Effect of ontological insecurity on vaccination behavior against COVID-19: a hospital-based cross-sectional study.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has brought great uncertainty to our society and it may have disrupted people's ontological security. Consequently, this hospital-based study concerns the impact of ontological insecurity on vaccination behavior against COVID-19. STUDY DESIGN: This cross-sectional study was conducted among hospital inpatients. METHODS: A questionnaire survey addressing inpatient ontological insecurity and vaccination behavior against COVID-19 was administered in Taizhou, China. A total of 1223 questionnaires were collected; specifically, 1185 of them were credible, for a validity rate of 96.9%. RESULTS: The score of ontological insecurity was 13.27 ± 7.84, which was higher in participants who did not recommend vaccination for others than those who did (12.95 ± 8.25 vs 14.00 ± 6.78, P = 0.022). There was no difference between the vaccinated and unvaccinated groups (13.22 ± 7.96 vs 13.35 ± 7.67, P = 0.779). Lower ontological insecurity (odds ratio [OR] = 1.40, 95% confidence interval [CI]: 1.08-1.81) and being inoculated with COVID-19 vaccines (OR = 2.17, 95% CI: 1.67-2.82) were significantly associated with recommendation of COVID-19 vaccines to others after adjusting for sex, age, education, and occupation. Associations between low ontological insecurity and recommendations for COVID-19 vaccines were observed in men, adults aged 18-59 years, non-farmers, and vaccine recipients. CONCLUSIONS: This study suggests that the ontological insecurity of participants affects their behavior of recommending the COVID-19 vaccination to others rather than getting vaccinated themselves. This promotion of vaccination can be considered from the perspective of improving ontological security in China.

n-3 PUFA and caloric restriction diet alters lipidomic profiles in obese men with metabolic syndrome: a preliminary open study.

PURPOSE: For people with metabolic syndrome (MetS), altering the macronutrient composition of their diets might ameliorate metabolic abnormalities. The common method of clinical assessment only measures total lipid concentrations but ignores the individual species that contribute to these total concentrations. Thus, to predict the amelioration of MetS following caloric restriction (CR) and the intake of fish oil, we used lipidomics to investigate changes in plasma lipids and identify potential lipid metabolites. METHODS: Lipidomics was performed using ultra-high-performance liquid chromatography-tandem mass spectrometry on plasma samples from a clinical trial conducted over 12 weeks. Subjects were randomized into two groups: CR (n = 12) and CR with fish oil (CRF, n = 9). Anthropometric and clinical parameters were measured and correlated with plasma lipidomics data. RESULTS: Compared with baseline, significant differences were observed in body weight, waist circumference, blood pressure and interleukin-6 in both groups, but triglyceride (TG) levels significantly decreased in only the CRF group (all p < 0.05). A total of 138 lipid species were identified. Levels of species containing long-chain polyunsaturated fatty acids were significantly elevated-greater than twofold-following fish oil intake, these included TG (60:9) and phosphatidylcholine (p40:6) (all q < 0.05). TG (60:9) tended to correlate negatively with body weight, body mass index, blood pressure, and HbA1c following fish oil intake. CONCLUSION: CR and fish oil can ameliorate MetS features, including anthropometric parameters, blood pressure, and blood lipid concentrations. The levels of particular lipid species such as TG-containing docosapentaenoic acid were elevated post-intervention and negatively associated with MetS features. TG (60:9) may be proposed as a lipid metabolite to predict amelioration in MetS following the intake of CR and fish oil.

Efficacy and safety of tofacitinib for moderate-to-severe plaque psoriasis: a systematic review and meta-analysis of randomized controlled trials.

The effects of tofacitinib in treating moderate-to-severe plaque psoriasis were unclear. We aimed to assess the effects of tofacitinib in treating moderate-to-severe plaque psoriasis. We searched PubMed, Cochrane Central Register of Controlled Trials and EMBASE for relevant randomized controlled trials (RCTs) and conducted a systematic review and meta-analysis. Four RCTs with 2724 participants were included. Compared to placebo, tofacitinib significantly improved psoriasis {≥75% reduction in the Psoriasis Area and Severity Index score: 5 mg BID: risk difference (RD) 0.32 [95% confidence interval (CI) 0.28-0.35], 10 mg BID: RD 0.51 (95% CI 0.43-0.58); ≥90% reduction in the Psoriasis Area and Severity Index score: 5 mg BID: RD 0.19 (95% CI 0.17-0.22), 10 mg BID: RD 0.36 (95% CI 0.31-0.42); Physician's Global Assessment 0/1: 5 mg BID: RD 0.31 (95% CI 0.27-0.35), 10 mg BID: RD 0.48 (95% CI 0.44-0.53)} and participants' life quality [Dermatology Life Quality Index 0/1: 5 mg BID: RD 0.24 (95% CI 0.20-0.2), 10 mg BID: RD 0.36 (95% CI 0.33-0.40)]. Tofacitinib was associated with an increase in minor adverse events [upper respiratory tract infection: 5 mg BID: RD 0.02 (95% CI 0.00-0.03), 10 mg BID: RD 0.02 (95% CI 0.00-0.04); hypercholesterolaemia: 5 mg BID: RD 0.02 (95% CI 0.01-0.04), 10 mg BID: RD 0.02 (95% CI 0.01-0.04)]. In conclusion, tofacitinib may be a treatment option for moderate-to-severe plaque psoriasis that is unresponsive to other therapies and patients who are intolerable to other therapies or prefer oral medications.

