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Introduction: The clinical characteristics of patients positive for anti-small ubiquitin-like modifier 1-activating enzyme subunit 1 (SAE1) antibodies and diagnosed with idiopathic inflammatory myopathies (IIMs) vary across different cohorts and ethnicities, particularly concerning interstitial lung disease (ILD). We aimed to assess the clinical utility of the line immunoblot assay (LIA) in detecting anti-SAE1 autoantibodies and evaluate the clinical relevance and chronology of ILD development in relation to SAE1 autoantibody positivity among Taiwanese patients. Methods: We retrospectively conducted a population-based cohort analysis involving 6,496 patients who visited Chang Gung Memorial Health System across Taiwan from May 2018 to December 2021. Patients were assayed for myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies (MAAs) using the LIA method, and the antinuclear antibody (ANA) indirect immunofluorescence (IIF) method was used to evaluate ANA patterns. Of these, 70 SAE1-positive patients (1.08%) were included and followed up until December 2023. Associations with clinical characteristics and final diagnosis, particularly ILD, were assessed. Results: Among the 70 SAE1-positive patients, 10 (14.3%) were strongly positive and 60 (85.7%) were weakly positive. In the strong positive group, 70% (7/10) were diagnosed with IIM, with most (5/7) showing a concordant ANA IIF pattern (speckled type). Six patients presented ILD either before (1/6) or after (5/6) IIM diagnosis; the majority (4/6) were classified as organizing pneumonia. The remaining 30.0% (3/10) had connective tissue disease (CTD) other than IIM without detectable ILD during follow-up, and none demonstrated a concordant ANA IIF pattern. In the weakly positive group, only 5.0% (3/60) had IIM and 3.3% (2/60) had ILD. The positive predictive value for strong positive SAE1 autoantibodies in diagnosing IIM was significantly higher than for weak positives (70.0% vs. 5.0%; p < 0.001). Conclusions: The study suggests that strong positive SAE1 autoantibodies detected via LIA are more closely associated with IIM compared to weak positive results. A high prevalence of ILD was observed among strong positive Taiwanese patients, indicating the need for prompt screening. Patients with weak positive or discordant ANA IIF results may represent false positives with a lower ILD risk. [ABSTRACT FROM AUTHOR]

While research has shown that students' epistemic beliefs can be a strong predictor of their academic performance, cognitive abilities, or self-efficacy, studies of this topic in computer education are rare. The purpose of this study was twofold. First, it aimed to validate a newly developed questionnaire for measuring students' epistemic beliefs about computer programming at middle school level. Second, the study aimed to understand how students' epistemic beliefs predict their computational thinking disposition and computer programming self-efficacy. A total of 406 middle school students completed a survey consisting of three research instruments: the Computer Programming Epistemic Belief Inventory (CPEBI), the Computational Thinking Scale (CTS), and the Computer Programming Self-Efficacy Scale (CPSES). The results indicated that the epistemic belief of "uncertainty" was a significant and positive predictor of the "abstraction" and "generalization" dimensions of computational thinking dispositions. In addition, the belief of "complexity" was an antecedent to three dimensions of computational thinking, namely, "algorithmic thinking," "evaluation," and "generalization." Only the "evaluation" dimension of CT disposition had significant and positive relationships with "programming self-efficacy." The roles of "uncertainty" and "complexity" of computer programming epistemic beliefs are discussed. Implications and suggestions for future computer programming education, especially for young students, are provided. [ABSTRACT FROM AUTHOR]

This research aimed to investigate the structural relationships among teachers' computational thinking (CT), design thinking (DT), robotics teaching beliefs, and robotics pedagogical content knowledge (RPCK). A total of 98 in-service and pre-service teachers who participated in a robotics teaching professional development workshop served as the sample of the study. A survey including the Computational Thinking Scale, the Design Thinking Disposition Scale, the Robotics Teaching Beliefs Scale and the Technological Pedagogical Content Knowledge–Robotics Scale was conducted after the workshop. A confirmatory factor analysis was employed to validate the measurement constructs, and Partial Least Squares - Structural Equation Modeling (PLS-SEM) analysis was utilized to examine the relationships among the factors. The results revealed that both CT and DT dispositions could positively predict teachers' robotics teaching beliefs, which subsequently predicted their RPCK. Moreover, a direct positive relationship between CT and RPCK was identified, while such a relationship was not evident for DT. The model demonstrates the critical role of CT in shaping teachers' beliefs and pedagogical strategies of robotics teaching, and provides insights into the indirect influence of DT. Finally, the Model of Robotics Teaching Professional Development (MRTPD) was proposed to profile how to promote teachers' pedagogical content knowledge of robotics teaching from their CT and DT dispositions. [ABSTRACT FROM AUTHOR]

