sulfurization temperatures.

Nanostructured p-type CZTS thin films prepared by a facile solution process for 3D p-n junction solar cells.

Nanoporous p-type semiconductor thin films prepared by a simple solution-based process with appropriate thermal treatment and three-dimensional (3D) p-n junction solar cells fabricated by depositing n-type semiconductor layers onto the nanoporous p-type thin films show considerable photovoltaic performance compared with conventional thin film p-n junction solar cells. Spin-coated p-type Cu2ZnSnS4 (CZTS) thin films prepared using metal chlorides and thiourea show unique nanoporous thin film morphology, which is composed of a cluster of CZTS nanograins of 50-500 nm, and the obvious 3D p-n junction structure is fabricated by the deposition of n-type CdS on the nanoporous CZTS thin films by chemical bath deposition. The photovoltaic properties of 3D p-n junction CZTS solar cells are predominantly affected by the scale of CZTS nanograins, which is easily controlled by the sulfurization temperature of CZTS precursor films. The scale of CZTS nanograins determines the minority carrier transportation within the 3D p-n junction between CZTS and CdS, which are closely related with the photocurrent of series resistance of 3D p-n junction solar cells. 3D p-n junction CZTS solar cells with nanograins below 100 nm show power conversion efficiency of 5.02%, which is comparable with conventional CZTS thin film solar cells.