Costimulation blockade of CD40 and CD28 pathways in limb transplantation.

Costimulation blockade remains a promising experimental regimen for the induction of transplantation tolerance. The simultaneous blockade of both the CD40 and CD28 pathways has been synergistic in prolonging organ allograft survival but has not previously been investigated in a model of limb allotransplantation. This study determined the efficacy of this combination in the murine limb allograft model. C57B1/6 (H-2K(b)) female mice were recipients of heterotopic vascularized limb allografts from Balb/c (H-2K(d)) male donors. Experimental groups received treatment with a short course of MR1 (hamster anti-mouse anti-CD40 ligand antibody) alone or in combination with CTLA4-Ig, a fusion protein that blocks the B7/CD28 pathway. Untreated recipients rejected limb allografts at a mean of 9.6 +/- 1.1 (standard error of the mean) days postoperatively. Recipients of a prolonged course of MR1 rejected limb allografts at 75 +/- 25 days. When both MR1 and CTLA4-Ig were used, limb allograft survival of >120 days was observed despite a much shorter course of therapy. Rejection in both treatment groups was consistent with a chronic antibody-mediated process. Donor antigen rechallenge in these recipients by in vitro assay and skin allograft demonstrated a hyperacute response consistent with presensitization. Long-term limb allograft survival is produced by the synergistic effect of blocking both the CD40 and CD28 costimulatory pathways. However, permanent acceptance was not achieved, and allografts eventually succumbed to what appeared to be antibody-mediated rejection. The additional use of newer agents that block more recently described costimulatory pathways may be essential for the induction of tolerance by costimulation blockade.

Immunochemical properties of Naja naja atra (Taiwan cobra) phospholipase A2 using polyclonal and monoclonal antibodies.

The immuno-chemical properties of Naja naja atra phospholipase A2 (NNA-PLA2) were studied by using the chemically modified PLA2 derivatives and the PLA2 homologues toward anti-NNA-PLA2 polyclonal and monoclonal antibodies. Anti-NNA-PLA2 polyclonal antibodies inhibited the enzymatic activity of NNA-PLA2 and Hemachatus haemachatus DE-I by 87% and 68%, respectively. However, the enzymatic activities of Naja nigricollis CMS-9 and notexin were not significantly affected by the polyclonal antibodies. Competitive enzyme immunoassay revealed that the affinity of NNA-PLA2 for polyclonal antibodies was 330-fold higher than that of Hemachatus haemachatus DE-I. Naja nigricollis CMS-9 and notexin failed to inhibit the binding of NNA-PLA2 to polyclonal antibodies. This implies that the epitope(s) of NNA-PLA2 might comprise some substituted residues in the sequence of PLA2 homologues. Three monoclonal antibodies against NNA-PLA2 were prepared by a hybridoma technique. Two of these monoclonal antibodies inhibited the enzymatic activity of NNA-PLA2, but the other did not. Removal of the N-terminal octapeptide affected the epitope interacting with these monoclonal antibodies. Selective modification of tyrosine residues at positions 3 and 63 or lysine residues at positions 6 and 65 induced a substantial reduction in affinity of NNA-PLA2 for polyclonal and monoclonal antibodies. The three monoclonal antibodies failed to recognize PLA2 homologues. The comparison of the sequence of NNA-PLA2 to those of PLA2 homologues showed that most of the amino acid substitutions of PLA2 homologues occur in the spatially nearby region of the N-terminal region and residues at positions 63 and 65.(ABSTRACT TRUNCATED AT 250 WORDS)

A computer simulation model for cost-effectiveness analysis of mass screening for Type 2 diabetes mellitus.

