Effectiveness and evolution of anti-SARS-CoV-2 spike protein titers after three doses of COVID-19 vaccination in people with HIV.

BACKGROUND: Real-world vaccine effectiveness following the third dose of vaccination against SARS-CoV-2 remains less investigated among people with HIV (PWH). METHODS: PWH receiving the third dose of BNT162b2 and mRNA-1273 (either 50- or 100-µg) were enrolled. Participants were followed for 180 days until the fourth dose of COVID-19 vaccination, SARS-CoV-2 infection, seroconversion of anti-nucleocapsid IgG, death, or loss to follow-up. Anti-spike IgG was determined every 1-3 months. RESULTS: Of 1427 participants undergoing the third-dose COVID-19 vaccination, 632 (44.3%) received 100-µg mRNA-1273, 467 (32.8%) 50-µg mRNA-1273, and 328 (23.0%) BNT162b2 vaccine and the respective rate of SARS-CoV-2 infection or seroconversion of anti-nucleocapsid IgG was 246.1, 280.8 and 245.2 per 1000 person-months of follow-up (log-rank test, p = 0.28). Factors associated with achieving anti-S IgG titers >1047 BAU/mL included CD4 count <200 cells/mm3 (adjusted odds ratio [aOR], 0.11; 95% CI, 0.04-0.31), plasma HIV RNA >200 copies/mL (aOR, 0.27; 95% CI, 0.09-0.80), having achieved anti-spike IgG >141 BAU/mL within 3 months after primary vaccination (aOR, 3.69; 95% CI, 2.68-5.07), receiving BNT162b2 vaccine as the third dose (aOR, 0.20; 95% CI, 0.10-0.41; reference, 100-µg mRNA-1273), and having previously received two doses of mRNA vaccine in primary vaccination (aOR, 2.46; 95% CI, 1,75-3.45; reference, no exposure to mRNA vaccine). CONCLUSIONS: PWH receiving different types of the third dose of COVID-19 vaccine showed similar vaccine effectiveness against SARS-CoV-2 infection. An additional dose with 100-µg mRNA-1273 could generate a higher antibody response than with 50-µg mRNA-1273 and BNT162b2 vaccine.

Effect of early dexamethasone on outcomes of COVID-19: A quasi-experimental study using propensity score matching.

BACKGROUND: The RECOVERY trial demonstrated that the use of dexamethasone is associated with a 36% lower 28-day mortality in hospitalized patients with COVID-19 on invasive mechanical ventilation. Nevertheless, the optimal timing to start dexamethasone remains uncertain. METHODS: We conducted a quasi-experimental study at National Taiwan University Hospital (Taipei, Taiwan) using propensity score matching to simulate a randomized controlled trial to receive or not to receive early dexamethasone (6 mg/day) during the first 7 days following the onset of symptoms. Treatment was standard protocol-based, except for the timing to start dexamethasone, which was left to physicians' decision. The primary outcome is 28-day mortality. Secondary outcomes include secondary infection within 60 days and fulfilling the criteria of de-isolation within 20 days. RESULTS: A total of 377 patients with COVID-19 were enrolled. Early dexamethasone did not decrease 28-day mortality in all patients (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.97-1.10) or in patients who required O2 for severe/critical disease at admission (aOR, 1.05; 95%CI, 0.94-1.18); but is associated with a 24% increase in superinfection in all patients (aOR, 1.24; 95% CI, 1.12-1.37) and a 23% increase in superinfection in patients of O2 for several/critical disease at admission (aOR, 1.23; 95% CI, 1.02-1.47). Moreover, early dexamethasone is associated with a 42% increase in likelihood of delayed clearance of SARS-CoV-2 virus (adjusted hazard ratio, 1.42; 95% CI, 1.01-1.98). CONCLUSION: An early start of dexamethasone (within 7 days after the onset of symptoms) could be harmful to hospitalized patients with COVID-19.

Reversibly reconfigurable GSST metasurface for broadband beam steering and achromatic focusing in the long-wave infrared.

