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Ou YH, Chang YT, Chen DP, Chuang CW, Tsao KC, Wu CH, Kuo AJ, You HL, Huang CG. Benefit analysis of the auto-verification system of intelligent inspection for microorganisms. Front Microbiol 2024; 15:1334897. [PMID: 38562474 PMCID: PMC10982382 DOI: 10.3389/fmicb.2024.1334897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
In recent years, the automatic machine for microbial identification and antibiotic susceptibility tests has been introduced into the microbiology laboratory of our hospital, but there are still many steps that need manual operation. The purpose of this study was to establish an auto-verification system for bacterial naming to improve the turnaround time (TAT) and reduce the burden on clinical laboratory technologists. After the basic interpretation of the gram staining results of microorganisms, the appearance of strain growth, etc., the 9 rules were formulated by the laboratory technologists specialized in microbiology for auto-verification of bacterial naming. The results showed that among 70,044 reports, the average pass rate of auto-verification was 68.2%, and the reason for the failure of auto-verification was further evaluated. It was found that the main causes reason the inconsistency between identification results and strain appearance rationality, the normal flora in the respiratory tract and urine that was identified, the identification limitation of the mass spectrometer, and so on. The average TAT for the preliminary report of bacterial naming was 35.2 h before, which was reduced to 31.9 h after auto-verification. In summary, after auto-verification, the laboratory could replace nearly 2/3 of manual verification and issuance of reports, reducing the daily workload of medical laboratory technologists by about 2 h. Moreover, the TAT on the preliminary identification report was reduced by 3.3 h on average, which could provide treatment evidence for clinicians in advance.
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Affiliation(s)
- Yu-Hsiang Ou
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Ta Chang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ding-Ping Chen
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang, Gung University, Taoyuan,, Taiwan
| | - Chun-Wei Chuang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiu-Hsiang Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - An-Jing Kuo
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huey-Ling You
- Departments of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chang YJ, Huang CG, Shie SS, Lin JJ, Chen CJ. Clinical features and virologic lineages of COVID-19-associated encephalitis in Taiwanese children during early epidemic wave of omicron in 2022: Report from a medical center. J Microbiol Immunol Infect 2024; 57:48-54. [PMID: 37926632 DOI: 10.1016/j.jmii.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 09/08/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A surge of encephalitis was reported in children during the early wave of the omicron epidemic in Taiwan. Information on the COVID-19-associated encephalitis, including epidemiologic features and factors of unfavorable outcomes, remained unclear. METHODS A total of 128 hospitalized Taiwanese children with laboratory-confirmed COVID-19 were enrolled between April 01, 2022, and May 31, 2022. The information on demographics and clinical features was abstracted from the medical records. Virologic lineages were determined by sequences of the spike protein. Factors associated with encephalitis and unfavorable outcomes were identified by comparisons to children without encephalitis and with favorable outcomes, respectively. RESULTS The leading syndromes associated with COVID-19 in hospitalized children were febrile seizure (20, 15.7%), fever as the solitary symptom (18, 14.1%), and croup syndrome (14, 10.9%). Encephalitis was diagnosed in nine (7.03%) children. When compared to the three leading syndromes, children with encephalitis were at older ages, had greater rates of hypotension, PICU admissions, use of inotropic agents (P < .001 for all above comparisons), mortality (P = .008), and longer hospital stays (P = .016), but not the underlying comorbidities (P = .376). Unfavorable outcomes were identified in 3 (33.3%) of 9 encephalitis cases and associated with a lower Glasgow coma scale, hypotension, and higher C-reactive protein (P < .05 for all). BA.2.3.7 was the dominant sublineage in children with or without encephalitis. CONCLUSIONS Omicron BA.2.3.7 can cause fulminant and lethal encephalitis in healthy children. Depressed consciousness and hypotension at presentation were significant risks of unfavorable outcomes for pediatric COVID-19-associated encephalitis.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 333 Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou-Chang Gung Memorial Hospital, Taiwan; Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taiwan
| | - Shian-Sen Shie
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 333 Taoyuan, Taiwan
| | - Chih-Jung Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan.
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Chen YN, Hsu KH, Huang CG, Chiang MC, Chu SM, Chen CL, Hsu JF, Chueh HY. Clinical Characteristics of Infants with Symptomatic Congenital and Postnatal Cytomegalovirus Infection-An 11-Year Multicenter Cohort Study in Taiwan. Children (Basel) 2023; 11:17. [PMID: 38255331 PMCID: PMC10813870 DOI: 10.3390/children11010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
(1) Background: Cytomegalovirus (CMV) infection is a prevalent viral disease among infants. The prevalence typically ranges from 0.2% to 2.4% among all newborns. There are limited data regarding the demographic characteristics of infants with symptomatic CMV infections. (2) Methods: In this retrospective cohort study using the Chang Gung Memorial Hospital multicenter database, infants with CMV infection determined by a positive urine culture, positive blood polymerase chain reaction assay or positive immunoglobulin M result for CMV from 2011 through 2021 were included. Clinical characteristics at initial diagnosis, management and outcomes were investigated. Congenital CMV (cCMV) infection is diagnosed within three weeks after birth; postnatal CMV (pCMV) is diagnosed when CMV is detected after the first 3 weeks of life. (3) Results: Among the 505 CMV-infected infants identified, 272 were included in the analysis. According to the age at initial presentation, 21 infants had cCMV infection and 251 had pCMV infection. Higher incidences of prematurity and being small for gestational age and a lower Z score for weight at diagnosis were observed in the cCMV group. While thrombocytopenia (61.9%) was the leading presentation in the cCMV group, hepatitis (59.8%) and prolonged jaundice (21.9%) were more common in the pCMV group. (4) Conclusions: Utilizing an 11-year multicenter database, we demonstrated the characteristics of infants with CMV infection in Taiwan and highlighted the demographic disparities and differing symptoms between the cCMV and pCMV groups. These findings emphasize the necessity for future research to refine screening policies, explore treatment options, and establish follow-up protocols for affected infants.
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Affiliation(s)
- Yu-Ning Chen
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan; (Y.-N.C.); (K.-H.H.); (M.-C.C.); (S.-M.C.); (J.-F.H.)
| | - Kai-Hsiang Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan; (Y.-N.C.); (K.-H.H.); (M.-C.C.); (S.-M.C.); (J.-F.H.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan;
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan; (Y.-N.C.); (K.-H.H.); (M.-C.C.); (S.-M.C.); (J.-F.H.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan; (Y.-N.C.); (K.-H.H.); (M.-C.C.); (S.-M.C.); (J.-F.H.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan;
| | - Jen-Fu Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan; (Y.-N.C.); (K.-H.H.); (M.-C.C.); (S.-M.C.); (J.-F.H.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ho-Yen Chueh
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33302, Taiwan
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Yang CR, Chang SY, Gong YN, Huang CG, Tung TH, Liu W, Chan TC, Hung KS, Shang HS, Tsai JJ, Kao CL, Wu HL, Daisy Liu LY, Lin WY, Fan YC, King CC, Ku CC. The emergence and successful elimination of SARS-CoV-2 dominant strains with increasing epidemic potential in Taiwan's 2021 outbreak. Heliyon 2023; 9:e22436. [PMID: 38107297 PMCID: PMC10724543 DOI: 10.1016/j.heliyon.2023.e22436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Taiwan's experience with severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 guided its development of strategies to defend against SARS-CoV-2 in 2020, which enabled the successful control of Coronavirus disease 2019 (COVID-19) cases from 2020 through March 2021. However, in late-April 2021, the imported Alpha variant began to cause COVID-19 outbreaks at an exceptional rate in Taiwan. In this study, we aimed to determine what epidemiological conditions enabled the SARS-CoV-2 Alpha variant strains to become dominant and decline later during a surge in the outbreak. In conjunction with contact-tracing investigations, we used our bioinformatics software, CoVConvert and IniCoV, to analyze whole-genome sequences of 101 Taiwan Alpha strains. Univariate and multivariable regression analyses revealed the epidemiological factors associated with viral dominance. Univariate analysis showed the dominant Alpha strains were preferentially selected in the surge's epicenter (p = 0.0024) through intensive human-to-human contact and maintained their dominance for 1.5 months until the Zero-COVID Policy was implemented. Multivariable regression found that the epidemic periods (p = 0.007) and epicenter (p = 0.001) were two significant factors associated with the dominant virus strains spread in the community. These dominant virus strains emerged at the outbreak's epicenter with frequent human-to-human contact and low vaccination coverage. The Level 3 Restrictions and Zero-COVID policy successfully controlled the outbreak in the community without city lockdowns. Our integrated method can identify the epidemiological conditions for emerging dominant virus with increasing epidemiological potential and support decision makers in rapidly containing outbreaks using public health measures that target fast-spreading virus strains.
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Affiliation(s)
- Chin-Rur Yang
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, 1 Jen-Ai Road Section 1, Taipei, 10051, Taiwan, ROC
| | - Sui-Yuan Chang
- Department (Dept.) of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan, ROC
- Dept. of Laboratory Medicine, National Taiwan University Hospital, Taipei, 10051, Taiwan, ROC
| | - Yu-Nong Gong
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
- Dept. of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, 33302, Taiwan, ROC
| | - Chung-Guei Huang
- Dept. of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, 33302, Taiwan, ROC
- Dept. of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Tsung-Hua Tung
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, NTU 17 Xu-Zhou Road, Taipei, 10055, Taiwan, ROC
- Dept. of Health, Taipei City Government, Taipei, Taiwan, ROC
| | - Wei Liu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, NTU 17 Xu-Zhou Road, Taipei, 10055, Taiwan, ROC
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, 11529, Taiwan, ROC
| | - Kuo-Sheng Hung
- Center for Precision Medicine and Genomics, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan, ROC
| | - Hung-Sheng Shang
- Division of Clinical Pathology, Dept. of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan, ROC
| | - Jih-Jin Tsai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan, ROC
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan, ROC
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan, ROC
| | - Chuan-Liang Kao
- Department (Dept.) of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan, ROC
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, NTU 17 Xu-Zhou Road, Taipei, 10055, Taiwan, ROC
| | - Hui-Lin Wu
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, 10051, Taiwan, ROC
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan, ROC
| | - Li-Yu Daisy Liu
- Division of Biometry, Department of Agronomy, National Taiwan University, Taipei, 10617, Taiwan, ROC
| | - Wan-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, NTU 17 Xu-Zhou Road, Taipei, 10055, Taiwan, ROC
| | - Yi-Chin Fan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, NTU 17 Xu-Zhou Road, Taipei, 10055, Taiwan, ROC
| | - Chwan-Chuen King
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, NTU 17 Xu-Zhou Road, Taipei, 10055, Taiwan, ROC
| | - Chia-Chi Ku
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, 1 Jen-Ai Road Section 1, Taipei, 10051, Taiwan, ROC
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Huang CG, Wu YC, Hsieh MJ, Lin YJ, Hsieh TH, Huang PW, Yang SL, Tsao KC, Shih SR, Lee LA. Impact of patient characteristics on innate immune responses and inflammasome activation in ex vivo human lung tissues infected with influenza A virus. Front Cell Infect Microbiol 2023; 13:1269329. [PMID: 37900310 PMCID: PMC10611511 DOI: 10.3389/fcimb.2023.1269329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Background Influenza A virus (IAV) infection poses a persistent global health challenge, necessitating a nuanced grasp of host immune responses for optimal interventions. While the interplay between aging, immunosenescence, and IAV is recognized as key in severe lower respiratory tract infections, the role of specific patient attributes in shaping innate immune reactions and inflammasome activity during IAV infection remains under-investigated. In this study, we utilized an ex vivo infection model of human lung tissues with H3N2 IAV to discern relationships among patient demographics, IAV nucleoprotein (NP) expression, toll-like receptor (TLR) profiles, PD-1/PD-L1 markers, and cytokine production. Methods Our cohort consisted of thirty adult patients who underwent video-assisted thoracoscopic surgery during 2018-2019. Post-surgical lung tissues were exposed to H3N2 IAV for ex vivo infections, and the ensuing immune responses were profiled using flow cytometry. Results We observed pronounced IAV activity within lung cells, as indicated by marked NP upregulation in both epithelial cells (P = 0.022) and macrophages (P = 0.003) in the IAV-exposed group relative to controls. Notably, interleukin-2 levels correlated with variations in TLR1 expression on epithelial cells and PD-L1 markers on macrophages. Age emerged as a modulating factor, dampening innate immune reactions, as evidenced by reduced interleukin-2 and interferon-γ concentrations (both adjusted P < 0.05). Intriguingly, a subset of participants with pronounced tumor necrosis factor-alpha post-mock infection (Cluster 1) showed attenuated cytokine responses in contrast to their counterparts in Cluster 2 and Cluster 3 (all adjusted P < 0.05). Individuals in Cluster 2, characterized by a low post-mock infection NP expression in macrophages, exhibited reduced variations in both NP and TLR1-3 expressions on these cells and a decreased variation in interleukin-2 secretion in comparison to their Cluster 3 counterparts, who were identified by their elevated NP macrophage expression (all adjusted P < 0.05). Conclusion Our work elucidates the multifaceted interplay of patient factors, innate immunity, and inflammasome responses in lung tissues subjected to ex vivo H3N2 IAV exposure, reflecting real-world lower respiratory tract infections. While these findings provide a foundation for tailored therapeutic strategies, supplementary studies are requisite for thorough validation and refinement.
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Affiliation(s)
- Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Cheng Wu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- School of Medicine, College of Life Sciences and Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Ming-Ju Hsieh
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Jhu Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Tzu-Hsuan Hsieh
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Po-Wei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Shu-Li Yang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Ru Shih
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
| | - Li-Ang Lee
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- School of Medicine, College of Life Sciences and Medicine, National Tsing Hua University, Hsinchu, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
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Hung CY, Hsiao SH, Huang CG, Chang CS, Chen GY, Huang YL, Dutta A, Huang CT. Relatively preserved functional immune capacity with standard COVID-19 vaccine regimen in people living with HIV. Front Immunol 2023; 14:1204314. [PMID: 37731482 PMCID: PMC10507403 DOI: 10.3389/fimmu.2023.1204314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction People living with HIV (PLWH) are at a higher risk of severe disease with SARS-CoV-2 virus infection. COVID-19 vaccines are effective in most PLWH. However, suboptimal immune responses to the standard two-shot regimen are a concern, especially for those with moderate to severe immunodeficiency. An additional dose is recommended as part of the extended primary series in Taiwan. Herein, we study the efficacy of this additional shot in PLWH with mild immunodeficiency compared to that in healthy non-HIV people. Methods In total, 72 PLWH that were asymptomatic or with mild immunodeficiency (CD4 counts ≥200/mm3) and suppressed virology, and 362 healthcare workers of our hospital were enrolled. None of the participants had a history of SARS-CoV-2 infection. They received mRNA-1273 and ChAdOx1 vaccines. Anti-SARS-CoV-2 neutralizing and anti-Spike IgG antibodies, and SARS-CoV-2-specific T cell responses were evaluated. Results The standard two-shot regimen elicited lower responses in PLWH than the healthcare workers without HIV infection, although the difference was statistically insignificant. They had comparable levels of neutralizing and anti-Spike antibodies and comparable effector CD4+ and CD8+ T cell responses. The third shot boosted the SARS-CoV-2 immunity significantly more with better antibody responses and higher IFN-γ and IL-2 responses of the CD4+ and CD8+ T cells in PLWH compared to those without HIV. Upon in vitro stimulation with extracted Wuhan strain SARS-CoV-2 proteins, CD8+ T cells from PLWH after 3 shots had more durable effector responses than the non-HIV controls with extended time of stimulation. Conclusion This subtle difference between PLWH and non-HIV people implied immune exhaustion with two shots in non-HIV people. Slightly compromised immunity in PLWH indeed preserved the functional capacity for further response to the third shot or natural infection.