The cost-effectiveness analysis of mass screening for Type 2 diabetes mellitus (DM) was performed to elucidate whether, who and how often it should be conducted in Taiwan. A series of Markov process was developed to model the disease natural history of Type 2 DM. A hypothetical cohort with 30,000 residents aged over 30 years in Taiwan was randomly assigned to three arms of screening regimes, biennial, five-yearly and the control group. A Monte Carlo computer simulation was performed to calculate effectiveness of two screening regimes compared with the control group. Direct costs and utilities were incorporated to each corresponding state to calculate the incremental costs per life-years gained and per quality-adjusted life-years (QALYs) for biennial and five-yearly screening regimes. The incremental costs for biennial screening regime were estimated at $26,750 per life-year gained, and $17,833 per QALY. The corresponding figures for five-yearly screening regime were $10,531 per life-year gained and $17,113 per QALY. The incremental costs per life-year gained and per QALY increase with age, ranging from $17,238 for aged 30-39 years to $54,700 for aged over 70 years and from $9193 to 36,467, respectively. In conclusion, mass screening for Type 2 DM, especially in younger subjects, with 5-year inter-screening interval is cost-effective in Taiwan.

Secondary carpal tunnel surgery.

A small but significant group of patients with carpal tunnel syndrome "fail" primary carpal tunnel release and require secondary surgery. The persistence or recurrence of previous symptoms or the development of new symptoms is often indicative of the nature of the patient's problem. Postoperative complications may be classified into the general areas of neurological, vascular, tendon, and wrist complaints. A thorough clinical evaluation, including a complete neurological examination of the hand and upper extremity, provides an accurate assessment of the status of the median nerve. Important surgical techniques that may be used during secondary carpal tunnel surgery include internal neurolysis, neuroma-in-continuity assessment, neuroma management, nerve grafting, and tissue interposition flaps.

Successful distraction osteogenesis across a growing cranial suture without an osteotomy.

The application of distraction osteogenesis to the membranous bones of the craniofacial skeleton and its effects on cranial volume and overall skull shape have not been fully studied. This pilot study was designed to compare distraction of a cranial suture in the rabbit model with distraction across an osteotomy and to evaluate the response of the suture both grossly and histologically. Additionally, the need for a period of rigid fixation after distraction was evaluated. Calibrated distraction of either the coronal suture or an osteotomy in the midsection of the parietal bone using an internal distractor (Synthes Maxillofacial, Paoli, Pa.) was studied in juvenile and adult New Zealand White rabbits. Skull growth and distraction were followed by serial cephalograms, and bone biopsies of the distracted sites were obtained after death for histologic evaluation. Craniometric analysis of the skulls was also performed. There was significantly greater mean marker separation in the juvenile suture distraction group (6.6 +/- 0.2 mm; n = 3) than in the control group (2.2 +/- 0.2 mm; p < 0.01). Marker separation was also significantly greater across the parietal osteotomy (6.4 +/- 0.1 mm) than in the sham group (no marker separation). Craniometric data demonstrated the ability of the juvenile skull to distribute the change at the coronal suture throughout the skull to maintain symmetry and minimize disproportion. No distraction was obtained across the adult suture. In the juvenile suture distraction group without a period of stable fixation, a relapse of 17 +/- 6 percent was noted after 1 week, an additional 2.3 +/- 0.5 percent after the second week, and no further change in the third postdistraction week (n = 2; p < 0.01). These results show that in this animal model, distraction osteogenesis can be achieved across a growing cranial suture without an osteotomy or suturectomy and that the degree of distraction and new bone formation is comparable to that across an osteotomy. This suggests that cranial expansion can be obtained in a growing animal without using a more invasive cranial osteotomy. Additionally, the first week after distraction seems to be the most critical time period to maintain stable fixation.

Normative curves of fetal nasal bone length for the ethnic Chinese population.

OBJECTIVE: The purpose of this study is to determine the association between fetal nasal bone length (NBL) and gestational age (GA), biparietal diameter (BPD) and head circumference (HC) in women undergoing prenatal assessments and Down syndrome screening. METHODS: Cross-sectional data were obtained from 3,003 women with singleton pregnancies who underwent a prenatal ultrasound examination at the Department of Obstetrics and Gynecology, Cheng Hsin General Hospital between August 2006 and July 2009. RESULTS: Statistical analyses involved linear regression. NBL with GA, BPD and HC as measured between 14(+0) and 35(+6) weeks of gestation were linearly related. CONCLUSIONS: Using multiple parameters (GA, BPD and HC) to estimate NBL is more accurate than using than using GA or BPD or HC alone, as indicated by the higher predictive value.