Active optical metasurfaces promise compact, lightweight, and energy-efficient optical systems with unprecedented performance. Chalcogenide phase-change material Ge2Sb2Se4Te1 (GSST) has shown tremendous advantages in the design of mid-infrared active metasurfaces. However, most of the GSST-based active metasurfaces can only work efficiently within a narrow frequency range. Furthermore, their design flexibility and reversible switching capability are severely restricted by the melting of GSST during re-amorphization. Here, we propose broadband, reversibly tunable, GSST-based transmissive metasurfaces operating in the long-wave infrared spectrum, where the GSST micro-rods are cladded by refractory materials. To accurately evaluate the performance of the proposed metasurfaces, two figures of merits are defined: FOMΦ for the evaluation of wavefront matching, and FOMop for the assessment of the overall performance incorporating both wavefront modulation efficiency and switching contrast ratio. For the proof of concept, two meta-devices are numerically presented: a multifunctional deflector that offers continuous beam steering and long-wave pass filtering simultaneously, and a large-area (1 cm × 1 cm) broadband (11-14 µm) varifocal metalens with the ability of achromatic imaging (12.5-13.5 µm). In particular, the metalens features high FOMop values over 16 dB in the achromatic band, with the average focusing efficiency approximating 70% (60%) in amorphous (crystalline) state and a spectral switching contrast ratio surpassing 25 dB. Our design scheme provides an additional degree of freedom for dynamic modulation and offers a novel approach for achieving high-efficiency mid-infrared compact optical devices.

[Experience Providing Psychological Care to an HIV-Positive Patient With SARS-CoV-2 Infection].

Infectious diseases are often stigmatized and criminalized because of the way they are transmitted. An experience providing care to a 37-year-old patient with human immunodeficiency virus (HIV) infection who was admitted to a medical center's quarantine ward in July 2021 due to SARS-CoV-2 infection is described in this article. This patient lived with his mother, who was later diagnosed with COVID-19 as well. He was worried about his mother's health condition and, meanwhile, feared that information about his diseases and person would be exposed by the media. These stressors led to increased feelings of shame and anxiety and to situational low self-esteem. Several interventions were provided, including education regarding the importance of personal hygiene and of maintaining combination antiretroviral therapy (cART) to bolster immune system functions. During the isolation period, the nurses most regularly interacted with the patient directly. Thus, we worked to build the nurse-patient relationship by listening to the patient's worries, guaranteeing his privacy would not be compromised, and guiding him to express his emotions to reduce anxiety and enhance confidence. This experience demonstrated the importance of providing psychological care to COVID-19/HIV co-infected patients. We suggest that the government and media distribute correct and neutral information to destigmatize communicable diseases and to foster a friendlier healthcare environment.

Dielectric metalens for miniaturized imaging systems: progress and challenges.

Lightweight, miniaturized optical imaging systems are vastly anticipated in these fields of aerospace exploration, industrial vision, consumer electronics, and medical imaging. However, conventional optical techniques are intricate to downscale as refractive lenses mostly rely on phase accumulation. Metalens, composed of subwavelength nanostructures that locally control light waves, offers a disruptive path for small-scale imaging systems. Recent advances in the design and nanofabrication of dielectric metalenses have led to some high-performance practical optical systems. This review outlines the exciting developments in the aforementioned area whilst highlighting the challenges of using dielectric metalenses to replace conventional optics in miniature optical systems. After a brief introduction to the fundamental physics of dielectric metalenses, the progress and challenges in terms of the typical performances are introduced. The supplementary discussion on the common challenges hindering further development is also presented, including the limitations of the conventional design methods, difficulties in scaling up, and device integration. Furthermore, the potential approaches to address the existing challenges are also deliberated.

Frequency-tunable terahertz angular selectivity based on a dielectric-graphene multilayer structure.

To achieve frequency-tunable angular selectivity at terahertz frequencies, a tunable epsilon-near-zero (ENZ) metamaterial based on a subwavelength dielectric-graphene multilayer structure is designed. The ENZ frequency of the dielectric-graphene multilayer can be dynamically tuned by the gate voltage applied to graphene. Transmittance angular spectra show that only the incident lights close to normal incidence can propagate through the structure while other incident lights cannot, which indicates that our structure can be utilized for frequency-tunable terahertz angular selection. The optimal directivity D reaches 183 and the transmittance at normal incidence reaches 0.462. This multilayer-based tunable terahertz ENZ metamaterial will possess potential application prospects in tunable highly directive antennas.