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Affiliation(s)
- Chen-Yiu Hung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sung-Han Hsiao
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Shiang Chang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Guan-Yan Chen
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Lin Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Avijit Dutta
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Infectious Diseases, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Shao PL, Tu HC, Gong YN, Shu HY, Kirby R, Hsu LY, Yeo HY, Kuo HY, Huang YC, Lin YF, Weng HY, Wu YL, Chen CC, Chen TW, Lee KM, Huang CG, Shih SR, Chen WJ, Wu CC, Yu CJ, Tsai SF. Emergence and Persistent Dominance of SARS-CoV-2 Omicron BA.2.3.7 Variant, Taiwan. Emerg Infect Dis 2023; 29:792-796. [PMID: 36918378 PMCID: PMC10045703 DOI: 10.3201/eid2904.221497] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Since April 2022, waves of SARS-CoV-2 Omicron variant cases have surfaced in Taiwan and spread throughout the island. Using high-throughput sequencing of the SARS-CoV-2 genome, we analyzed 2,405 PCR-positive swab samples from 2,339 persons and identified the Omicron BA.2.3.7 variant as a major lineage within recent community outbreaks in Taiwan.
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Huang CG, Hsu JF, Chuang LP, Li HY, Fang TJ, Huang YS, Yang AC, Lee GS, Kuo TBJ, Yang CCH, Lee LA, Chuang HH. Adenotonsillectomy-related changes in systemic inflammation among children with obstructive sleep apnea. J Chin Med Assoc 2023:02118582-990000000-00199. [PMID: 36989493 DOI: 10.1097/jcma.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Adenotonsillar hypertrophy is the most common cause of pediatric obstructive sleep apnea (OSA). Although adenotonsillectomy considerably reduces OSA and systemic inflammation, whether and how systemic inflammation influences the effects of adenotonsillectomy on OSA has yet to be determined. METHODS This study investigated the associations between changes in anatomical variables, % changes in subjective OSA-18 questionnaire scores, % changes in eleven polysomnographic parameters, and % changes in 27 systemic inflammatory biomarkers in 74 children with OSA. RESULTS Fifty-six (75.6%) boys and 18 (24.4%) girls with the mean age of 7.4 ± 2.2 years and apnea-hypopnea index (AHI) of 14.2 ± 15.9 events/h were included in the statistical analysis. The mean period between before and after adenotonsillectomy was 5.6 ± 2.6 months. After adenotonsillectomy, the OSA-18 score, eight of eleven polysomnographic parameters, and 20 of 27 inflammatory biomarkers significantly improved (all p < 0.005). Notably, there were significant associations between change in tonsil size and % change in AHI (r = 0.23), change in tonsil size and % changes in interleukin-8 (IL-8) (r = 0.34), change in tonsil size and % change in and IL-10 (r = -0.36), % change in IL-8 and % change in C-C chemokine ligand 5 (CCL5) (r = 0.30), and % change in CCL5 and % change in AHI (r = 0.38) (all p < 0.005). Interestingly, % change in IL-8 and % change in CCL5 serially mediated the relationship between change in tonsil size and % change in AHI (total effect: β = 16.672, standard error = 8.274, p = 0.048). CONCLUSION These preliminary findings suggest that systemic inflammation is not only a complication of OSA but also that it mediates the surgical effects, which may open avenues for potential interventions to reduce tonsil size and OSA severity through the regulation of IL-8 and CCL5.
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Affiliation(s)
- Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Jen-Fu Hsu
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Pang Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Hsueh-Yu Li
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- Department of Otorhinolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taiwan, ROC
| | - Tuan-Jen Fang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- Department of Otorhinolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taiwan, ROC
| | - Yu-Shu Huang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Albert C Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Guo-She Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Otolaryngology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan, ROC
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Center for Mind and Brain Medicine, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan, ROC
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Li-Ang Lee
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- Department of Otorhinolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taiwan, ROC
- Center for Mind and Brain Medicine, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan, ROC
- School of Medicine, College of Life Science and Medicine, National Tsing Hua University, Hsinchu, Taiwan, ROC
| | - Hai-Hua Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Family Medicine, Chang Gung Memorial Hospital, Taipei Branch and Linkou Main Branch, Taoyuan, Taiwan, ROC
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan, ROC
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9
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Kung YA, Huang SY, Huang CG, Liu KT, Huang PN, Yu KY, Yang SL, Chen CP, Cheng CY, Lee IK, Lin SM, Chang HP, Lin YT, Liu YC, Chen GW, Shih SR. Factors influencing neutralizing antibody titers elicited by coronavirus disease 2019 vaccines. Microbes Infect 2023; 25:105044. [PMID: 36096357 PMCID: PMC9461341 DOI: 10.1016/j.micinf.2022.105044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
The World Health Organization has highlighted the importance of an international standard (IS) for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) neutralizing antibody titer detection to calibrate diagnostic techniques. We applied an IS to calibrate neutralizing antibody titers (NTs) (international units/mL) in response to coronavirus disease 2019 (COVID-19) vaccination. Moreover, the association between different factors and neutralizing antibodies was analyzed. A total of 1667 serum samples were collected from participants receiving different COVID-19 vaccines. Antibody titers were determined by a microneutralization assay using live viruses in a biosafety level 3 (BSL-3) laboratory and a commercial serological MeDiPro kit. The titer determined using the MeDiPro kit was highly correlated with the NT determined using live viruses and calibrated using IS. Fever and antipyretic analgesic treatment were related to neutralizing antibody responses in ChAdOx1-S and BNT162b2 vaccinations. Individuals with diabetes showed a low NT elicited by MVC-COV1901. Individuals with hypertension receiving the BNT162b2 vaccine had lower NTs than those without hypertension. Our study provided the international unit (IU) values of NTs in vaccinated individuals for the development of vaccines and implementation of non-inferiority trials. Correlation of the influencing factors with NTs can provide an indicator for selecting COVID-19 vaccines based on personal attributes.
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Affiliation(s)
- Yu-An Kung
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Yu Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan,Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Ting Liu
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Peng-Nien Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Division of Pediatric Infectious Diseases, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kar-Yee Yu
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Li Yang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Pei Chen
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Yun Cheng
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ing-Kit Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Min Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Han-Pin Chang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Te Lin
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chin Liu
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Guang-Wu Chen
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Artificial Intelligence Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Computer Science and Information Engineering, School of Electrical and Computer Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan.
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, And Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
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10
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Chuang CH, Huang CG, Huang CT, Chen YC, Kung YA, Chen CJ, Chuang TC, Liu CC, Huang PW, Yang SL, Gu PW, Shih SR, Chiu CH. Titers and breadth of neutralizing antibodies against SARS-CoV-2 variants after heterologous booster vaccination in health care workers primed with two doses of ChAdOx1 nCov-19: A single-blinded, randomized clinical trial. J Clin Virol 2022; 157:105328. [PMID: 36399969 PMCID: PMC9651991 DOI: 10.1016/j.jcv.2022.105328] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/27/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We conducted a single-blinded, randomized trial to evaluate the safety, reactogenicity, and immunogenicity of heterologous booster vaccination in health care workers (HCW) who had received two doses of ChAdOx1 nCov-19. METHODS HCW who had at least 90 days after the second dose were enrolled to receive one of the four vaccines: BNT162b2 (30 μg), half-dose mRNA-1273 (50 μg), mRNA-1273 (100 μg), and MVC-COV1901 (15 μg). The primary outcomes were humoral and cellular immunogenicity and secondary outcomes assessed safety and reactogenicity at 28 days post-booster. RESULTS MVC-COV1901 Three hundred and forty HCW were enrolled: 83 received BNT162b2 (2 excluded), 85 half-dose mRNA-1273, 85 mRNA-1273, and 85 MVC-COV1901. mRNA vaccines had more reactogenicity than protein vaccine. The fold-rise of anti-spike IgG geometric mean titer was 8.4 (95% CI 6.8-10.4) for MVC-COV1901, 32.2 (27.2-38.1) for BNT162b2, 47.6 (40.8-55.6) for half-dose mRNA-1273 and 63.2 (53.6-74.6) for mRNA-1273. The live virus microneutralization assays (LVMNA) against the wild type, alpha and delta variants were consistent with anti-spike IgG for all booster vaccines. The LVMNA in the four groups against omicron BA.1 variant were 6.4 to 13.5 times lower than those against the wild type. All booster vaccines induced a comparable T cell response. CONCLUSIONS Third dose booster not only increases neutralizing antibody titer but also enhances antibody breadth against SARS-CoV-2 variants. mRNA vaccines are preferred booster vaccines for those who received primary series of ChAdOx1 nCov-19.
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Affiliation(s)
- Chih-Hsien Chuang
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Department of Pediatrics, St. Paul's Hospital, Taoyuan, Taiwan,School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ching Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-An Kung
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Jung Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chun Chuang
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Chi Liu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Wei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Li Yang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Wen Gu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Ru Shih
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Corresponding author at: Department of Pediatrics, Chang Gung Memorial Hospital, No.5, Fu-Hsin Street, Kweishan 333, Taoyuan, Taiwan
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11
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Chen LC, Chiu CC, Chang FM, Wu PY, Yang SL, Huang CG, Huang YC. An outbreak of human Rhinovirus-A21 infection in a psychiatric ward during COVID-19 pandemic. J Microbiol Immunol Infect 2022; 55:1326-1329. [PMID: 35995670 PMCID: PMC9365704 DOI: 10.1016/j.jmii.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/02/2022] [Accepted: 07/26/2022] [Indexed: 12/27/2022]
Abstract
A cluster of acute respiratory illnesses involving 12 inpatients and 3 healthcare workers occurred in a psychiatric ward. Eight of them were identified as HRV-A21. Fever and cough were the most common symptoms. The study also provides further evidence of the impact of HRV on lower respiratory tract illness.
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Affiliation(s)
- Lung-Chiung Chen
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, 325, Taoyuan, Taiwan,Department of Internal Medicine, Taoyuan Armed Forces General Hospital, 325, Taoyuan, Taiwan
| | - Chih-Chien Chiu
- Infection Control Office, Taoyuan Armed Forces General Hospital, 325, Taoyuan, Taiwan,Department of Internal Medicine, Taoyuan Armed Forces General Hospital, 325, Taoyuan, Taiwan
| | - Fu-Mei Chang
- Infection Control Office, Taoyuan Armed Forces General Hospital, 325, Taoyuan, Taiwan
| | - Pei-Yuan Wu
- Centers for Disease Control, Northern Regional Center, Taoyuan, Taiwan
| | - Shu-Li Yang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan,School of Medicine, Chang Gung University, 333, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan,School of Medicine, Chang Gung University, 333, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- School of Medicine, Chang Gung University, 333, Taoyuan, Taiwan,Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital, 333, Taoyuan, Taiwan,Corresponding author. Division of Pediatric Infectious Diseases, Department of Paediatrics, Chang Gung Memorial Hospital, Linkou, No. 5, Fu-Shin Street, Kweishan, 333, Taoyuan, Taiwan. Fax: +886 3 3288957
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12
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Wen CN, Huang CG, Chang PY, Yang TH, You HL, Ning HC, Tsao KC. Application of the electronic book to promote self-directed learning in medical technologist continuing education: a cross-sectional study. BMC Med Educ 2022; 22:713. [PMID: 36217143 PMCID: PMC9549609 DOI: 10.1186/s12909-022-03724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Continuing education (CE) is essential for health professionals to improve competence in clinical practice, yet many medical technologists still experience barriers to learning in complex clinical settings. To better manage CE and address medical technologists' learning needs, we developed a learner-centred electronic book (e-book) to promote self-directed learning for medical technologists. METHODS A cross-sectional study was conducted to explore the acceptability and learning impacts of the e-book as CE material for medical technologists in two medical centres in Taiwan. We designed the learner-centred context in the e-book based on medical technologists' practice requirements and learning needs. Moreover, we adopted The New World Kirkpatrick Model with four levels (reactions, learning, behaviours and results) to evaluate the e-book's learning impacts on medical technologists. A total of 280 medical technologists were invited to complete a questionnaire and a post-test, providing learning patterns as well as their satisfaction with the e-book and their learning outcomes after using it. RESULTS Most readers had positive learning experiences and better learning outcomes, including knowledge acquisition and behavioural change, after reading the e-book. The e-book became a new CE activity and reached medical technologists in various types of laboratories. CONCLUSIONS The low-cost and learner-centred e-book effectively overcame CE learning barriers for medical technologists. The interactivity and flexibility of e-learning particularly helped learners to engage in clinical scenarios in laboratory medicine. This study could pave the way for medical educators to build a high-quality e-learning model in CE.
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Affiliation(s)
- Chiao-Ni Wen
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Pi-Yueh Chang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Han Yang
- Department of Medical Laboratories Administrative Center, Chang Gung Medical Foundation, Taoyuan, Taiwan
| | - Huey-Ling You
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsiao-Chen Ning
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan.
- Department of Medical Research and Development Linko Branch, Chang Gung Medical Foundation, Taoyuan City, 333, Taiwan, R.O.C..
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
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13
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Hsin LJ, Chao YP, Chuang HH, Kuo TBJ, Yang CCH, Huang CG, Kang CJ, Lin WN, Fang TJ, Li HY, Lee LA. Mild simulator sickness can alter heart rate variability, mental workload, and learning outcomes in a 360° virtual reality application for medical education: a post hoc analysis of a randomized controlled trial. Virtual Real 2022; 27:1-17. [PMID: 36118174 PMCID: PMC9470506 DOI: 10.1007/s10055-022-00688-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/28/2022] [Indexed: 06/02/2023]
Abstract
Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤ 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360° VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.
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Affiliation(s)
- Li-Jen Hsin
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Yi-Ping Chao
- Department of Computer Science and Information Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, 33302 Taiwan
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305 Taiwan
| | - Hai-Hua Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
- Department of Family Medicine, Taipei Branch and Linkou Main Branch, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305 Taiwan, Republic of China
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, 10608 Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, 300044 Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 11221 Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 11221 Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305 Taiwan
- Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Wan-Ni Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 11221 Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, 300044 Taiwan
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14
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Chao YP, Kang CJ, Chuang HH, Hsieh MJ, Chang YC, Kuo TBJ, Yang CCH, Huang CG, Fang TJ, Li HY, Lee LA. Comparison of the effect of 360° versus two-dimensional virtual reality video on history taking and physical examination skills learning among undergraduate medical students: a randomized controlled trial. Virtual Real 2022; 27:637-650. [PMID: 35992202 PMCID: PMC9379871 DOI: 10.1007/s10055-022-00664-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 05/25/2022] [Indexed: 05/07/2023]
Abstract
Before caring for patients, video instruction is commonly used for undergraduate medical students, and 360° virtual reality (VR) videos have gained increasing interest in clinical medical education. Therefore, the effect of immersive 360° VR video learning compared with two-dimensional (2D) VR video learning in clinical skills acquisition should be evaluated. This randomized, intervention-controlled clinical trial was aimed to assess whether immersive 360° VR video improves undergraduate medical students' learning effectiveness and reduces the cognitive load in history taking and physical examination (H&P) training. From May 1 2018 to October 30 2018, 64 senior undergraduate medical students in a tertiary academic hospital were randomized to receive a 10-min immersive 360° (360° VR video group; n = 32) or 2D VR instructional video (2D VR video group; n = 32), including essential knowledge and competency of H&P. The demographic characteristics of the two groups were comparable for age, sex, and cognitive style. The total procedure skill score, physical examination score, learner's satisfaction score, and total cognitive load in the 360° VR video group were significantly higher than those in the 2D VR video group (effect sizes [95% confidence interval]: 0.72 [0.21-1.22], 0.63 [0.12-1.13], 0.56 [0.06-1.06], and 0.53 [0.03-1.03], respectively). This study suggested that a10-minute 360° VR video instruction helped undergraduate medical students perform fundamental H&P skills as effectively as 2D VR video. Furthermore, the 360° VR video might result in significantly better procedural metrics of physical examinations with higher learner satisfaction despite the higher cognitive load. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-022-00664-0.