Flexor digitorum superficialis nerve transfer to restore pronation: two case reports and anatomic study.

Loss of pronation affects most activities of daily living. We report 2 cases of traumatic loss of pronator teres function and successful reconstruction by transfer of a redundant motor branch to the flexor digitorum superficialis to the pronator teres branch(es). Follow-up period was 2 years and pronation strength was restored to +4/5 and 5/5 in the 2 patients. The anatomy of the median nerve in the proximal forearm was examined by dissecting 31 cadaver specimens. A branching scheme was formulated. The histomorphometric properties of the individual muscular branches were studied in 15 fresh specimens to evaluate their suitability and size match for nerve transfer.

A subcutaneous heterotopic limb transplantation model in the mouse for prolonged allograft survival.

A heterotopic position of a limb allograft is advantageous in the fragile mouse model to reduce mortality but is prone to autotomy. The purpose of this study was to describe a new heterotopic limb transplantation model in the mouse for prolonged allograft survival. Eleven lower hindlimbs were transplanted in a heterotopic subcutaneous position in the groin of the recipient animal with the donor skin inset as a skin paddle for monitoring. Seven transplants were syngeneic (Balb/c) and four were allogeneic (C57Bl/6 donor). The overall success rate (acute survival < 7 days) was 73% (8/11) and the mortality rate was 18% (2/11). Five of seven syngeneic transplants survived for 60 days and were harvested for histology. Recipients of successful allogeneic transplants (n = 3) received no immunosuppression and rejected their allografts between 8 and 11 days postoperatively. Mixed lymphocyte culture and flow cytometry demonstrated secondary immune responses by pre-sensitized animals, and histology showed lymphocytic infiltration and necrosis consistent with acute rejection.

Development of a mouse model for heterotopic limb and composite-tissue transplantation.

The mouse remains the most suitable model to study the complexities of the immune system and transplant rejection. The purpose of this study was to describe a new mouse model for heterotopic limb and composite tissue transplantation. Eighteen procedures were performed, including 10 heterotopic lower hind limb, four vascularized skin, and four vascularized muscle transplantations. Three transplants were allogeneic, and the rest were syngeneic. All successful syngeneic transplants were harvested at 11 days postoperatively, except for one skin and one limb transplant that were followed for over 30 days. The allogeneic transplants showed signs of rejection between 7 to 11 days postoperatively. Results of mixed lymphocyte culture (p < 0.05) and histology evaluations from the allogeneic recipients were consistent with acute rejection as the cause of allograft loss. The mortality rate was 16.7 percent, and the overall success rate was 72.2 percent. Details of the operative procedure are described, and important technical factors are discussed.

Patient outcome following a thoracodorsal to musculocutaneous nerve transfer for reconstruction of elbow flexion.

This study reports patient outcome following a thoracodorsal to musculocutaneous nerve transfer. We retrospectively reviewed the charts of six patients who had undergone transfer of the thoracodorsal nerve to the musculocutaneous nerve for reconstruction of elbow flexion. The mean age was 47 years (standard deviation: 24 years; range: 17-72 years). The mean time from injury to surgery was 3 months (standard deviation: 2 months; range: 1-5 months). In all cases, the biceps muscle was successfully reinnervated; in one case the Medical Research Council (MRC) muscle grade was grade 5, in four cases it was grade 4, and in one case it was grade 2. No patients complained of functional weakness with shoulder adduction and/or internal rotation. In the majority of cases, transfer of the thoracodorsal nerve to the musculocutaneous nerve provides excellent recovery of elbow flexion.

Evaluation of a population-based screening for type 2 diabetes: a community-based screening project in Puli, Taiwan.

BACKGROUND: A Markov method incorporating the relationships between prevalence, incidence, and mortality with respect to type 2 diabetes was used to assess a population-based screening for this disease. METHODS: Data from a population-based screening project for residents of Puli, Taiwan, over 30 years of age (n= 1,219) were used to estimate the annual incidence of asymptomatic type 2 diabetes, the prevalence to incidence (P/I) ratio, and the hazard rate of death due to type 2 diabetes. These parameters were employed to develop a Markov process to evaluate the effects of early detection of type 2 diabetes on the risk of death from this disease in a simulated population (n= 10,000) receiving biennial, 5-year interval, or no screening. RESULTS: The estimated annual incidence, average duration from asymptomatic to symptomatic type 2 diabetes (P/I ratio), and hazard rate for death from this disease were 0.86% (95% CI 0.50-1.48), 10 years (95% CI 7.69-14.01), and 1.1% per year, respectively. This yields an optimal screening interval of 5 years. Simulation of a 5-year interval screening regimen versus no screen ing yielded a relative risk reduction of 31% (95% CI 12-46%). A similar value was found for a biennial screening regime. CONCLUSIONS: The results suggest that early detection of type 2 diabetes via a community-based screening project in developing countries with high prevalence is worthwhile.