[Nursing Experience Caring for a COVID-19 Patient With Hearing Loss].

The focus of this article is on a male patient with hearing loss who was diagnosed with COVID-19 after returning to Taiwan from overseas. Due to the severe pneumonia infiltration, the patient received the clinical-trial treatment Remdesivir. In addition to facing the isolation and new-drug-related anxieties of the patient, the medical team faced difficulties in communicating effectively with the patient and in helping him through the isolation period. During the period of hospitalization (March 14th to April 13th, 2020), the author used Roy's adaptation model to perform a nursing assessment, which confirmed that the patient faced the following problems: (1) ineffective breathing pattern related to COVID-19, (2) impaired verbal communication related to hearing impairment, and (3) social isolation related to the isolation experience and the communication barrier with healthcare workers. During the nursing care process, the author helped the patient receive the antiviral treatment and taught him how to do diaphragmatic breathing in a comfortable, recumbent position to improve his breathing pattern. To reduce the difficulty of communication, the author made a pile of cards with common care-related words, provided pen and paper to write, and used a mobile-phone-based social-networking application to communicate with the patient. The author used writing to communicate with the patient and learned some simple signs from him to enable interaction. Moreover, the intervention helped him adapt to the isolation and treatment protocols to reach holistic nursing care. Based on this experience, the author suggests that hospitals cooperate with sign language organizations to teach healthcare workers simple communication skills, including sign language and cards to provide more complete care for patients with hearing loss during hospitalization.

Circular-polarization-sensitive absorption in refractory metamaterials composed of molybdenum zigzag arrays.

Circularly polarized light (CPL) is utilized in various fields, including optical communication and biological imaging. To overcome the lack of circular-polarization-sensitive absorbers working at high temperature, a refractory and circular-polarization-sensitive absorber comprised of molybdenum zigzag arrays is proposed. At certain resonant wavelengths, one component of circular polarization is absorbed by confining electromagnetic field in the dielectric layer, while the other component is backscattered. The circular-polarization-sensitive absorber could be applied as a CPL thermal radiator as well as a reflective linear-to-circular polarizer. As a CPL thermal radiator, left-handed circular radiation and right-handed circular radiation are dominant at different temperatures, respectively. As a linear-to-circular polarizer, both perfect left-handed circularly polarized light and nearly perfect right-handed circularly polarized light are obtained.

Nonvolatile tunable silicon-carbide-based midinfrared thermal emitter enabled by phase-changing materials.

Polar crystals can enable strong light-matter interaction at an infrared regime and provide many practical applications including thermal emission. However, the dynamic control of thermal emission based on polar crystals remains elusive as the lattice vibrations are solely determined by the crystal structure. Here, a nonvolatile tunable midinfrared thermal emitter enabled by a phase-changing film Ge2Sb2Te5 on silicon carbide polar crystal is demonstrated. By controlling the state of Ge2Sb2Te5 from an amorphous to a crystalline state, the emissivity of the thermal emitter is tuned from a low value to near unity with a maximum change in peak emissivity exceeding 10 dB over the Reststrahlen band of SiC (11.4 µm to 12.3 µm). This nonvolatile tunable thermal emitter, which presents a lot of advantages in terms of tunability, zero static power, angular insensitivity, and ease of fabrication, can be potentially applied for light sources, infrared camouflage, and radiative cooling devices.

Thermal camouflage based on the phase-changing material GST.

Camouflage technology has attracted growing interest for many thermal applications. Previous experimental demonstrations of thermal camouflage technology have not adequately explored the ability to continuously camouflage objects either at varying background temperatures or for wide observation angles. In this study, a thermal camouflage device incorporating the phase-changing material Ge2Sb2Te5 (GST) is experimentally demonstrated. It has been shown that near-perfect thermal camouflage can be continuously achieved for background temperatures ranging from 30 °C to 50 °C by tuning the emissivity of the device, which is attained by controlling the GST phase change. The thermal camouflage is robust when the observation angle is changed from 0° to 60°. This demonstration paves the way toward dynamic thermal emission control both within the scientific field and for practical applications in thermal information.