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Affiliation(s)
- Yi-Ping Chao
- Department of Computer Science and Information Engineering, Graduate Institute of Medical Mechatronics, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, 33305 Taoyuan, Taiwan
| | - Chung-Jan Kang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
| | - Hai-Hua Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, 33305 Taiwan
- School of Medicine, College of Life Science, National Tsing Hua University, Hsinchu, 300044 Taiwan
- Department of Industrial Engineering and Management, National Taipei University of Technology, 10608 Taipei, Taiwan
| | - Ming-Ju Hsieh
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, 33305 Taiwan
| | - Yu-Che Chang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, 33305 Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, 11221 Taipei, Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, 11221 Taipei, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, 33305 Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, 33302 Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
| | - Hsueh-Yu Li
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
| | - Li-Ang Lee
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
- School of Medicine, College of Life Science, National Tsing Hua University, Hsinchu, 300044 Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, 11221 Taipei, Taiwan
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15
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Chiu YF, Huang YW, Chen CY, Chen YC, Gong YN, Kuo RL, Huang CG, Shih SR. Visualizing Influenza A Virus vRNA Replication. Front Microbiol 2022; 13:812711. [PMID: 35733972 PMCID: PMC9207383 DOI: 10.3389/fmicb.2022.812711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Influenza A virus (IAV) has caused recurrent epidemics and severe pandemics. In this study, we adapted an MS2-MCP live-cell imaging system to visualize IAV replication. A reporter plasmid, pHH-PB2-vMSL, was constructed by replacing a part of the PB2-coding sequence in pHH-PB2 with a sequence encoding 24 copies of a stem-loop structure from bacteriophage MS2 (MSL). Binding of MS2 coat protein (MCP) fused to green fluorescent protein (GFP) to MSL enabled the detection of vRNA as fluorescent punctate signals in live-cell imaging. The introduction of pHH-PB2-vMSL into A549 cells transduced to express an MCP-GFP fusion protein lacking the nuclear localization signal (MCP-GFPdN), subsequently allowed tracking of the distribution and replication of PB2-vMSL vRNA after IAV PR8 infection. Spatial and temporal measurements revealed exponential increases in vRNA punctate signal intensity, which was only observed after membrane blebbing in apoptotic cells. Similar signal intensity increases in apoptotic cells were also observed after MDCK cells, transduced to express MCP-GFPdN, were infected with IAV carrying PB2-vMSL vRNA. Notably, PB2-vMSL vRNA replication was observed to occur only in apoptotic cells, at a consistent time after apoptosis initiation. There was a lack of observable PB2-vMSL vRNA replication in non-apoptotic cells, and vRNA replication was suppressed in the presence of apoptosis inhibitors. These findings point to an important role for apoptosis in IAV vRNA replication. The utility of the MS2-imaging system for visualizing time-sensitive processes such as viral replication in live host cells is also demonstrated in this study.
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Affiliation(s)
- Ya-Fang Chiu
- Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan.,Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Wen Huang
- Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Yuan Chen
- Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chia Chen
- Department of Biochemical Science and Technology, College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Yu-Nong Gong
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Rei-Lin Kuo
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
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16
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Nguyen TT, Chiu CH, Lin CY, Chiu NC, Chen PY, Le TTV, Le DN, Duong AH, Nguyen VL, Huynh TN, Truong HK, Phan TL, Nguyen TTT, Shih SR, Huang CG, Weng YJ, Hsieh EF, Chang S, Chen C, Tai IC, Huang LM. Efficacy, safety, and immunogenicity of an inactivated, adjuvanted enterovirus 71 vaccine in infants and children: a multiregion, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet 2022; 399:1708-1717. [PMID: 35427481 DOI: 10.1016/s0140-6736(22)00313-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Children are susceptible to severe or fatal enterovirus 71 (EV71) infections. We aimed to evaluate the efficacy, safety, and immunogenicity of EV71vac, an aluminium phosphate-adjuvanted inactivated EV71 vaccine in children aged 2-71 months. METHODS We did a randomised, double-blinded, placebo-controlled, phase 3 trial at five hospitals in Taiwan and two in Vietnam. Children aged 2-71 months were stratified by country and age, and randomly assigned (1:1) to receive two doses of EV71vac or placebo via intramuscular injection 56 days apart. Children aged 2-23 months received a third booster dose on day 366. The primary endpoint was the clinical efficacy of the total vaccinated cohort against EV71-associated diseases during the follow-up period, from 14 days after the second dose to when 15 cases of EV71 infections were confirmed in the per-protocol population. Our safety analysis included all participants who received at least one dose of EV71vac. This trial is registered with ClinicalTrials.gov, NCT03865238, and is complete. FINDINGS Between April 23 and Dec 25, 2019, of 3663 children assessed, 3061 were randomly assigned, of whom 3049 were vaccinated: 1521 children in the EV71vac group and 1528 in the placebo group. By May 20, 2021, our primary efficacy analysis included 2959 children, with 1476 children in the EV71vac group and 1483 children in the placebo group. The vaccine efficacy of EV71vac was 96·8% (95% CI 85·5-100) against EV71 associated diseases (p<0·0001). The percentage of participants who reported solicited adverse events were similar in both groups: 865 (56·9%) in the EV71vac group and 852 (55·8%) in the placebo group. Almost all reported solicited adverse events were mild and self-limited. INTERPRETATION EV71vac is safe, well-tolerated, and highly effective in preventing EV71 associated diseases in children aged 2-71 months. FUNDING Medigen Vaccine Biologics and A+ Industrial Innovative R&D Program of the Ministry of Economic Affairs, Taiwan.
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Affiliation(s)
| | - Cheng-Hsun Chiu
- Department of Paediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chien-Yu Lin
- Department of Paediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Nan-Chang Chiu
- Department of Paediatrics, MacKay Children's Hospital, Taipei City, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Po-Yen Chen
- Section of Infectious Disease, Department of Paediatrics, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Thi Tuong Vy Le
- Pasteur Institute in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dang Ngan Le
- Centre for Disease Control of Tien Giang Province, Vietnam
| | - An Han Duong
- Centre for Disease Control of Dong Thap Province, Vietnam
| | | | | | - Huu Khanh Truong
- Department of Paediatrics, Children's Hospital 1 in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Trong Lan Phan
- Pasteur Institute in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Shin-Ru Shih
- Research Centre for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Guei Huang
- Research Centre for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Jen Weng
- Medigen Vaccine Biologics, Taipei City, Taiwan
| | | | | | - Charles Chen
- College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - I-Chen Tai
- Medigen Vaccine Biologics, Taipei City, Taiwan.
| | - Li-Min Huang
- Department of Paediatrics, National Taiwan University Children's Hospital, Taipei City, Taiwan.
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17
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Hsieh TH, Lin YJ, Hsioa MJ, Wang HJ, Chen LT, Yang SL, Huang CG. Transcriptome Differences in Normal Human Bronchial Epithelial Cells in Response to Influenza A pdmH1N1 or H7N9 Virus Infection. Cells 2022; 11:cells11050781. [PMID: 35269402 PMCID: PMC8909308 DOI: 10.3390/cells11050781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/25/2023] Open
Abstract
Avian influenza A (H7N9) virus infections frequently lead to acute respiratory distress syndrome and death in humans. The emergence of H7N9 virus infections is a serious public health threat. To identify virus–host interaction differences between the highly virulent H7N9 and pandemic influenza H1N1 (pdmH1N1), RNA sequencing was performed of normal human bronchial epithelial (NHBE) cells infected with either virus. The transcriptomic analysis of host cellular responses to viral infection enables the identification of potential cellular factors related to infection. Significantly different gene expression patterns were found between pdmH1N1- and H7N9-infected NHBE cells. In addition, the H7N9 virus infection induced strong immune responses, while cellular repair mechanisms were inhibited. The differential expression of specific factors observed between avian H7N9 and pdmH1N1 influenza virus strains can account for variations in disease pathogenicity. These findings provide a framework for future studies examining the molecular mechanisms underlying the pathogenicity of avian H7N9 virus.
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Affiliation(s)
- Tzu-Hsuan Hsieh
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.H.); (Y.-J.L.); (M.-J.H.); (H.-J.W.); (L.-T.C.); (S.-L.Y.)
| | - Ya-Jhu Lin
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.H.); (Y.-J.L.); (M.-J.H.); (H.-J.W.); (L.-T.C.); (S.-L.Y.)
| | - Mei-Jen Hsioa
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.H.); (Y.-J.L.); (M.-J.H.); (H.-J.W.); (L.-T.C.); (S.-L.Y.)
| | - Hsin-Ju Wang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.H.); (Y.-J.L.); (M.-J.H.); (H.-J.W.); (L.-T.C.); (S.-L.Y.)
| | - Lu-Ting Chen
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.H.); (Y.-J.L.); (M.-J.H.); (H.-J.W.); (L.-T.C.); (S.-L.Y.)
| | - Shu-Li Yang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.H.); (Y.-J.L.); (M.-J.H.); (H.-J.W.); (L.-T.C.); (S.-L.Y.)
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (T.-H.H.); (Y.-J.L.); (M.-J.H.); (H.-J.W.); (L.-T.C.); (S.-L.Y.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence:
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18
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Liu KT, Gong YN, Huang CG, Huang PN, Yu KY, Lee HC, Lee SC, Chiang HJ, Kung YA, Lin YT, Hsiao MJ, Huang PW, Huang SY, Wu HT, Wu CC, Kuo RL, Chen KF, Hung CT, Oguntuyo KY, Stevens CS, Kowdle S, Chiu HP, Lee B, Chen GW, Shih SR. Quantifying Neutralizing Antibodies in Patients with COVID-19 by a Two-Variable Generalized Additive Model. mSphere 2022; 7:e0088321. [PMID: 35107336 PMCID: PMC8809379 DOI: 10.1128/msphere.00883-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/07/2022] [Indexed: 12/17/2022] Open
Abstract
Considering the urgent demand for faster methods to quantify neutralizing antibody titers in patients with coronavirus (CoV) disease 2019 (COVID-19), developing an analytical model or method to replace the conventional virus neutralization test (NT) is essential. Moreover, a "COVID-19 immunity passport" is currently being proposed as a certification for people who travel internationally. Therefore, an enzyme-linked immunosorbent assay (ELISA) was designed to detect severe acute respiratory syndrome CoV 2 (SARS-CoV-2)-neutralizing antibodies in serum, which is based on the binding affinity of SARS-CoV-2 viral spike protein 1 (S1) and the viral spike protein receptor-binding domain (RBD) to antibodies. The RBD is considered the major binding region of neutralizing antibodies. Furthermore, S1 covers the RBD and several other regions, which are also important for neutralizing antibody binding. In this study, we assessed 144 clinical specimens, including those from patients with PCR-confirmed SARS-CoV-2 infections and healthy donors, using both the NT and ELISA. The ELISA results analyzed by spline regression and the two-variable generalized additive model precisely reflected the NT value, and the correlation between predicted and actual NT values was as high as 0.917. Therefore, our method serves as a surrogate to quantify neutralizing antibody titer. The analytic method and platform used in this study present a new perspective for serological testing of SARS-CoV-2 infection and have clinical potential to assess vaccine efficacy. IMPORTANCE Herein, we present a new approach for serological testing for SARS-CoV-2 antibodies using innovative laboratory methods that demonstrate a combination of biology and mathematics. The traditional virus neutralization test is the gold standard method; however, it is time-consuming and poses a risk to medical personnel. Thus, there is a demand for methods that rapidly quantify neutralizing antibody titers in patients with COVID-19 or examine vaccine efficacy at a biosafety level 2 containment facility. Therefore, we used a two-variable generalized additive model to analyze the results of the enzyme-linked immunosorbent assay and found the method to serve as a surrogate to quantify neutralizing antibody titers. This methodology has potential for clinical use in assessing vaccine efficacy.
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Affiliation(s)
- Kuan-Ting Liu
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Nong Gong
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Peng-Nien Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Infectious Diseases, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kar-Yee Yu
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hou-Chen Lee
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sun-Che Lee
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Jung Chiang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-An Kung
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Te Lin
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei-Jen Hsiao
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Wei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sheng-Yu Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Tai Wu
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Ching Wu
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology/Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Rei-Lin Kuo
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Asthma, Allergy, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chuan-Tien Hung
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Christian S. Stevens
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shreyas Kowdle
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hsin-Ping Chiu
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benhur Lee
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Guang-Wu Chen
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Artificial Intelligence Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Computer Science and Information Engineering, School of Electrical and Computer Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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19
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Chao YP, Chuang HH, Hsin LJ, Kang CJ, Fang TJ, Li HY, Huang CG, Kuo TBJ, Yang CCH, Shyu HY, Wang SL, Shyu LY, Lee LA. Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial. JMIR Serious Games 2021; 9:e13124. [PMID: 34813485 PMCID: PMC8663656 DOI: 10.2196/13124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/02/2020] [Accepted: 09/10/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. OBJECTIVE The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. METHODS This pilot system-design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. RESULTS All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. CONCLUSIONS Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners' needs and prompted learning through the different video modules. TRIAL REGISTRATION ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641.
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Affiliation(s)
- Yi-Ping Chao
- Department of Computer Science and Information Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Hai-Hua Chuang
- Department of Family Medicine, Chang Gung Memorial Hospital, Taipei Branch & Linkou Main Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Hsin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Chung-Jan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan.,Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Yih Shyu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Educational Technology, Tamkang University, New Taipei, Taiwan
| | - Shu-Ling Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center of Teacher Education, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Liang-Yu Shyu
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Li-Ang Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
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20
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Cheng CW, Huang PY, Wu TS, Huang CG, Tsao KC, Lin CS, Chung TY, Lai CC, Yang CT, Chiu CH. Infection Control Operations of a Large Hospital in Taiwan to Prevent Nosocomial Outbreaks during COVID-19 Pandemic. Biomed J 2021; 44:S8-S14. [PMID: 34710639 PMCID: PMC8547780 DOI: 10.1016/j.bj.2021.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) is highly contagious, with a potential to cause large nosocomial outbreaks in the hospital setting. We report the advance deployment of comprehensive, multi-level infection control measures in a 3,700-bed large hospital to prevent nosocomial outbreaks of COVID-19 during the pandemic. Methods We implemented a series of dynamic infection control policies during the pandemic. A confirmed COVID-19 case was defined by positive real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay. All healthcare worker (HCW) having symptoms or close contact with the confirmed case received the RT-PCR test. Results A total of 5,722 patients were tested in our hospital from January to May 2020. Twenty-five patients were confirmed COVID-19, including two inpatients. A cluster of 4 HCWs with COVID-19 associated with the 2nd inpatient was identified in the early stage of epidemic. Our enhanced traffic control bundling, mask wearing, hand hygiene and environmental cleaning were reinforced after the outbreak. All other confirmed cases were identified at our outdoor quarantine station or epidemic clinic afterwards, and the results of testing for 146 symptomatic HCWs were all negative. Conclusions Integrated teamwork, advance deployment of infection control measures and efficient diagnostic testing and response protected HCW and facilities from large SARS-CoV-2 outbreaks and preserved the capacity and function of the health care system during the pandemic.