A convenient method to differentiate the monoclonal antibodies with differing immunochemical properties.

Three monoclonal antibodies (mAbs) against Naja naja atra phospholipase A2 (PLA2) were prepared by hybridoma technique. Of which two mAbs, 1E531 and 5F92 inhibited the enzymatic activity of PLA2, but 5F6F10 did not. 1E531 and 5F92 nearly exhibited the same binding patterns which was different from that observed with 5F6F10 toward the chemically modified derivatives and homologous variants of PLA2 as revealed by enzyme immunoassay. This suggests that, based on the results of comparative analysis on their relative reactivity with modified derivatives and PLA2 homologues, the mAbs with different immunochemical properties could be differentiated.

A population-based study of the association between areca nut chewing and type 2 diabetes mellitus in men (Keelung Community-based Integrated Screening programme No. 2).

AIMS/HYPOTHESIS: The aim of this study was to assess whether the diabetogenicity of areca nut (Areca catechu or 'betel-nut'), which has previously been demonstrated experimentally in mice, independently contributes to the risk of hyperglycaemia or type 2 diabetes in men in Taiwan, where the habit has become established relatively recently. METHODS: We used data from a population-based cross-sectional survey and a multiple-disease-screening programme that tested for hyperglycaemia, type 2 diabetes and risk factors related to type 2 diabetes. Data on habitual areca nut chewing were available for 14,816 men. Multiple logistic regression models were used to determine whether areca nut chewing was an independent risk factor for type 2 diabetes. RESULTS: Compared with non-chewers, areca nut chewers had higher age-adjusted prevalence rates for hyperglycaemia (11.4% vs 8.7%) and type 2 diabetes (10.3% vs 7.8%). Areca nut chewing independently increased the risk of hyperglycaemia (adjusted odds ratio [OR] 1.19, 95% CI 0.97-1.45) and type 2 diabetes (adjusted OR 1.29, 95% CI 1.04-1.60). The independent effects of duration of chewing were dose-dependent for type 2 diabetes (adjusted OR 1.32 for the duration of 10-19 years and 1.41 for the duration of > or =20 years), as were the effects of increased rates of areca nut chewing (adjusted OR 1.14 for <10 pieces/day, 1.30 for 10-19 pieces/day and 2.02 for > or =20 pieces/day); similar findings were noted for hyperglycaemia. CONCLUSIONS/INTERPRETATION: The habit of chewing areca nut independently contributes to the risk of both hyperglycaemia and type 2 diabetes in Taiwanese men. This association is dose-dependent with respect to the duration of areca nut use and the quantity of areca nut chewed per day.

Assessing progression and efficacy of treatment for diabetic retinopathy following the proliferative pathway to blindness: implication for diabetic retinopathy screening in Taiwan.

AIMS: The natural history and treatment efficacy of diabetic retinopathy (DR) play important roles in the evaluation of screening. Therefore, the natural history of DR and rates of transition after treatment (including metabolic control and laser photocoagulation) from no diabetic retinopathy (NDR) to blindness were quantified. METHODS: We studied a cohort of 795 patients with diabetes mellitus (DM) receiving fundus examination in the ophthalmology out-patient department of one medical centre between 1 January 1990 and 31 December 1992 in Taiwan. Follow-up data until 31 December 1998 were collected by chart review. Two multistate Markov models were proposed to assess the efficacy of the treatment regime in reducing progression to blindness. RESULTS: The average times spent in states (i) no diabetic retinopathy (NDR), (ii) background diabetic retinopathy (BDR), (iii) preproliferative diabetic retinopathy (PPDR), and (iv) proliferative retinopathy (PDR) were 10.86 years, 8.33 years, 1.67 years, and 2.17 years, respectively. Early detection of PPDR may lead to a 60% reduction in PDR and an 83% reduction in blindness. Simulated results based on these parameters show that an annual screening programme, a biennial screening regime and a 4-yearly screening regime can lead to 54% (95% confidence interval (CI): 44-62%), 51% (95% CI: 41-59%), and 46% (95% CI: 36-54%) reductions in blindness, respectively. CONCLUSIONS: Assessing the progression of DR following the proliferative pathway in this study suggests that screening for DR is worthwhile and that a 4-year interscreening interval for patients as yet without DR may be justified.