Tunable angle-independent refractive index sensor based on Fano resonance in integrated metal and graphene nanoribbons.

We propose a novel mechanism to construct a tunable and ultracompact refractive index sensor by using the Fano resonance in metal-graphene hybrid nanostructure. Plasmon modes in graphene nanoribbons and waveguide resonance modes in the slits of metal strip array coexist in this system. Strong interference between the two different modes occurs when they are spectrally overlapped, resulting in a Fano-type asymmetrically spectral lineshape which can be used for detecting the variations of ambient refractive index. The proposed sensor has a relatively high figure of merit (FOM) over 20 and its sensing performance shows a good tolerance to roughness. In addition to the wide range measurement enabled by the electrical tuning of graphene plasmon modes, such ultracompact system also provides an angle-independent operation and therefore, it can efficiently work for the detection of gas, liquid, or solids. Such optical nanostructure may also be applied to diverse fields such as temperature/pressure metering, medical detection, and mechanical precision measurement.

Medication-overuse headache in China: clinical profile, and an evaluation of the ICHD-3 beta diagnostic criteria.

BACKGROUND: Although medication-overuse headache (MOH) is common in China, its clinical profile is not yet fully established. Meanwhile, ICHD-3 beta has been published, but its diagnostic criteria require further validation. METHODS: We retrospectively classified the clinical features of 240 consecutive patients with MOH (55 males, 185 females), whose demographic data, headache features, overused medications (type, quantity, frequency and duration of use), headache-attributed burden, and outcomes were reviewed. We then applied the criteria of the several versions of ICHD (II, IIR and 3-beta) to these patients. RESULTS: Compared with those with other headaches, patients with MOH were more likely to be less well educated (64.6% vs 42.0% for secondary school or lower, p < 0.0001), and on lower annual incomes (72.3% vs 56.0% for an income of Chinese yuan (CNY) 30,000 or less, p < 0.0001). Combination analgesics were the most commonly overused medications, and, caffeine (89.9%), aminopyrine (70.0%), phenacetin (53.9%) and phenobarbital (48.8%) were the most commonly used specific components of these. Only two patients (0.8%) had previously been given the diagnosis of MOH; accordingly, the median time to diagnosis after the estimated onset of the disorder was 4.0 years. The majority of patients (83.7%) improved with treatment. All 240 patients fulfilled the diagnostic criteria for MOH according to ICHD-3 beta; only 134 (55.8%) satisfied the diagnostic criteria for definite MOH according to ICHD-II, while 195 (81.2%) met those of ICHD-IIR. CONCLUSIONS: MOH in China is associated with lower educational level and annual income. MOH has rarely been diagnosed and correctly treated in China. ICHD-3 beta appears to be more appropriate for the diagnosis of MOH than previous versions.

Quantitative measurement of phase variation amplitude of ultrasonic diffraction grating based on diffraction spectral analysis.

A new method based on diffraction spectral analysis is proposed for the quantitative measurement of the phase variation amplitude of an ultrasonic diffraction grating. For a traveling wave, the phase variation amplitude of the grating depends on the intensity of the zeroth- and first-order diffraction waves. By contrast, for a standing wave, this amplitude depends on the intensity of the zeroth-, first-, and second-order diffraction waves. The proposed method is verified experimentally. The measured phase variation amplitude ranges from 0 to 2π, with a relative error of approximately 5%. A nearly linear relation exists between the phase variation amplitude and driving voltage. Our proposed method can also be applied to ordinary sinusoidal phase grating.

Higher prevalence of migraine in essential tremor: a case-control study.