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Affiliation(s)
- Chun-Wen Cheng
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Infection Control Committee, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Po-Yen Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Infection Control Committee, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Infection Control Committee, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Sui Lin
- Infection Control Committee, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ting-Ying Chung
- Infection Control Committee, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Infection Control Committee, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Departments of Ophthalmology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Infection Control Committee, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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21
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Hsieh SM, Liu MC, Chen YH, Lee WS, Hwang SJ, Cheng SH, Ko WC, Hwang KP, Wang NC, Lee YL, Lin YL, Shih SR, Huang CG, Liao CC, Liang JJ, Chang CS, Chen C, Lien CE, Tai IC, Lin TY. Safety and immunogenicity of CpG 1018 and aluminium hydroxide-adjuvanted SARS-CoV-2 S-2P protein vaccine MVC-COV1901: interim results of a large-scale, double-blind, randomised, placebo-controlled phase 2 trial in Taiwan. Lancet Respir Med 2021; 9:1396-1406. [PMID: 34655522 PMCID: PMC8514195 DOI: 10.1016/s2213-2600(21)00402-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 01/09/2023]
Abstract
Background MVC-COV1901, a recombinant protein vaccine containing pre-fusion-stabilised spike protein S-2P adjuvanted with CpG 1018 and aluminium hydroxide, has been shown to be well tolerated with a good safety profile in healthy adults aged 20–49 years in a phase 1 trial, and provided a good cellular and humoral immune responses. We present the interim safety, tolerability, and immunogenicity results of a phase 2 clinical trial of the MVC-COV1901 vaccine in Taiwan. Methods This is a large-scale, double-blind, randomised, placebo-controlled phase 2 trial done at ten medical centres and one regional hospital in Taiwan. Individuals aged 20 years or older who were generally healthy or had stable pre-existing medical conditions were eligible for enrolment. Exclusion criteria included (but were not limited to) travel overseas within 14 days of screening, intention to travel overseas within 6 months of the screening visit, and the absence of prespecified medical conditions, including immunosuppressive illness, a history of autoimmune disease, malignancy with risk to recur, a bleeding disorder, uncontrolled HIV infection, uncontrolled hepatitis B and C virus infections, SARS-CoV-1 or SARS-CoV-2 infections, an allergy to any vaccine, or a serious medical condition that could interfere with the study. Study participants were randomly assigned (6:1) to receive two doses of either MVC-COV1901 or placebo, administered via intramuscular injection on day 1 and day 29. MVC-COV1901 contained 15 μg of S-2P protein adjuvanted with 750 μg CpG 1018 and 375 μg aluminium hydroxide in a 0·5 mL aqueous solution, and the placebo contained the same volume of saline. Randomisation was done centrally by use of an interactive web response system, stratified by age (≥20 to <65 years and ≥65 years). Participants and investigators were masked to group assignment. The primary outcomes were to evaluate the safety, tolerability, and immunogenicity of MVC-COV1901 from day 1 (the day of the first dose) to day 57 (28 days after the second dose). Safety was assessed in all participants who received at least one dose. Immunogenicity was assessed by measuring geometric mean titres (GMTs) and seroconversion rates of neutralising antibody and antigen-specific IgG in the per-protocol population. This study is registered with ClinicalTrials.gov, NCT04695652. Findings Of 4173 individuals screened between Dec 30, 2020, and April 2, 2021, 3854 were enrolled and randomly assigned: 3304 to the MVC-COV1901 group and 550 to the placebo group. A total of 3844 participants (3295 in the MVC-COV1901 group and 549 in the placebo group) were included in the safety analysis set, and 1053 participants (903 and 150) had received both doses and were included in the per-protocol immunogenicity analysis set. From the start of this phase 2 trial to the time of interim analysis, no vaccine-related serious adverse events were recorded. The most common solicited adverse events in all study participants were pain at the injection site (2346 [71·2%] of 3295 in the MVC-COV1901 group and 128 [23·3%] of 549 in the placebo group), and malaise or fatigue (1186 [36·0%] and 163 [29·7%]). Fever was rarely reported (23 [0·7%] and two [0·4%]). At 28 days after the second dose of MVC-COV1901, the wild-type SARS-CoV-2 neutralising antibody GMT was 662·3 (95% CI 628·7–697·8; 408·5 IU/mL), the GMT ratio (geometric mean fold increase in titres at day 57 vs baseline) was 163·2 (155·0–171·9), and the seroconversion rate was 99·8% (95% CI 99·2–100·0). Interpretation MVC-COV1901 has a good safety profile and elicits promising immunogenicity responses. These data support MVC-COV1901 to enter phase 3 efficacy trials. Funding Medigen Vaccine Biologics and Taiwan Centres for Disease Control, Ministry of Health and Welfare.
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Affiliation(s)
- Szu-Min Hsieh
- Department of Internal Medicine, Division of Infectious Diseases, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Che Liu
- Clinical Research Centre, Taipei Medical University Hospital, Taipei, Taiwan; School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Hsu Chen
- Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Centre, Centre of Tropical Medicine and Infectious Diseases, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Sen Lee
- Department of Internal Medicine, Division of Infectious Disease, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Shu-Hsing Cheng
- School of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kao-Pin Hwang
- School of Medicine, China Medical University Hospital and Children Hospital, China Medical University, Taichung, Taiwan
| | | | - Yu-Lin Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Program in Medical Biotechnology, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Ling Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Biomedical Translation Research Centre, Academia Sinica, Taipei, Taiwan
| | - Shin-Ru Shih
- Research Centre for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Research Centre for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan; Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Che Liao
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Jian-Jong Liang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chih-Shin Chang
- Biomedical Translation Research Centre, Academia Sinica, Taipei, Taiwan
| | - Charles Chen
- Medigen Vaccine Biologics, Taipei, Taiwan; College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - Chia En Lien
- Medigen Vaccine Biologics, Taipei, Taiwan; Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Chen Tai
- Medigen Vaccine Biologics, Taipei, Taiwan.
| | - Tzou-Yien Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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22
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Hsieh SM, Liu WD, Huang YS, Lin YJ, Hsieh EF, Lian WC, Chen C, Janssen R, Shih SR, Huang CG, Tai IC, Chang SC. Safety and immunogenicity of a Recombinant Stabilized Prefusion SARS-CoV-2 Spike Protein Vaccine (MVC-COV1901) Adjuvanted with CpG 1018 and Aluminum Hydroxide in healthy adults: A Phase 1, dose-escalation study. EClinicalMedicine 2021; 38:100989. [PMID: 34222848 PMCID: PMC8233066 DOI: 10.1016/j.eclinm.2021.100989] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This was a phase 1, dose-escalation open-label trial to evaluate the safety and immunogenicity of MVC-COV1901, a SARS-CoV-2 S-2P protein vaccine adjuvanted with aluminum hydroxide and CpG 1018. METHODS Between September 28 and November 13 2020, 77 participants were screened. Of these, 45 healthy adults from 20 to 49 years of age were to be administered two doses of MVC-COV1901 in doses of 5 μg, 15 μg, or 25 μg of spike protein at 28 days apart. There were 15 participants in each dose group; all were followed for 28 days after the second dose at the time of the interim analysis. Adverse events and laboratory data were recorded for the safety evaluation. Blood samples were collected for humoral, and cellular immune response at various time points. Trial Registration: ClinicalTrials.gov NCT04487210. FINDINGS Solicited adverse events were mostly mild and similar. No subject experienced fever. After the second dose, the geometric mean titers (GMTs) for SARS-CoV-2 spike-specific immunoglobulin G were 7178.2, 7746.1, 11,220.6 in the 5 μg, 15 μg, and 25 μg dose groups, respectively. The neutralizing activity were detected in both methods. (Day 43 GMTs, 538.5, 993.1, and 1905.8 for pseudovirus; and 33.3, 76.3, and 167.4 for wild-type virus). The cellular immune response induced by MVC-COV1901 demonstrated substantially higher numbers of IFN-γ- producing cells, suggesting a Th1-skewed immune response. INTERPRETATION The MVC-COV1901 vaccine was well tolerated and elicited robust immune responses and is suitable for further development. FUNDING Medigen Vaccine Biologics Corporation.
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Affiliation(s)
- Szu-Min Hsieh
- Section of Infectious Diseases, Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Wang-Da Liu
- Section of Infectious Diseases, Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Yu-Shan Huang
- Section of Infectious Diseases, Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | | | | | | | - Charles Chen
- Medigen Vaccine Biologics Corp., Taiwan
- College of Science and Technology, Temple University, Philadelphia, PA 19122, U.S.A
| | - Robert Janssen
- Dynavax Technologies Corporation, Emeryville, CA 94608, U.S.A
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Guei Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - I-Chen Tai
- Medigen Vaccine Biologics Corp., Taiwan
- Corresponding author.
| | - Shan-Chwen Chang
- Section of Infectious Diseases, Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
- Corresponding author.
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23
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Huang PY, Wu TS, Cheng CW, Chen CJ, Huang CG, Tsao KC, Lin CS, Chung TY, Lai CC, Yang CT, Chen YC, Chiu CH. A hospital cluster of COVID-19 associated with a SARS-CoV-2 superspreading event. J Microbiol Immunol Infect 2021; 55:436-444. [PMID: 34334353 PMCID: PMC8294754 DOI: 10.1016/j.jmii.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND/PURPOSE Superspreading events (SSEs) are pivotal in the spread of SARS-CoV-2. This study aimed to investigate an SSE of COVID-19 in a hospital and explore the transmission dynamics and heterogeneity of SSE. METHODS We performed contact tracing for all close contacts in a cluster. We did nasopharyngeal or throat swabbing for SARS-CoV-2 by real-time RT-PCR. Environmental survey was performed. The epidemiological and clinical characteristics of the SSE were studied. RESULTS Patient 1 with congestive heart failure and cellulitis, who had onset of COVID-19 two weeks after hospitalization, was the index case. Patient 1 led to 8 confirmed cases, including four health care workers (HCW). Persons tested positive for SARS-CoV-2 were HCW (n = 4), patient 1's family (n = 2), an accompanying person of an un-infected in-patient (n = 1), and an in-patient admitted before the SSE (n = 1). The attack rate among the HCW was 3.2 % (4/127). Environmental survey confirmed contamination at the bed rails, mattresses, and sink in the room patient 1 stayed, suggesting fomite transmission. The index case's sputum remained positive on illness day 35. Except one asymptomatic patient, at least three patients acquired the infection from the index case at the pre-symptomatic period. The effective reproduction number (Rt) was 0.9 (8/9). CONCLUSION The host factor (heart failure, longer viral shedding), transmissibility of SARS-CoV-2 (Rt, pre-symptomatic transmission), and possible multiple modes of transmission altogether contributed to the SSE. Rapid response and advance deployment of multi-level protection in hospitals could mitigate COVID-19 transmission to one generation, thereby reducing its impact on the healthcare system.
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Affiliation(s)
- Po-Yen Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Infection Control Committee, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Infection Control Committee, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Wen Cheng
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Infection Control Committee, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Jung Chen
- Infection Control Committee, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University College of Medicine, Taoyuan, Taiwan; Research Center for Emerging Viral Infections, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University College of Medicine, Taoyuan, Taiwan; Research Center for Emerging Viral Infections, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Sui Lin
- Infection Control Committee, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Ying Chung
- Infection Control Committee, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Infection Control Committee, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Ching Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Infection Control Committee, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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24
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Huang CG, Dutta A, Huang CT, Chang PY, Hsiao MJ, Hsieh YC, Lin SM, Shih SR, Tsao KC, Yang CT. Relative COVID-19 Viral Persistence and Antibody Kinetics. Pathogens 2021; 10:pathogens10060752. [PMID: 34199240 PMCID: PMC8231980 DOI: 10.3390/pathogens10060752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/15/2022] Open
Abstract
A total of 15 RT-PCR confirmed COVID-19 patients were admitted to our hospital during the in-itial outbreak in Taiwan. The average time of virus clearance was delayed in seven patients, 24.14 ± 4.33 days compared to 10.25 ± 0.56 days post-symptom onset (PSO) in the other eight pa-tients. There was strong antibody response in patients with viral persistence at the pharynx, with peak values of serum antibody 677.2 ± 217.8 vs. 76.70 ± 32.11 in patients with delayed versus rapid virus clearance. The patients with delayed viral clearance had excessive antibodies of compromised quality in an early stage with the delay in peak virus neutralization efficacy, 34.14 ± 7.15 versus 12.50 ± 2.35 days PSO in patients with rapid virus clearance. Weak antibody re-sponse of patients with rapid viral clearance was also effective, with substantial and comparable neutralization efficacy, 35.70 ± 8.78 versus 41.37 ± 11.49 of patients with delayed virus clearance. Human Cytokine 48-Plex Screening of the serial sera samples revealed elevated concentrations of proinflammatory cytokines and chemokines in a deceased patient with delayed virus clear-ance and severe disease. The levels were comparatively less in the other two patients who suf-fered from severe disease but eventually survived.
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Affiliation(s)
- Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan; (C.-G.H.); (P.-Y.C.); (M.-J.H.); (S.-R.S.); (K.-C.T.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Avijit Dutta
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan;
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan;
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Pi-Yueh Chang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan; (C.-G.H.); (P.-Y.C.); (M.-J.H.); (S.-R.S.); (K.-C.T.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Mei-Jen Hsiao
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan; (C.-G.H.); (P.-Y.C.); (M.-J.H.); (S.-R.S.); (K.-C.T.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yu-Chia Hsieh
- Division of Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan;
- Division of Infectious Diseases, Department of Pediatrics, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan;
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shin-Ru Shih
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan; (C.-G.H.); (P.-Y.C.); (M.-J.H.); (S.-R.S.); (K.-C.T.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan; (C.-G.H.); (P.-Y.C.); (M.-J.H.); (S.-R.S.); (K.-C.T.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan;
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-3-3281200
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25
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Chuang HH, Hsu JF, Chuang LP, Chiu CH, Huang YL, Li HY, Chen NH, Huang YS, Chuang CW, Huang CG, Lai HC, Lee LA. Different Associations between Tonsil Microbiome, Chronic Tonsillitis, and Intermittent Hypoxemia among Obstructive Sleep Apnea Children of Different Weight Status: A Pilot Case-Control Study. J Pers Med 2021; 11:jpm11060486. [PMID: 34071547 PMCID: PMC8227284 DOI: 10.3390/jpm11060486] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
The tonsil microbiome is associated with chronic tonsillitis and obstructive sleep apnea (OSA) in children, and the gut microbiome is associated with host weight status. In this study, we hypothesized that weight status may be associated with clinical profiles and the tonsil microbiome in children with OSA. We prospectively enrolled 33 non-healthy-weight (cases) and 33 healthy-weight (controls) pediatric OSA patients matched by the proportion of chronic tonsillitis. Differences in the tonsil microbiome between the non-healthy-weight and healthy-weight subgroups and relationships between the tonsil microbiome and clinical variables were investigated. Non-healthy weight was associated with significant intermittent hypoxemia (oxygen desaturation index, mean blood saturation (SpO2), and minimal SpO2) and higher systolic blood pressure percentile, but was not related to the tonsil microbiome. However, chronic tonsillitis was related to Acidobacteria in the non-healthy-weight subgroup, and oxygen desaturation index was associated with Bacteroidetes in the healthy-weight subgroup. In post hoc analysis, the children with mean SpO2 ≤ 97% had reduced α and β diversities and a higher abundance of Bacteroidetes than those with mean SpO2 > 97%. These preliminary findings are novel and provide insights into future research to understand the pathogenesis of the disease and develop personalized treatments for pediatric OSA.
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Affiliation(s)
- Hai-Hua Chuang
- Department of Family Medicine, Chang Gung Memorial Hospital, Taipei Branch and Linkou Main Branch, Taoyuan 33305, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (C.-H.C.); (Y.-L.H.); (H.-Y.L.); (N.-H.C.); (Y.-S.H.)
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 10608, Taiwan
- Obesity Institute, Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA
| | - Jen-Fu Hsu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (C.-H.C.); (Y.-L.H.); (H.-Y.L.); (N.-H.C.); (Y.-S.H.)
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan
| | - Li-Pang Chuang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (C.-H.C.); (Y.-L.H.); (H.-Y.L.); (N.-H.C.); (Y.-S.H.)
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (C.-H.C.); (Y.-L.H.); (H.-Y.L.); (N.-H.C.); (Y.-S.H.)
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan
| | - Yen-Lin Huang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (C.-H.C.); (Y.-L.H.); (H.-Y.L.); (N.-H.C.); (Y.-S.H.)
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan
| | - Hsueh-Yu Li
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (C.-H.C.); (Y.-L.H.); (H.-Y.L.); (N.-H.C.); (Y.-S.H.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan
| | - Ning-Hung Chen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (C.-H.C.); (Y.-L.H.); (H.-Y.L.); (N.-H.C.); (Y.-S.H.)
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan
| | - Yu-Shu Huang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (C.-H.C.); (Y.-L.H.); (H.-Y.L.); (N.-H.C.); (Y.-S.H.)
- Department of Child Psychiatry, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan
| | - Chun-Wei Chuang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (C.-W.C.); (C.-G.H.); (H.-C.L.)
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (C.-W.C.); (C.-G.H.); (H.-C.L.)
- Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hsin-Chih Lai
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (C.-W.C.); (C.-G.H.); (H.-C.L.)
- Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
| | - Li-Ang Lee
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (C.-H.C.); (Y.-L.H.); (H.-Y.L.); (N.-H.C.); (Y.-S.H.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan
- Correspondence: ; Tel.: +886-3328-1200 (ext. 3968)
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26
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Huang SY, Kung YA, Huang PN, Chang SY, Gong YN, Han YJ, Chiang HJ, Liu KT, Lee KM, Chang CY, Chang CC, Huang CG, Shih SR. Stability of SARS-CoV-2 Spike G614 Variant Surpasses That of the D614 Variant after Cold Storage. mSphere 2021; 6:e00104-21. [PMID: 33789940 PMCID: PMC8546686 DOI: 10.1128/msphere.00104-21] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 12/11/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) carrying the D614G mutation on the spike protein is the predominant circulating variant and is associated with enhanced infectivity. However, whether this dominant variant can potentially spread through the cold chain and whether the spike protein affects virus stability after cold storage remain unclear. To compare the infectivity of two SARS-CoV-2 variants, namely, SARS-CoV-2 variants with spike protein with the D614 mutation (S-D614) and G614 mutation (S-G614), after different periods of refrigeration (4°C) and freezing (-20°C). We also determined the integrity of the viral RNA and the ability of the spike protein to bind angiotensin-converting enzyme 2 (ACE2) after storage at these conditions. The results showed that SARS-CoV-2 was more stable and infectious after storage at -20°C than at 4°C. Particularly, the S-G614 variant was found to be more stable than the S-D614 variant. The spike protein of the S-G614 variant had better binding ability with the ACE2 receptor than that of the S-D614 variant after storage at -20°C for up to 30 days. Our findings revealed that SARS-CoV-2 remains stable and infectious after refrigeration or freezing, and their stability and infectivity up to 30 days depends on the spike variant. Stability and infectivity are related to each other, and the higher stability of S-G614 compared to that of S-D614 may contribute to rapid viral spread of the S-G614 variant.IMPORTANCE It has been observed that variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are more stable and infectious after storage at -20°C than at 4°C. A SARS-CoV-2 S-D614G variant is currently the most dominant variant in circulation and is associated with enhanced infectivity. We compared the stability of two SARS-CoV-2 variants: the early S-D614 variant carrying the D614 spike protein and the new S-G614 variant carrying the G614 spike protein, stored at both 4°C and -20°C for different periods. We observed that SARS-CoV-2 remains stable and infectious after refrigeration or freezing, which further depends on the spike variant, that is, the ability of the spike protein to bind with the ACE2 receptor with higher efficiency. The high stability of the S-G614 variant also explains its rapid spread and infectivity. Therefore, precautions should be taken during and after handling food preserved under cold conditions.
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Affiliation(s)
- Sheng-Yu Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-An Kung
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Peng-Nien Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Infectious Diseases, Department of Pediatrics, Linkou Chung Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sheng-Yun Chang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Bachelor Program in Artificial Intelligence, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Nong Gong
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ju Han
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Science, Division of Biotechnology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Jung Chiang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Ting Liu
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Science, Division of Biotechnology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Ming Lee
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yu Chang
- Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chia-Ching Chang
- Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Electrophysics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Physics, Academia Sinica, Nankang, Taipei, Taiwan
| | - Chung-Guei Huang
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Research Center for Food and Cosmetic Safety, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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27
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Lei XD, Wu XQ, Zhang Z, Xiao KL, Wang YW, Huang CG. A machine learning model for predicting the ballistic impact resistance of unidirectional fiber-reinforced composite plate. Sci Rep 2021; 11:6503. [PMID: 33753825 PMCID: PMC7985305 DOI: 10.1038/s41598-021-85963-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/09/2021] [Indexed: 11/09/2022] Open
Abstract
It has been a vital issue to ensure both the accuracy and efficiency of computational models for analyzing the ballistic impact response of fiber-reinforced composite plates (FRCP). In this paper, a machine learning (ML) model is established in an effort to bridge the ballistic impact protective performance and the characteristics of microstructure for unidirectional FRCP (UD-FRCP), where the microstructure of the UD-FRCP is characterized by the two-point correlation function. The results showed that the ML model, after trained by 175 cases, could reasonably predict the ballistic impact energy absorption of the UD-FRCP with a maximum error of 13%, indicating that the model can ensure both computational accuracy and efficiency. Besides, the model's critical parameter sensitivities are investigated, and three typical ML algorithms are analyzed, showing that the gradient boosting regression algorithm has the highest accuracy among these algorithms for the ballistic impact problem of UD-FRCP. The study proposes an effective solution for the traditional difficulty of the ballistic impact simulation of composites with both high efficiency and accuracy.
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Affiliation(s)
- X D Lei
- Key Laboratory for Mechanics in Fluid Solid Coupling Systems, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China.,School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - X Q Wu
- Key Laboratory for Mechanics in Fluid Solid Coupling Systems, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Z Zhang
- Key Laboratory for Mechanics in Fluid Solid Coupling Systems, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China.,School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - K L Xiao
- Key Laboratory for Mechanics in Fluid Solid Coupling Systems, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China.,School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Y W Wang
- Key Laboratory for Mechanics in Fluid Solid Coupling Systems, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China.,School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - C G Huang
- Key Laboratory for Mechanics in Fluid Solid Coupling Systems, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190, China.,School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049, China.,Hefei Institutes of Physical Science, Chinese Academy of Sciences, Heifei, 230031, China
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28
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Huang KYA, Tan TK, Chen TH, Huang CG, Harvey R, Hussain S, Chen CP, Harding A, Gilbert-Jaramillo J, Liu X, Knight M, Schimanski L, Shih SR, Lin YC, Cheng CY, Cheng SH, Huang YC, Lin TY, Jan JT, Ma C, James W, Daniels RS, McCauley JW, Rijal P, Townsend AR. Breadth and function of antibody response to acute SARS-CoV-2 infection in humans. PLoS Pathog 2021; 17:e1009352. [PMID: 33635919 PMCID: PMC8130932 DOI: 10.1371/journal.ppat.1009352] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 05/18/2021] [Accepted: 02/02/2021] [Indexed: 12/31/2022] Open
Abstract
Serological and plasmablast responses and plasmablast-derived IgG monoclonal antibodies (MAbs) have been analysed in three COVID-19 patients with different clinical severities. Potent humoral responses were detected within 3 weeks of onset of illness in all patients and the serological titre was elicited soon after or concomitantly with peripheral plasmablast response. An average of 13.7% and 3.5% of plasmablast-derived MAbs were reactive with virus spike glycoprotein or nucleocapsid, respectively. A subset of anti-spike (10 of 32) antibodies cross-reacted with other betacoronaviruses tested and harboured extensive somatic mutations, indicative of an expansion of memory B cells upon SARS-CoV-2 infection. Fourteen of 32 anti-spike MAbs, including five anti-receptor-binding domain (RBD), three anti-non-RBD S1 and six anti-S2, neutralised wild-type SARS-CoV-2 in independent assays. Anti-RBD MAbs were further grouped into four cross-inhibiting clusters, of which six antibodies from three separate clusters blocked the binding of RBD to ACE2 and five were neutralising. All ACE2-blocking anti-RBD antibodies were isolated from two recovered patients with prolonged fever, which is compatible with substantial ACE2-blocking response in their sera. Finally, the identification of non-competing pairs of neutralising antibodies would offer potential templates for the development of prophylactic and therapeutic agents against SARS-CoV-2.
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Affiliation(s)
- Kuan-Ying A. Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tiong Kit Tan
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ting-Hua Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Chung-Guei Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ruth Harvey
- Worldwide Influenza Centre, The Francis Crick Institute, 1 Midland Road, London, United Kingdom
| | - Saira Hussain
- Worldwide Influenza Centre, The Francis Crick Institute, 1 Midland Road, London, United Kingdom
| | - Cheng-Pin Chen
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, and National Yang-Ming University, Taipei, Taiwan
| | - Adam Harding
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | | | - Xu Liu
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Michael Knight
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Lisa Schimanski
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chun Lin
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, and Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, and National Yang-Ming University, Taipei, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, and Taipei Medical University, Taipei, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzou-Yien Lin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jia-Tsrong Jan
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Che Ma
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - William James
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Rodney S. Daniels
- Worldwide Influenza Centre, The Francis Crick Institute, 1 Midland Road, London, United Kingdom
| | - John W. McCauley
- Worldwide Influenza Centre, The Francis Crick Institute, 1 Midland Road, London, United Kingdom
| | - Pramila Rijal
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Alain R. Townsend
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
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29
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Yen CS, Huang YC, Chen CJ, Shie SS, Yang SL, Huang CG, Tsao KC, Chiu CH, Hsieh YC, Kuo CY, Arthur Huang KY, Lin TY. Detection of norovirus and rotavirus among inpatients with acute gastroenteritis in a medical center in northern Taiwan, 2013–2018. Journal of Microbiology, Immunology and Infection 2020; 53:955-962. [DOI: 10.1016/j.jmii.2020.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 12/14/2022]
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30
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Gong YN, Tsao KC, Hsiao MJ, Huang CG, Huang PN, Huang PW, Lee KM, Liu YC, Yang SL, Kuo RL, Chen KF, Liu YC, Huang SY, Huang HI, Liu MT, Yang JR, Chiu CH, Yang CT, Chen GW, Shih SR. SARS-CoV-2 genomic surveillance in Taiwan revealed novel ORF8-deletion mutant and clade possibly associated with infections in Middle East. Emerg Microbes Infect 2020; 9:1457-1466. [PMID: 32543353 PMCID: PMC7473175 DOI: 10.1080/22221751.2020.1782271] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 12/29/2022]
Abstract
Taiwan experienced two waves of imported infections with Coronavirus Disease 2019 (COVID-19). This study aimed at investigating the genomic variation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Taiwan and compared their evolutionary trajectories with the global strains. We performed culture and full-genome sequencing of SARS-CoV-2 strains followed by phylogenetic analysis. A 382-nucleotides deletion in open reading frame 8 (ORF8) was found in a Taiwanese strain isolated from a patient on February 4, 2020 who had a travel history to Wuhan. Patients in the first wave also included several sporadic, local transmission cases. Genomes of 5 strains sequenced from clustered infections were classified into a new clade with ORF1ab-V378I mutation, in addition to 3 dominant clades ORF8-L84S, ORF3a-G251V and S-D614G. This highlighted clade also included some strains isolated from patients who had a travel history to Turkey and Iran. The second wave mostly resulted from patients who had a travel history to Europe and Americas. All Taiwanese viruses were classified into various clades. Genomic surveillance of SARS-CoV-2 in Taiwan revealed a new ORF8-deletion mutant and a virus clade that may be associated with infections in the Middle East, which contributed to a better understanding of the global SARS-CoV-2 transmission dynamics.
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Affiliation(s)
- Yu-Nong Gong
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Jen Hsiao
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Peng-Nien Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Infectious Diseases, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Wei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Ming Lee
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chun Liu
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Li Yang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Rei-Lin Kuo
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Asthma, Allergy, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yen-Chin Liu
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Yu Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsing-I. Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | | | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Guang-Wu Chen
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Computer Science and Information Engineering, School of Electrical and Computer Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, and Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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31
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Kuo TY, Lin MY, Coffman RL, Campbell JD, Traquina P, Lin YJ, Liu LTC, Cheng J, Wu YC, Wu CC, Tang WH, Huang CG, Tsao KC, Chen C. Development of CpG-adjuvanted stable prefusion SARS-CoV-2 spike antigen as a subunit vaccine against COVID-19. Sci Rep 2020; 10:20085. [PMID: 33208827 PMCID: PMC7676267 DOI: 10.1038/s41598-020-77077-z] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/03/2020] [Indexed: 01/06/2023] Open
Abstract
The COVID-19 pandemic is a worldwide health emergency which calls for an unprecedented race for vaccines and treatment. In developing a COVID-19 vaccine, we applied technology previously used for MERS-CoV to produce a prefusion-stabilized SARS-CoV-2 spike protein, S-2P. To enhance immunogenicity and mitigate the potential vaccine-induced immunopathology, CpG 1018, a Th1-biasing synthetic toll-like receptor 9 (TLR9) agonist was selected as an adjuvant candidate. S-2P in combination with CpG 1018 and aluminum hydroxide (alum) was found to be the most potent immunogen and induced high titer of neutralizing antibodies in sera of immunized mice against pseudotyped lentivirus reporter or live wild-type SARS-CoV-2. In addition, the antibodies elicited were able to cross-neutralize pseudovirus containing the spike protein of the D614G variant, indicating the potential for broad spectrum protection. A marked Th1 dominant response was noted from cytokines secreted by splenocytes of mice immunized with CpG 1018 and alum. No vaccine-related serious adverse effects were found in the dose-ranging study in rats administered single- or two-dose regimens of S-2P combined with CpG 1018 alone or CpG 1018 with alum. These data support continued development of CHO-derived S-2P formulated with CpG 1018 and alum as a candidate vaccine to prevent COVID-19 disease.
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MESH Headings
- Adjuvants, Immunologic/therapeutic use
- Aluminum Hydroxide/therapeutic use
- Animals
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- CHO Cells
- COVID-19 Vaccines/adverse effects
- COVID-19 Vaccines/immunology
- COVID-19 Vaccines/therapeutic use
- Cricetinae
- Cricetulus
- Cytokines/blood
- Cytokines/metabolism
- Female
- HEK293 Cells
- Humans
- Immunogenicity, Vaccine
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Oligodeoxyribonucleotides/therapeutic use
- Rats
- Rats, Sprague-Dawley
- Spike Glycoprotein, Coronavirus/immunology
- Spleen/immunology
- Th1 Cells/immunology
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Affiliation(s)
- Tsun-Yung Kuo
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
- Department of Biotechnology and Animal Science, National Ilan University, Yilan City, Yilan County, Taiwan
| | - Meei-Yun Lin
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
| | | | | | | | - Yi-Jiun Lin
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
| | | | - Jinyi Cheng
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
| | - Yu-Chi Wu
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
| | - Chung-Chin Wu
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
| | | | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Charles Chen
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan.
- College of Science and Technology, Temple University, Philadelphia, PA, 19122, USA.