BACKGROUND: The existence of an association between migraine and essential tremor has long been controversial. The prevalence of migraine in essential tremor patients was surveyed to explore the association between the two diseases. METHODS: A case-control clinical study was conducted to investigate the prevalence of migraine in 150 consecutive essential tremor patients and in 150 matched controls without tremor. Detailed information about essential tremor and migraine was obtained using a structured questionnaire at a face-to-face interview. Moreover, a functional variant of the dopamine receptor D3 gene (Ser9Gly, rs6280) was studied in 46 essential tremor patients with and without migraine using direct sequencing analysis. RESULTS: The prevalence of lifetime migraine in essential tremor patients was significantly higher than that in controls (22.0% vs. 12.7%; p=0.035; odds ratio=1.95; 95% confidence interval=1.05-3.60). No significant difference was found in the migraine features between the essential tremor and control groups and most tremor characteristics were no different in essential tremor patients with and without migraine. A higher male prevalence of essential tremor patients without migraine was observed. Moreover, 44 of 46 (95.7%) essential tremor patients had the dopamine receptor D3 Ser9Gly variant, but no significant difference was found in the frequencies of the variant between essential tremor patients with and without migraine (87.5% vs. 100.0%; p=0.22). CONCLUSION: Our data suggest that essential tremor patients have a higher risk of lifetime migraine than do controls and the dopamine receptor D3 Ser9Gly variant may be lower in essential tremor with migraine than the general essential tremor patients.

Blockade of Nav1.8 currents in nociceptive trigeminal neurons contributes to anti-trigeminovascular nociceptive effect of amitriptyline.

Amitriptyline (AMI), a tricyclic antidepressant, has been widely used to prevent migraine attacks and alleviate other various chronic pain, but the underlying mechanism remains unclear. Accumulated evidence suggests that the efficacy of AMI is related to the blockade of voltage-gated sodium channels. The aim of the present study was to investigate the effect of AMI on Na(v)1.8 currents in nociceptive trigeminal neurons and trigeminovascular nociception induced by electrical stimulation of the dura mater surrounding the superior sagittal sinus (SSS) in rats, as in the animal model of vascular headaches such as migraines. Using a whole-cell voltage recording technique, we showed that Na(v)1.8 currents were blocked by AMI in a concentration-dependent manner, with an IC50 value of 6.82 µM in acute isolated trigeminal ganglion neurons of the rats. AMI caused a hyperpolarizing shift in the voltage-dependent activation and steady-state inactivation and significantly blocked in a use-dependent manner and slowed the recovery from the inactivation of Na(v)1.8 currents. In addition, the systemic administration of AMI and A-803467 (a selective Na(v)1.8 channel blocker) potently alleviated the nociceptive behaviors (head flicks and grooming) induced by the electrical stimulation of the dura mater surrounding the SSS. Taken together, our data suggest that Na(v)1.8 currents in nociceptive trigeminal neurons are blocked by AMI through modulating the activation and inactivation kinetics, which may contribute to anti-nociceptive effect of AMI in animal models of migraines.

Effects of UCMS-induced depression on nociceptive behaviors induced by electrical stimulation of the dura mater.

The comorbidity between migraine and depression not only provides a major treatment challenge, but also represents a heavy burden on society. However, the relationship between depression and migraine and their molecular biological mechanisms remain unclear. This study investigated the effects of depression elicited by unpredictable chronic mild stress (UCMS) on trigeminovascular nociception in conscious rats and detected a concentration of calcitonin gene-related peptide (CGRP) and substance P (SP) in the external jugular vein. We divided the rats into four groups: control-stimulated (C/S), control-nonstimulated (C/NS), UCMS-stimulated (U/S), and UCMS-nonstimulated (U/NS). We stimulated the dura mater adjacent to the superior sagittal sinus of rats in the C/S and U/S groups and observed their nociceptive behaviors. We found significant differences between the UCMS and control groups in weight, sucrose preference, and locomotor behavior. Nociceptive behaviors (number of head flicks and head-turning time) were significantly increased in the U/S compared with the C/S group, and head-turning time correlated with depressive-like behaviors. The plasma level of SP was increased significantly in the U/NS compared with the C/NS group. However, no significant differences involving the other groups were observed. UCMS-induced depression can exacerbate trigeminovascular nociception, making rats more sensitive to pain.

Clinical profile of cluster headaches in China - a clinic-based study.