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32
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Zhou D, Duyvesteyn HME, Chen CP, Huang CG, Chen TH, Shih SR, Lin YC, Cheng CY, Cheng SH, Huang YC, Lin TY, Ma C, Huo J, Carrique L, Malinauskas T, Ruza RR, Shah PNM, Tan TK, Rijal P, Donat RF, Godwin K, Buttigieg KR, Tree JA, Radecke J, Paterson NG, Supasa P, Mongkolsapaya J, Screaton GR, Carroll MW, Gilbert-Jaramillo J, Knight ML, James W, Owens RJ, Naismith JH, Townsend AR, Fry EE, Zhao Y, Ren J, Stuart DI, Huang KYA. Structural basis for the neutralization of SARS-CoV-2 by an antibody from a convalescent patient. Nat Struct Mol Biol 2020; 27:950-958. [PMID: 32737466 DOI: 10.1038/s41594-020-0480-y] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/10/2020] [Indexed: 12/28/2022]
Abstract
The COVID-19 pandemic has had an unprecedented health and economic impact and there are currently no approved therapies. We have isolated an antibody, EY6A, from an individual convalescing from COVID-19 and have shown that it neutralizes SARS-CoV-2 and cross-reacts with SARS-CoV-1. EY6A Fab binds the receptor binding domain (RBD) of the viral spike glycoprotein tightly (KD of 2 nM), and a 2.6-Å-resolution crystal structure of an RBD-EY6A Fab complex identifies the highly conserved epitope, away from the ACE2 receptor binding site. Residues within this footprint are key to stabilizing the pre-fusion spike. Cryo-EM analyses of the pre-fusion spike incubated with EY6A Fab reveal a complex of the intact spike trimer with three Fabs bound and two further multimeric forms comprising the destabilized spike attached to Fab. EY6A binds what is probably a major neutralizing epitope, making it a candidate therapeutic for COVID-19.
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Affiliation(s)
- Daming Zhou
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
| | - Helen M E Duyvesteyn
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
| | - Cheng-Pin Chen
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, and National Yang-Ming University, Taipei, Taiwan
| | - Chung-Guei Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Hua Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chun Lin
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, and Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, and National Yang-Ming University, Taipei, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, and Taipei Medical University, Taipei, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzou-Yien Lin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Che Ma
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Jiandong Huo
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
- The Rosalind Franklin Institute, Harwell Campus, Didcot, UK
- Protein Production UK, Research Complex at Harwell, Harwell Science & Innovation Campus, Didcot, UK
| | - Loic Carrique
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
| | - Tomas Malinauskas
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
| | - Reinis R Ruza
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
| | - Pranav N M Shah
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
| | - Tiong Kit Tan
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Pramila Rijal
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, UK
| | - Robert F Donat
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Kerry Godwin
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Karen R Buttigieg
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Julia A Tree
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Julika Radecke
- Diamond Light Source Ltd, Harwell Science & Innovation Campus, Didcot, UK
| | - Neil G Paterson
- Diamond Light Source Ltd, Harwell Science & Innovation Campus, Didcot, UK
| | - Piyada Supasa
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Juthathip Mongkolsapaya
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Dengue Hemorrhagic Fever Research Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gavin R Screaton
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Miles W Carroll
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | - Michael L Knight
- William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - William James
- William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - Raymond J Owens
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
- The Rosalind Franklin Institute, Harwell Campus, Didcot, UK
- Protein Production UK, Research Complex at Harwell, Harwell Science & Innovation Campus, Didcot, UK
| | - James H Naismith
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
- The Rosalind Franklin Institute, Harwell Campus, Didcot, UK
- Protein Production UK, Research Complex at Harwell, Harwell Science & Innovation Campus, Didcot, UK
| | - Alain R Townsend
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, UK
| | - Elizabeth E Fry
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
| | - Yuguang Zhao
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
| | - Jingshan Ren
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK
| | - David I Stuart
- Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Wellcome Centre for Human Genetics, Headington, Oxford, UK.
- Centre for Translational Immunology, Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, UK.
- Diamond Light Source Ltd, Harwell Science & Innovation Campus, Didcot, UK.
| | - Kuan-Ying A Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Huang CT, Hsu SY, Chang KW, Huang CG, Yang CT, Cheng MH. Heparin-induced thrombocytopenia and thrombosis in a patient with Covid-19. Thromb Res 2020; 196:11-14. [PMID: 32810772 PMCID: PMC7834633 DOI: 10.1016/j.thromres.2020.07.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Ching-Tai Huang
- Department of Infectious Disease, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shao-Yun Hsu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ko-Wei Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America.
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Huang CG, Jia ZG, Gu ZQ, Zhao P, Lyu GZ. [Clinical effects of vacuum sealing drainage in the treatment of alkali burn wounds]. Zhonghua Shao Shang Za Zhi 2020; 36:534-539. [PMID: 32842399 DOI: 10.3760/cma.j.cn501120-20200115-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To preliminarily observe the clinical effects of vacuum sealing drainage (VSD) in the treatment of alkali burn wounds. Methods: From June 2016 to March 2020, 60 male patients with alkali burns who met the inclusion criteria and hospitalized in the Affiliated Hospital of Jiangnan University were recruited in this prospectively randomized control study. According to the random number table, silver sulfadiazine group and VSD group were both allocated with 30 patients, aged (36±8) and (35±10) years respectively; with total burn area of (7.2±2.0) % and (8.5±3.0) % total body surface area respectively. After admission, patients in silver sulfadiazine group were treated with conventional silver sulfadiazine dressing change once a day after debridement; patients in VSD group were given continuous VSD treatment after debridement, with the negative pressure setting at -10.67 kPa, and the negative pressure materials were replaced every 6 to 8 days. On treatment day 1, 4, and 7, the exudate from the wounds of patients in silver sulfadiazine group and the wound drainage fluid of patients in VSD group were collected, the pH value was measured by a portable pH meter, and the volume of exudate/drainage fluid was measured. After 7, 14, and 21 days of treatment, the wound healing rates of patients were calculated in the two groups. Before treatment and 7 days after treatment, venous blood was collected from the patients in the two groups to detect the serum level of tumor necrosis factor α (TNF-α) and interleukin 8 (IL-8). Within treatment day 14, Visual Analogue Scale was used to assess the pain score of patients in the two groups during each time of dressing change. The medical costs and discharge satisfaction scores of patients in the two groups were recorded. Data were statistically analyzed with analysis of variance for repeated measurement, t test, and Bonferroni correction. Results: (1) On treatment day 1, 4, and 7, the pH values of the drainage fluid of patients in VSD group were 9.75±0.59, 9.01±0.46, and 8.13±0.28, respectively, which were significantly higher than 9.35±0.62, 8.18±0.18, and 7.58±0.09 of exudate of patients in silver sulfadiazine group (t=2.03, 6.80, 7.56, P<0.05 or P<0.01). On treatment day 1 and 4, the volumes of drainage fluid of patients in VSD group were (553±83) and (239±65) mL respectively, which were significantly higher than (440±77) and (175±49) mL of exudate of patients in silver sulfadiazine group (t=3.44, 2.24, P<0.05). On treatment day 7, the volume of drainage fluid of patients in VSD group was (21±8) mL, which was significantly lower than (149±44) mL of exudate of patients in silver sulfadiazine group (t=-12.61, P<0.01). (2) After 7, 14, and 21 days of treatment, the wound healing rates of patients in VSD group were (39±6) %, (74±10) %, and (92±3) %, respectively, which were significantly higher than (25±3) %, (59±6) %, and (77±6) % in silver sulfadiazine group (t=7.07, 5.59, 7.09, P<0.01). (3) Before treatment, the serum levels of TNF-α and IL-8 of patients in the two groups were similar. After 7 days of treatment, the serum levels of TNF-α and IL-8 of patients in VSD group were significantly lower than those in silver sulfadiazine group (t=-8.75, -8.04, P<0.01). (4) The pain score during dressing change and medical cost of patients in VSD group were significantly lower than those in silver sulfadiazine group (t=-4.28, -7.56, P<0.01), while the discharge satisfaction score of patients in VSD group was significantly higher than that in silver sulfadiazine group (t=10.91, P<0.05). Conclusions: The application of VSD technology in clinical alkali burn wounds can effectively promote the removal of residual lye, alleviate the further damage of lye to skin tissue, shorten the wound healing time, effectively remove inflammatory mediators, reduce the pain of dressing change, decrease the total cost of treatment, and enhance satisfaction of patient.
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Affiliation(s)
- C G Huang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Jiangnan University (Wuxi Third People's Hospital), Wuxi 214041, China
| | - Z G Jia
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Jiangnan University (Wuxi Third People's Hospital), Wuxi 214041, China
| | - Z Q Gu
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Jiangnan University (Wuxi Third People's Hospital), Wuxi 214041, China
| | - P Zhao
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Jiangnan University (Wuxi Third People's Hospital), Wuxi 214041, China
| | - G Z Lyu
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Jiangnan University (Wuxi Third People's Hospital), Wuxi 214041, China
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Huang ACC, Huang CG, Yang CT, Hu HC. Concomitant infection with COVID-19 and Mycoplasma pneumoniae. Biomed J 2020; 43:458-461. [PMID: 32891590 PMCID: PMC7358157 DOI: 10.1016/j.bj.2020.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/14/2020] [Accepted: 07/12/2020] [Indexed: 01/19/2023] Open
Abstract
In late 2019, cases of atypical pneumonia caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were first reported in Wuhan, China. The disease was officially called coronavirus disease 2019 (COVID-19) and has been declared a pandemic disease by the World Health Organization (WHO). The clinical symptoms may include fever, cough, fatigue, headache, and diarrhea. The radiographic features comprise various presentations, including ground-glass opacities, tiny nodules, and consolidation. However, some atypical pathogens related to community-acquired pneumonia (CAP) may share similar presentations. They may be difficult to distinguish according to the clinical presentation and radiographic findings. Recently, there have been several reports reminding physicians to heed the possibility of co-infection with other pathogens in patients diagnosed with COVID-19. We report a COVID-19 patient co-infected with Mycoplasma pneumoniae who recovered well after combination therapy. We propose that all COVID-19 patients should undergo a meticulous screening routine to ensure that they receive adequate treatments.
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Affiliation(s)
- Allen Chung-Cheng Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chuang HH, Hsu JF, Chuang LP, Chen NH, Huang YS, Li HY, Chen JY, Lee LA, Huang CG. Differences in Anthropometric and Clinical Features among Preschoolers, School-Age Children, and Adolescents with Obstructive Sleep Apnea-A Hospital-Based Study in Taiwan. Int J Environ Res Public Health 2020; 17:ijerph17134663. [PMID: 32610444 PMCID: PMC7370095 DOI: 10.3390/ijerph17134663] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Abstract
Pediatric obstructive sleep apnea (OSA) is associated with adverse health outcomes; however, little is known about the diversity of this population. This retrospective study aims to investigate age-related differences in the anthropometric and clinical features of this population. A total of 253 Taiwanese children (70 (27.7%) girls and 183 (72.3%) boys) with OSA were reviewed. Their median age, body mass index (BMI) z-score, and apnea-hypopnea index were 6.9 years, 0.87, and 9.5 events/h, respectively. The cohort was divided into three subgroups: ‘preschoolers’ (≥2 and <6 years), ‘school-age children’ (≥6 and <10 years), and ‘adolescents (≥10 and <18 years)’. The percentage of the male sex, BMI z-score, neck circumference, systolic blood pressure z-score, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio tended to increase with age. Adenoid grades tended to decrease with age. Overall, disease severity was independently correlated with neck circumference, tonsil size, and adenoid grade. Increased neck circumference and tonsillar hypertrophy were the most influential factors for younger children, whereas adenoidal hypertrophy became more important at an older age. In conclusion, gender prevalence ratio, anthropometric measures, and clinical features varied with age, and the pathogenic drivers were not necessarily the same as the aggravating ones.
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Affiliation(s)
- Hai-Hua Chuang
- Department of Family Medicine, Chang Gung Memorial Hospital, Taipei and Linkou Branches, Taoyuan 33305, Taiwan; (H.-H.C.); (J.-Y.C.)
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 10608, Taiwan
- Obesity Institute, Genomic Medicine Institute, Geisinger, Danville, 17822 PA, USA
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (N.-H.C.); (Y.-S.H.); (H.-Y.L.)
| | - Jen-Fu Hsu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (N.-H.C.); (Y.-S.H.); (H.-Y.L.)
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, 33305 Taoyuan, Taiwan
| | - Li-Pang Chuang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (N.-H.C.); (Y.-S.H.); (H.-Y.L.)
- Department of Pulmonary and Critical Care Medicine, Sleep Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Ning-Hung Chen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (N.-H.C.); (Y.-S.H.); (H.-Y.L.)
- Department of Pulmonary and Critical Care Medicine, Sleep Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Yu-Shu Huang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (N.-H.C.); (Y.-S.H.); (H.-Y.L.)
- Department of Child Psychiatry, Sleep Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Hsueh-Yu Li
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (N.-H.C.); (Y.-S.H.); (H.-Y.L.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Taipei and Linkou Branches, Taoyuan 33305, Taiwan; (H.-H.C.); (J.-Y.C.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (N.-H.C.); (Y.-S.H.); (H.-Y.L.)
| | - Li-Ang Lee
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-F.H.); (L.-P.C.); (N.-H.C.); (Y.-S.H.); (H.-Y.L.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Correspondence: (L.-A.L.); (C.-G.H.); Tel.: +886-3328-1200 (ext. 3968) (L.-A.L.); +886-3328-1200 (ext. 5653) (C.-G.H.)
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: (L.-A.L.); (C.-G.H.); Tel.: +886-3328-1200 (ext. 3968) (L.-A.L.); +886-3328-1200 (ext. 5653) (C.-G.H.)
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Ho SY, Chiu CH, Huang YC, Chen CJ, Lien R, Chu SM, Huang CG, Tsao KC, Shih SR, Hsu JF. Investigation and successful control of an echovirus 11 outbreak in neonatal intensive care units. Pediatr Neonatol 2020; 61:180-187. [PMID: 31669107 DOI: 10.1016/j.pedneo.2019.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Echovirus 11 emerged as a predominant enterovirus strain and was associated with neonatal mortalities in Taiwan in 2018. We investigated an echovirus 11 outbreak in the neonatal intensive care units (NICUs) in a tertiary hospital in northern Taiwan and analyzed infection control efforts. METHODS Between May and June 2018, an outbreak of 10 infants with echovirus 11 infections occurred in the NICUs. Comprehensive surveillance, including virus isolation, real-time reverse transcription-polymerase chain reaction (RT-PCR), and consequential degenerate hybrid oligonucleotide primer (CODEHOP) methods, were arranged for specimens (rectal or throat swabs), which were obtained from all contacts, newly admitted cases, and suspected cases during the outbreak since June 2. RESULTS Ten cases were identified with echovirus 11 infection in this outbreak. Eight of these 10 confirmed cases were identified by viral isolation, and the remaining two cases were identified by RT-PCR surveillance. In addition to confirmed cases, the surveillance of 19 contacts, 47 newly admitted cases, and nine suspected cases showed negative results. All confirmed cases eventually recovered. CONCLUSION RT-PCR and CODEHOP methods significantly shorten the time of laboratory diagnosis of enterovirus infection compared with conventional methods. The outbreak of echovirus 11 in the NICUs was caused by three imported cases and was successfully controlled by the implementation of isolation, rapid surveillance, reinforced disinfection, and infection control measures.
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Affiliation(s)
- Sheng-Yuan Ho
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Jung Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan; Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Tsai MS, Li HY, Huang CG, Wang RYL, Chuang LP, Chen NH, Liu CH, Yang YH, Liu CY, Hsu CM, Cheng WN, Lee LA. Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real-World Evidence. Laryngoscope 2020; 130:2292-2298. [PMID: 32045010 DOI: 10.1002/lary.28558] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/30/2019] [Accepted: 01/12/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real-world evidence. STUDY DESIGN Retrospective cohort study. METHODS Patients newly diagnosed with OSA during 1997-2012 were identified using the National Health Insurance Research Database of Taiwan. Patients without OSA were randomly selected and matched in a 1:4 ratio by age, sex, urbanization level, and income. All patients were followed up until death or the end of 2013. The primary outcome was AD occurrence. RESULTS This study included 3,978 OSA patients and 15,912 non-OSA patients. OSA was independently and significantly associated with a higher incidence of AD in an adjusted Cox proportional hazard model (adjusted hazard ratio: 2.12; 95% confidence interval [CI], 1.27-3.56). The average period of AD detection from the time of OSA occurrence was 5.44 years (standard deviation: 2.96). Subgroup analyses revealed that the effect of OSA remained significant in patients aged ≥60 years, male subgroups, patients without CPAP or surgical treatment, and patients without pharmacological therapies. Patients with OSA who received treatment (continuous positive airway pressure or surgery) exhibited a significantly reduced risk of AD compared with those without treatment (incidence rate ratio 0.23, 95% CI, 0.06-0.98). CONCLUSION OSA is independently associated with an increased risk of AD. Treatment for OSA reduces the AD risk in OSA patients. AD irreversibility renders OSA as a potential modifiable target for slowing or preventing the process of AD development. LEVEL OF EVIDENCE IV Laryngoscope, 130:2292-2298, 2020.
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Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology - Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Robert Y L Wang
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pulmonary and Critical Care Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ning-Hung Chen
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pulmonary and Critical Care Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Hung Liu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology - Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Nuan Cheng
- Department of Sports Sciences, University of Taipei, Taipei, Taiwan
| | - Li-Ang Lee
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chen HC, Wang CJ, Lo YL, Hsu HC, Huang CG, Kuo IC, Lu YA, Hsin LJ, Lin WN, Fang TJ, Li HY, Lee LA. Parapharyngeal fat pad area at the subglosso-supraglottic level is associated with corresponding lateral wall collapse and apnea-hypopnea index in patients with obstructive sleep apnea: a pilot study. Sci Rep 2019; 9:17722. [PMID: 31776365 PMCID: PMC6881471 DOI: 10.1038/s41598-019-53515-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/01/2019] [Indexed: 01/26/2023] Open
Abstract
The aim of this study was to assess associations between fat pad areas at various anatomic levels and the sites of lateral wall collapse and disease severity in adult patients with obstructive sleep apnea (OSA). Forty-one patients with OSA who prospectively underwent drug-induced sleep computed tomography were included. Areas of parapharyngeal fat pads and degrees of lateral wall collapse at three representative anatomic levels (nasopharynx, oropharynx, and subglosso-supraglottis), and apnea-hypopnea index (AHI) were measured. In the subglosso-supraglottic region, the parapharyngeal fat pad area in 17 (41%) patients with complete lateral wall collapse was significantly larger than that in 24 (59%) patients without complete collapse (median, 236.0 mm2 vs 153.0 mm2; P = 0.02). In multivariate regression analysis, the parapharyngeal fat pad area at the subglosso-supraglottic level (β = 0.02; P = 0.01) and body mass index (β = 3.24; P = 0.01) were independently associated with AHI. Our preliminary results supported that parapharyngeal fat pads at the subglosso-supraglottic level may be involved in the development of lateral wall collapse and then determine the severity of OSA. Further studies are warranted to investigate the effect of reducing parapharyngeal fat pads in the treatment of OSA.
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Affiliation(s)
- Hung-Chin Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Chao-Jan Wang
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC.,Department of Medical Imaging and Intervention, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC
| | - Yu-Lun Lo
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC.,Department of Thoracic Medicine, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC
| | - Hao-Chun Hsu
- Department of Bio-Industrial Mechatronics Engineering, National Taiwan University, Taipei, 10617, Taiwan, ROC
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - I-Chun Kuo
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Yi-An Lu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Li-Jen Hsin
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Wan-Ni Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC. .,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC.
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Lee KF, Tsai MM, Tsai CY, Huang CG, Ou YH, Hsieh CC, Hsieh HL, Wang CS, Lin KH. DEK Is a Potential Biomarker Associated with Malignant Phenotype in Gastric Cancer Tissues and Plasma. Int J Mol Sci 2019; 20:E5689. [PMID: 31766266 PMCID: PMC6888682 DOI: 10.3390/ijms20225689] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/13/2022] Open
Abstract
Gastric cancer (GC) is the second most widespread cause of cancer-related mortality worldwide. The discovery of novel biomarkers of oncoproteins can facilitate the development of therapeutic strategies for GC treatment. In this study, we identified novel biomarkers by integrating isobaric tags for relative and absolute quantitation (iTRAQ), a human plasma proteome database, and public Oncomine datasets to search for aberrantly expressed oncogene-associated proteins in GC tissues and plasma. One of the most significantly upregulated biomarkers, DEK, was selected and its expression validated. Our immunohistochemistry (IHC) (n = 92) and quantitative real-time polymerase chain reaction (qRT-PCR) (n = 72) analyses disclosed a marked increase in DEK expression in tumor tissue, compared with paired nontumor mucosa. Importantly, significantly higher preoperative plasma DEK levels were detected in GC patients than in healthy controls via enzyme-linked immunosorbent assay (ELISA). In clinicopathological analysis, higher expression of DEK in both tissue and plasma was significantly associated with advanced stage and poorer survival outcomes of GC patients. Data from receiver operating characteristic (ROC) curve analysis disclosed a better diagnostic accuracy of plasma DEK than carcinoembryonic antigen (CEA), carbohydrate antigen 19.9 (CA 19.9), and C-reactive protein (CRP), highlighting its potential as an effective plasma biomarker for GC. Plasma DEK is also more sensitive in tumor detection than the other three biomarkers. Knockdown of DEK resulted in inhibition of GC cell migration via a mechanism involving modulation of matrix metalloproteinase MMP-2/MMP-9 level and vice versa. Our results collectively support plasma DEK as a useful biomarker for making diagnosis and prognosis of GC patients.
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Affiliation(s)
- Kam-Fai Lee
- Department of Pathology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
| | - Ming-Ming Tsai
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan; (M.-M.T.); (H.-L.H.)
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Chia-yi 613, Taiwan;
| | - Chung-Ying Tsai
- Department of Biochemistry, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (C.-Y.T.); (Y.-H.O.)
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chung-Guei Huang
- Department of Medical Biotechnology and Laboratory Science, and Graduate Institute of Biomedical Science, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Yu-Hsiang Ou
- Department of Biochemistry, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (C.-Y.T.); (Y.-H.O.)
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Ching-Chuan Hsieh
- Department of General Surgery, Chang Gung Memorial Hospital, Chia-yi 613, Taiwan;
| | - Hsi-Lung Hsieh
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan; (M.-M.T.); (H.-L.H.)
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chia-Siu Wang
- Department of General Surgery, Chang Gung Memorial Hospital, Chia-yi 613, Taiwan;
| | - Kwang-Huei Lin
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of Biochemistry, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (C.-Y.T.); (Y.-H.O.)
- Liver Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
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Li HY, Tsai MS, Huang CG, Wang RYL, Chuang LP, Chen NH, Liu CH, Hsu CM, Cheng WN, Lee LA. Alterations in Alzheimer's Disease-Associated Gene Expression in Severe Obstructive Sleep Apnea Patients. J Clin Med 2019; 8:jcm8091361. [PMID: 31480626 PMCID: PMC6780075 DOI: 10.3390/jcm8091361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA) increases the risk of Alzheimer’s disease (AD), and inflammation may be involved in the early pathogenesis of AD in patients with OSA. However, the potential pathways between OSA and AD have yet to be established. In this study, we aimed to investigate differential expressions of AD-associated genes in OSA patients without evident AD or dementia. Methods: This prospective case-control study included five patients with severe OSA and five age and sex-matched patients with non-severe OSA without evident dementia who underwent uvulopalatopharyngoplasty between 1 January 2013 and 31 December 2015. The expressions of genes associated with AD were analyzed using whole-exome sequencing. Unsupervised two-dimensional hierarchical clustering was performed on these genes. Pearson’s correlation was used as the distance metric to simultaneously cluster subjects and genes. Results: The expressions of CCL2, IL6, CXCL8, HLA-A, and IL1RN in the patients with severe OSA were significantly different from those in the patients with non-severe OSA and contributed to changes in the immune response, cytokine–cytokine receptor interactions, and nucleotide-binding oligomerization domain-like receptor signaling pathways. Conclusions: Inflammation may contribute to the onset of AD and physicians need to be aware of the potential occurrence of AD in patients with severe OSA.
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Affiliation(s)
- Hsueh-Yu Li
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ming-Shao Tsai
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Health Information and Epidemiology Laboratory, Chiayi, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 333, Taiwan.
- Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Robert Y L Wang
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 333, Taiwan
| | - Li-Pang Chuang
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Pulmonary and Critical Care Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ning-Hung Chen
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Pulmonary and Critical Care Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chi-Hung Liu
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wen-Nuan Cheng
- Department of Sports Sciences, University of Taipei, Taipei 111, Taiwan
| | - Li-Ang Lee
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
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Huang SY, Huang CH, Chen CJ, Chen TW, Lin CY, Lin YT, Kuo SM, Huang CG, Lee LA, Chen YH, Chen MF, Kuo RL, Shih SR. Novel Role for miR-1290 in Host Species Specificity of Influenza A Virus. Mol Ther Nucleic Acids 2019; 17:10-23. [PMID: 31173947 PMCID: PMC6554369 DOI: 10.1016/j.omtn.2019.04.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022]
Abstract
The role of microRNA (miRNA) in influenza A virus (IAV) host species specificity is not well understood as yet. Here, we show that a host miRNA, miR-1290, is induced through the extracellular signal-regulated kinase (ERK) pathway upon IAV infection and is associated with increased viral titers in human cells and ferret animal models. miR-1290 was observed to target and reduce expression of the host vimentin gene. Vimentin binds with the PB2 subunit of influenza A virus ribonucleoprotein (vRNP), and knockdown of vimentin expression significantly increased vRNP nuclear retention and viral polymerase activity. Interestingly, miR-1290 was not detected in either chicken cells or mouse animal models, and the 3′ UTR of the chicken vimentin gene contains no binding site for miR-1290. These findings point to a host species-specific mechanism by which IAV upregulates miR-1290 to disrupt vimentin expression and retain vRNP in the nucleus, thereby enhancing viral polymerase activity and viral replication.
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Affiliation(s)
- Sheng-Yu Huang
- Graduate Institute of Biomedical Science, Division of Biotechnology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chih-Heng Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; The Institute of Microbiology and Immunology, National Defense Medical Center, Taipei 11490, Taiwan; The Institute of Preventive Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chi-Jene Chen
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ting-Wen Chen
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu 30068, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, 30068, Taiwan
| | - Chun-Yuan Lin
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yueh-Te Lin
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, Taoyuan 33302, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shu-Ming Kuo
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chung-Guei Huang
- Graduate Institute of Biomedical Science, Division of Biotechnology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Hsiang Chen
- Graduate Institute of Biomedical Science, Division of Biotechnology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Mei-Feng Chen
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Rei-Lin Kuo
- Graduate Institute of Biomedical Science, Division of Biotechnology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan; Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan; Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan.
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Lee LA, Fang TJ, Li HY, Huang CG, Chen TC, Liao CT, Kang CJ, Chang KP, Yen TC. Low expression of pRB predicts disease relapse in early glottic cancer treated with transoral laser microsurgery. Laryngoscope 2018; 129:E220-E226. [PMID: 30382590 DOI: 10.1002/lary.27612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS To elucidate the associations among the immunohistochemical expression of tumor markers, clinicopathological variables, and disease-free survival (DFS) in patients with early-stage glottic squamous cell carcinoma (SCC) who underwent transoral laser microsurgery (TLM) as the primary treatment. STUDY DESIGN Retrospective chart review. METHODS The records of consecutive patients with Tis-T2N0 glottic SCC who underwent TLM between August 1, 2012 and October 31, 2015 were reviewed. Expression of Bcl-2, pRB, p16INK4A , p53, c-Myc, E-cadherin, and EGFR was examined using tissue microarrays containing tumor specimens through immunohistochemistry. Three-year DFS rates were calculated. RESULTS A total of 65 consecutive patients were identified, of which 28 were excluded due to insufficient tissue (n = 22) and low biomarker quality (n = 6). Therefore, 37 patients with complete records were included. The included patients were significantly older and had a more advanced type of cordectomy than did the excluded patients (P = .015 and .009, respectively). According to the findings of univariate analysis, age, betel quid chewing, type of cordectomy, BCL-2 expression, and pRB expression significantly predicted 3-year DFS. According to the findings of multivariate analysis, age (adjusted hazard ratio: 0.94, 95% CI: 0.88-1.00), betel quid chewing (adjusted hazard ratio: 5.07, 95% CI: 1.32-19.44), and pRB expression (adjusted hazard ratio: 0.02, 95% CI: 0.00-0.28) were independent predictors of 3-year DFS. CONCLUSIONS Low pRB expression is a potential biomarker for predicting disease relapse after primary TLM for early-stage glottic SCC and may help to identify high-risk patients who can subsequently undergo intensive management. LEVEL OF EVIDENCE 4 Laryngoscope, 129:E220-E226, 2019.
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Affiliation(s)
- Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Chung-Guei Huang
- the Department of Laboratory Medicine
- Department of Medical Biotechnology and Laboratory Science
- Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | | | - Chun-Ta Liao
- Department of Otorhinolaryngology-Head and Neck Surgery
| | | | | | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Linkou-Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Lu CT, Li HY, Lee GS, Huang YS, Huang CG, Chen NH, Lee LA. Snoring sound energy as a potential biomarker for disease severity and surgical response in childhood obstructive sleep apnoea: A pilot study. Clin Otolaryngol 2018; 44:47-52. [PMID: 30260574 DOI: 10.1111/coa.13231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/07/2018] [Accepted: 09/23/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the relationship between baseline snoring sound energy (SSE) and disease severity, changes in SSE after adenotonsillectomy, and the predictors of surgical success in children with obstructive sleep apnoea (OSA). DESIGN Prospective cohort study. SETTING Tertiary referral medical centre. PARTICIPANTS Thirty-two children with OSA whose apnoea-hypopnoea index ≥5 or apnoea-hypopnoea index ≥1.5 with OSA comorbidities were recruited. Patients with complicated OSA were excluded. All participants underwent snoring sound analysis, polysomnography, and adenotonsillectomy. MAIN OUTCOME MEASURES Snoring sound energy and apnoea-hypopnoea index were assessed at baseline and 6 months after adenotonsillectomy. Surgical success was defined as a postoperative apnoea-hypopnoea index <1.5. RESULTS The median age, body mass index, and apnoea-hypopnoea index was 9 years, 19.0 kg/m2 , and 13.2 events/h, respectively. Multivariate logistic regression showed that a baseline tonsil size of IV (odds ratio 15.7 [95% CI: 1.5-166.3]) and SSE of 801-1000 Hz > 21.9 dB (odds ratio 32.3 [95% CI: 2.6-396.6]) were significantly related to severe OSA. Following adenotonsillectomy, apnoea-hypopnoea index decreased significantly (P < 0.001). SSE of 41-200 Hz, 201-400 Hz and 801-1000 Hz also decreased significantly (P = 0.04, 0.01 and 0.006, respectively). Baseline SSE of 801-1000 Hz < 8.5 dB significantly predicted surgical success (odds ratio 11.0 [95% CI: 1.4-85.2]). CONCLUSIONS Our findings suggest the potential utility of SSE of 801-1000 Hz to screen for severe OSA, predict surgical success and assess therapeutic outcomes. Specific baseline SSE may represent a potential biomarker for childhood OSA.