BACKGROUND: The clinical profile of cluster headache in Chinese patients have not been fully studied. METHODS: The classification and clinical features of 120 consecutive patients with cluster headache (105 males, 15 females; mean age, 34.9 ± 10.5 years) visiting at International Headache Center from May 2010 to August 2012 were analyzed. RESULTS: Patients came from 16 different regions of China. Mean age at onset of cluster headache was 26.7 ± 10.9 years. Only 13 patients (10.8%) had previously been diagnosed with cluster headache. Mean time to diagnosis from first symptoms was 8.2 ± 7.1 years (range, 0-35 years). Chronic cluster headache was observed in only 9 patients (7.5%). The most commonly reported location of cluster headache was temporal region (75.0%), followed by retro-orbital region (68.3%), forehead (32.5%), vertex (32.5%) and occipital (22.5%). Lacrimation was the most consistently reported autonomic feature (72.5%). During acute attacks, 60.0% of patients experienced nausea, and 41.7% experienced photophobia and 40.8% experienced phonophobia. In addition, 38.3% reported restless behavior and 45.8% reported that physical activity exacerbated the pain. None of patients experienced visual or other kinds of aura symptoms before cluster attacks. We found that 38.3% of patients had <1 cluster period and 35.8% for 1-2 cluster periods per year with these periods occurring less frequently during the summer than during other seasons. Cluster duration was 1-2 months in 32.5% of patients. During cluster periods, 73.3% of patients had 1-2 attacks per day, and 39.2% experienced cluster attacks ranging in duration from 1 h to less than 2 h. The duration of attacks were 1.5 (1-2.25) hours for males and 1.5 (1-3) for females respectively. The World Health Organization quality of life-8 questionnaire showed that cluster headache reduced life quality. CONCLUSIONS: Compared to Western patients, Chinese patients showed a relatively low prevalence of chronic cluster headaches, pain sites mainly focused on areas distributed by the first division of the trigeminal nerve, a low frequency of restlessness and absent aura. These clinical features may be more common in Eastern populations, including mainland Chinese, Japanese and Taiwanese patients, than in Western patients.

Application of ICHD-II criteria in a headache clinic of China.

BACKGROUND: China has the huge map and the largest population in the world. Previous studies on the prevalence and classification of headaches were conducted based on the general population, however, similar studies among the Chinese outpatient population are scarce. This study aimed to analyze the characteristics of 1843 headache patients enrolled in a North China headache clinic of the General Hospital for Chinese People's Liberation Army from October 2011 to May 2012, with the International Classification of Headache Disorders, 2nd Edition (ICHD-II). METHODS AND RESULTS: Personal interviews were carried out and a detailed questionnaire was used to collect medical records including age, sex and headache characteristics. Patients came from 28 regions of China with the median age of 40.9 (9-80) years and the female/male ratio of 1.67/1. The primary headaches (78.4%) were classified as the following: migraine (39.1%), tension-type headache (32.5%), trigeminal autonomic cephalalgias (5.3%) and other primary headache (1.5%). Among the rest patients, 12.9% were secondary headaches, 5.9% were cranial neuralgias and 2.5% were unspecified or not elsewhere classified. Fourteen point nine percent (275/1843) were given an additional diagnosis of chronic daily headache, including medication-overuse headache (MOH, 49.5%), chronic tension-type headache (CTTH, 32.7%) and chronic migraine (CM, 13.5%). The visual analogue scale (VAS) score of TTH with MOH was significantly higher than that of CTTH (6.8±2.0 vs 5.6±2.0, P<0.001). The similar result was also observed in VAS score between migraine with MOH and CM (8.0±1.5 vs 7.0±1.5, P = 0.004). The peak age at onset of TTH for male and female were both in the 3(rd) decade of life. However, the age distribution at onset of migraine shows an obvious sex difference, i.e. the 2(nd) decade for females and the 1(st) decade for males. CONCLUSIONS/SIGNIFICANCE: This study revealed the characteristics of the headache clinic outpatients in a tertiary hospital of North China that migraine is the most common diagnosis. Furthermore, most headaches in this patient population can be classified using ICHD-II criteria.