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Affiliation(s)
- Chun-Ting Lu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Guo-She Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - Yu-Shu Huang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Child Psychiatry, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Ning-Hung Chen
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Internal Medicine, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
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Lee LA, Wang CJ, Lo YL, Huang CG, Kuo IC, Lin WN, Hsin LJ, Fang TJ, Li HY. Drug-Induced Sleep Computed Tomography-Directed Upper Airway Surgery for Obstructive Sleep Apnea: A Pilot Study. Otolaryngol Head Neck Surg 2018; 160:172-181. [PMID: 30226110 DOI: 10.1177/0194599818800288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE A surgical response to upper airway (UA) surgery for obstructive sleep apnea (OSA) depends on adequate correction of collapsible sites in the UA. This pilot study aimed to examine the surgical response to UA surgery directed by drug-induced sleep computed tomography (DI-SCT) for OSA. STUDY DESIGN Prospective case series. SETTING Tertiary referral center. SUBJECTS AND METHODS This study recruited 29 OSA patients (median age, 41 years; median body mass index, 26.9 kg/m2) who underwent single-stage DI-SCT-directed UA surgery between October 2012 and September 2014. DI-SCT was performed with propofol for light sedation with a bispectral monitor before and after UA surgery. Nonresponders were defined as those with a reduction in apnea-hypopnea index <50% after 6 months following UA surgery. RESULTS DI-SCT showed that 28 (97%) patients had collapses at multiple sites, all of whom underwent multilevel UA surgery accordingly. The apnea-hypopnea index decreased from 53.6 to 26.8 ( P < .001). There were 18 (62%) nonresponders and 11 (38%) responders. Multiple-site collapses could not predict surgical response ( P > .99). The nonresponders had significant improvements in velopharyngeal, oropharyngeal lateral wall, and tongue collapses (all P < .05), whereas the responders had significant improvements in velopharyngeal and oropharyngeal lateral wall collapses (both P ≤ .05). CONCLUSION Despite multilevel OSA surgery, residual UA obstruction in nonresponders likely occurs due to multiple mechanisms. DI-SCT may help to elucidate the reasons for a nonresponse.
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Affiliation(s)
- Li-Ang Lee
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,2 Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Jan Wang
- 2 Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,3 Department of Medical Imaging and Intervention, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Lun Lo
- 2 Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,4 Department of Thoracic Medicine, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- 5 Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,6 Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - I-Chun Kuo
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,2 Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ni Lin
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,2 Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Hsin
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,2 Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,2 Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,2 Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Kuo RL, Chen CJ, Tam EH, Huang CG, Li LH, Li ZH, Su PC, Liu HP, Wu CC. Interactome Analysis of NS1 Protein Encoded by Influenza A H7N9 Virus Reveals an Inhibitory Role of NS1 in Host mRNA Maturation. J Proteome Res 2018; 17:1474-1484. [PMID: 29558158 DOI: 10.1021/acs.jproteome.7b00815] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Influenza A virus infections can result in severe respiratory diseases. The H7N9 subtype of avian influenza A virus has been transmitted to humans and caused severe disease and death. Nonstructural protein 1 (NS1) of influenza A virus is a virulence determinant during viral infection. To elucidate the functions of the NS1 encoded by influenza A H7N9 virus (H7N9 NS1), interaction partners of H7N9 NS1 in human cells were identified with immunoprecipitation followed by SDS-PAGE coupled with liquid chromatography-tandem mass spectrometry (GeLC-MS/MS). We identified 36 cellular proteins as the interacting partners of the H7N9 NS1, and they are involved in RNA processing, mRNA splicing via spliceosome, and the mRNA surveillance pathway. Two of the interacting partners, cleavage and polyadenylation specificity factor subunit 2 (CPSF2) and CPSF7, were confirmed to interact with H7N9 NS1 using coimmunoprecipitation and immunoblotting based on the previous finding that the two proteins are involved in pre-mRNA polyadenylation machinery. Furthermore, we illustrate that overexpression of H7N9 NS1, as well as infection by the influenza A H7N9 virus, interfered with pre-mRNA polyadenylation in host cells. This study comprehensively profiled the interactome of H7N9 NS1 in host cells, and the results demonstrate a novel endotype for H7N9 NS1 in inhibiting host mRNA maturation.
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Affiliation(s)
- Rei-Lin Kuo
- Department of Medical Biotechnology and Laboratory Science, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan.,Research Center for Emerging Viral Infections, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan.,Division of Asthma, Allergy, and Rheumatology, Department of Pediatrics , Chang Gung Memorial Hospital , Linkou, Taoyuan 33302 , Taiwan.,Graduate Institute of Biomedical Sciences, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan
| | - Chi-Jene Chen
- Department of Medical Laboratory Science and Biotechnology , China Medical University , Taichung 40402 , Taiwan.,Research Center for Emerging Viruses , China Medical University Hospital , Taichung 40402 , Taiwan
| | - Ee-Hong Tam
- Department of Medical Biotechnology and Laboratory Science, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan.,Graduate Institute of Biomedical Sciences, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan
| | - Chung-Guei Huang
- Department of Medical Biotechnology and Laboratory Science, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan.,Graduate Institute of Biomedical Sciences, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan.,Department of Laboratory Medicine , Chang Gung Memorial Hospital , Linkou, Taoyuan 33302 , Taiwan
| | - Li-Hsin Li
- Department of Medical Biotechnology and Laboratory Science, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan
| | - Zong-Hua Li
- Department of Medical Biotechnology and Laboratory Science, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan
| | - Pei-Chia Su
- Department of Medical Biotechnology and Laboratory Science, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan
| | - Hao-Ping Liu
- Department of Veterinary Medicine , National Chung Hsing University , Taichung 40227 , Taiwan
| | - Chih-Ching Wu
- Department of Medical Biotechnology and Laboratory Science, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan.,Graduate Institute of Biomedical Sciences, College of Medicine , Chang Gung University , Taoyuan 33302 , Taiwan.,Department of Otolaryngology-Head & Neck Surgery , Chang Gung Memorial Hospital , Linkou, Taoyuan 33302 , Taiwan
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Huang CG, Lee LA, Liao CT, Yen TC, Yang SL, Liu YC, Li JC, Gong YN, Kang CJ, Huang SF, Fang KH, Chang KP, Lee LY, Hsueh C, Shih SR, Tsao KC. Molecular and serologic markers of HPV 16 infection are associated with local recurrence in patients with oral cavity squamous cell carcinoma. Oncotarget 2018; 8:34820-34835. [PMID: 28422732 PMCID: PMC5471014 DOI: 10.18632/oncotarget.16747] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/20/2017] [Indexed: 01/11/2023] Open
Abstract
Human papillomavirus (HPV) infections predict mortality in Taiwanese patients with oral cavity squamous cell carcinoma (OCSCC). To address their prognostic significance for local recurrence (LR), in this retrospective cohort study we investigated different serologic and molecular markers of HPV 16 infection in 85 consecutive patients with primary OCSCC who received standard treatment and had their sera stored before treatment. Resected tumor specimens were examined with PCR-based assays for HPV 16 E6/E7 mRNA expression. Sera were tested with suspension arrays for the presence of HPV-specific antibodies using synthetic L1 and E6 peptides as well as a synthetic E7 protein. HPV 16 E6/E7 mRNA, anti-L1, anti-E6, and anti-E7 antibodies tested positive in 12%, 25%, 38%, and 41% of the study patients, respectively. Multivariate analysis identified pathological T3/T4, E6/E7 mRNA, and anti-E7 antibodies as independent risk factors for LR, whereas anti-E6 antibodies were an independent protective factor. In patients with ≥ 3 (high-risk group), 2 (intermediate-risk), and ≤ 1 (low-risk) independent risk factors (predictors), the 5-year LR rates were 75%, 42%, and 4%, respectively. Results were validated in an independent cohort. Together, our preliminary data indicate that HPV 16 infections as well as low and high serum levels of anti-E6 and anti-E7 antibodies, respectively, can serve as biomarkers of LR in patients with OCSCC, whereas the clinical usefulness of anti-HPV 16 antibodies for risk stratification of newly diagnosed cases deserves further scrutiny.
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Affiliation(s)
- Chung-Guei Huang
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Ang Lee
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chun-Ta Liao
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Tzu-Chen Yen
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Molecular Imaging Center, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Shu-Li Yang
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yi-Chun Liu
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Jung-Chin Li
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Nong Gong
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chung-Jan Kang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Shiang-Fu Huang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Ku-Hao Fang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Kai-Ping Chang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Pathology, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chuen Hsueh
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Pathology, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Shin-Ru Shih
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan, ROC
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Lee LA, Wang SL, Chao YP, Tsai MS, Hsin LJ, Kang CJ, Fu CH, Chao WC, Huang CG, Li HY, Chuang CK. Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology-Head and Neck Surgery Disorders: Pilot Randomized Controlled Trial. JMIR Med Educ 2018; 4:e8. [PMID: 29519776 PMCID: PMC5865003 DOI: 10.2196/mededu.9237] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module or a conventional PowerPoint show (PPS) module using M-TEL to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. OBJECTIVE The aim of this study was to compare the impact of a novel IM module with a conventional PPS module using M-TEL for emergent ORL-HNS disorders with regard to learning outcomes, satisfaction, and learning experience. METHODS This pilot study was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of the two groups matched by age, sex, and cognitive style: the IM group and the PPS group. During the 100-min learning period, the participants were unblinded to use the IM or PPS courseware on a 7-inch tablet. Pretests and posttests using multiple-choice questions to evaluate knowledge and multimedia situational tests to evaluate competence were administered. Participants evaluated their satisfaction and learning experience by the AttrakDiff2 questionnaire, and provided feedback about the modules. RESULTS Overall, the participants had significant gains in knowledge (median of percentage change 71, 95% CI 1-100, P<.001) and competence (median of percentage change 25, 95% CI 0-33, P=.007) after 100 min of learning. Although there was no significant difference in knowledge gain between the two groups (median of difference of percentage change 24, 95% CI -75 to 36; P=.55), competence gain was significantly lower in the IM group compared with the PPS group (median of difference of percentage change -41, 95% CI -67 to -20; P=.008). However, the IM group had significantly higher scores of satisfaction (difference 2, 95% CI 2-4; P=.01), pragmatic quality (difference 1.7, 95% CI 0.1-2.7; P=.03), and hedonic stimulation (difference 1.9, 95% CI 0.3-3.1; P=.01) compared with the PPS group. Qualitative feedback indicated that the various games in the IM module attracted the participants' attention but that the nonlinearly arranged materials affected their learning. CONCLUSIONS Using M-TEL for undergraduate medical education on emergent ORL-HNS disorders, an IM module seems to be useful for gaining knowledge, but competency may need to occur elsewhere. While the small sample size reduces the statistical power of our results, its design seems to be appropriate to determine the effects of M-TEL using a larger group. TRIAL REGISTRATION ClinicalTrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV).
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Affiliation(s)
- Li-Ang Lee
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Ling Wang
- Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Digital Learning and Education, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Medical Mechatronics, Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Jen Hsin
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Hsiang Fu
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chieh Chao
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, Chang-Gung University, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Keng Chuang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Huang CG, Lee LA, Wu YC, Hsiao MJ, Horng JT, Kuo RL, Huang CH, Lin YC, Tsao KC, Chen MC, Chen TC, Shih SR. A pilot study on primary cultures of human respiratory tract epithelial cells to predict patients' responses to H7N9 infection. Oncotarget 2018; 9:14492-14508. [PMID: 29581859 PMCID: PMC5865685 DOI: 10.18632/oncotarget.24537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/10/2018] [Indexed: 12/23/2022] Open
Abstract
Avian influenza A(H7N9) virus infections frequently lead to acute respiratory distress syndrome and death in humans. We aimed to investigate whether primary cultures of human respiratory tract epithelial cells are helpful to understand H7N9 virus pathogenesis and tissue tropism, and to evaluate how patient-related characteristics can affect the host's response to infection. Normal human bronchial epithelial cells (isolated from two different donors) and primary epithelial cells (harvested from 27 patients undergoing airway surgery) were experimentally infected with H7N9 and/or H1N1pdm for 72 h. After virus infection, the culture media were collected for viral RNA quantitation and cytokine detection. Both H7N9 and H1N1pdm viruses replicated and induced a cytokine response differently for each donor in the normal human bronchial epithelial model. H7N9 replicated equivalently in epithelial cells harvested from the inferior turbinate and paranasal sinus, and those from the larynx and bronchus, at 72 h post-infection. Viral RNA quantity at 72 h was significantly higher in patients aged 21-64 years than in patients aged ≥ 65 years; however, no effects of sex, medical comorbidities, and obesity were noted. H7N9-infected cultured cells released multiple cytokines within 72 h. Levels of interleukin-1β, interleukin-6, interleukin-8, interferon-γ, and tumor necrosis factor-α were associated differently with patient-related characteristics (such as age, sex, obesity, and medical comorbidities). In the era of precision medicine, these findings illustrate the potential utility of this primary culture approach to predict a host's response to H7N9 infection or to future infection by newly emerging viral infections, and to dissect viral pathogenesis.
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Affiliation(s)
- Chung-Guei Huang
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
| | - Li-Ang Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC
| | - Yi-Cheng Wu
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33305, Taiwan, ROC
| | - Mei-Jen Hsiao
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
| | - Jim-Tong Horng
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Department of Biochemistry and Molecular Biology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC
| | - Rei-Lin Kuo
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC
| | - Chih-Heng Huang
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Institute of Preventive Medicine, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Ya-Chu Lin
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
| | - Kuo-Chien Tsao
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
| | - Min-Chi Chen
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan 33302, Taiwan, ROC
| | - Tse-Ching Chen
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33305, Taiwan, ROC
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
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50
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Lee LA, Chao YP, Huang CG, Fang JT, Wang SL, Chuang CK, Kang CJ, Hsin LJ, Lin WN, Fang TJ, Li HY. Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial. J Med Internet Res 2018; 20:e56. [PMID: 29439943 PMCID: PMC5829454 DOI: 10.2196/jmir.8987] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/13/2017] [Accepted: 12/01/2017] [Indexed: 12/03/2022] Open
Abstract
Background Electronic learning (e-learning) through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes and satisfaction in millennial medical students is unknown. Objective The aim of this study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, and satisfaction for emergent ORL-HNS disorders. Methods This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the group embedded figures test. The students were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional Microsoft PowerPoint show (PPS) group matched by age, sex, and cognitive style. The content for the gamified IM module was derived from and corresponded to the textbook-based learning material of the PPS module (video lectures). The participants were unblinded and used fully automated courseware containing the IM or PPS module on a 7-inch tablet for 100 min. Knowledge and competence were assessed using multiple-choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction. Results All of the participants (median age 23 years, range 22-26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, interquartile range [IQR]=17%-80%, P<.001) and competence (median 13%, IQR=0%-33%, P=.006). There were no significant differences in knowledge gain (40%, IQR=13%-76% vs 60%, IQR=20%-100%, P=.42) and competence gain (0%, IQR= −21% to 38% vs 25%, IQR=0%-33%, P=.16) between the IM and PPS groups. However, the IM group had a higher satisfaction score (8, IQR=6-9 vs 6, IQR=4-7, P=.01) compared with the PPS group. Using Friedman’s two-way nonparametric analysis of variance, cognitive styles (field-independent, field-intermediate, or field-dependent classification) and learning modules (IM or PPS) had significant effects on both knowledge gain (both adjusted P<.001) and satisfaction (both adjusted P<.001). Conclusions Mobile e-learning is an effective modality to improve knowledge of emergent ORL-HNS in millennial undergraduate medical students. Our findings suggest the necessity of developing various modules for undergraduate medical students with different cognitive styles. Trial Registration Clinicaltrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV)
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Affiliation(s)
- Li-Ang Lee
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Department of Computer Science and Information Engineering, Graduate Institute of Medical Mechatronics, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang-Gung University, Taoyuan, Taiwan
| | - Ji-Tseng Fang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Ling Wang
- Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Digital Learning and Education, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Cheng-Keng Chuang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Jen Hsin
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wan-Ni Lin
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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