Objective: To investigate the psoriatic disease risk among patients with previous appendicitis. Methods: This study was a nationwide population‐based case–control study about the association between the psoriatic disease risk among patients with a history of appendicitis in Taiwan. The study population consisted of newly diagnosed psoriatic disease with at least two outpatient visits, and the control group included those patients without psoriatic disease at the same index date. Patients with a previous diagnosis of appendicitis or who underwent appendectomy surgery prior to their psoriatic disease diagnosis were recorded. The odds ratio of psoriatic disease diagnosis in the two groups with and without a history of appendicitis were analyzed and compared. Results: A total of 48 894 individuals diagnosed with psoriatic disease were matched with 292 656 controls by age and gender. Notably, the proportion of patients with a history of appendicitis or primary appendectomy was significantly elevated among those with psoriatic disease compared with the control cohort (both p <.05). On average, the occurrence of appendicitis preceded the index date by 3.3 ± 2.3 years. Multivariate analysis revealed a heightened incidence rate of psoriatic disease in patients previously diagnosed with appendicitis, periodontal disease, Charlson comorbidity index score (CCIS) ≧1, and ill‐defined intestinal infections. This association persisted after adjusting for confounding factors, such as periodontal disease, CCIS, Salmonella, and ill‐defined intestinal infections. The odds ratios for psoriatic disease in individuals with a history of appendicitis, periodontal disease, CCIS ≧1, and ill‐defined intestinal infections were 1.16, 1.008, 1.69, and 1.23, respectively, with corresponding 95% confidence intervals of 1.03–1.31, 1.05–1.11, 1.65–1.74, and 1.20–1.26. These findings underscore the independent association between appendicitis and subsequent development of psoriatic disease, even after adjusting for relevant comorbidities and potential confounders. Conclusion: Our research illustrates that appendicitis is associated with an increased likelihood of developing a psoriatic disease, despite several limitations. These limitations encompass variables such as dietary and smoking habits, alongside other potential confounding factors that were not fully considered. Moreover, inherent biases in utilizing national health insurance data, such as the absence of laboratory information, as well as the constraints inherent in a retrospective study design, should be acknowledged. [ABSTRACT FROM AUTHOR]

Objective This study aimed to determine if a combination of 2 abnormal lipid profiles revealed a stronger association with low bone mass than a single blood lipid abnormality alone. Methods This study enrolled 1373 participants who had received a dual-energy x-ray absorptiometry scan from January 2016 to December 2016 in a medical center in southern Taiwan. Logistic regression was used to examine association between lipid profiles and osteopenia or osteoporosis after adjusting for covariates. Results Compared to people with total cholesterol (TC) < 200 mg/dL, those with TC ≥ 240 mg/dL tended to have osteopenia or osteoporosis (OR 2.61; 95% CI, 1.44-4.71). Compared to people with low-density lipoprotein cholesterol (LDL-C) < 130 mg/dL, those with LDL-C ≥ 160 mg/dL tended to develop osteopenia or osteoporosis (OR 2.13; 95% CI, 1.21-3.74). The association of increased triglyceride and decreased bone mass was similar, although not statistically significant. Those with the combination of TG ≥ 200 mg/dL and TC ≥ 240 mg/dL had a stronger tendency to have osteopenia or osteoporosis (OR 3.51; 95% CI, 1.11-11.13) than people with only one blood lipid abnormality. Similarly, people with TG ≥ 200 mg/dL and LDL-C ≥ 160 mg/dL had a stronger tendency to have osteopenia or osteoporosis (OR 9.31; 95% CI, 1.15-75.42) than people with only one blood lipid abnormality, after adjustment for the same covariates. Conclusion Blood levels of TC, LDL-C, and TG were associated with osteopenia or osteoporosis. Results indicate that individuals aged older than 50 years with abnormal lipid profiles should be urged to participate in a bone density survey to exclude osteopenia or osteoporosis. [ABSTRACT FROM AUTHOR]

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis primarily affecting peripheral and axial joints. The osteolytic effect in the damaged joint is mediated by osteoclast activation. We aimed to investigate differential gene expression in peripheral CD14+ monocytes between patients with psoriatic arthritis (n = 15) and healthy controls (HCs; n = 15). Circulating CD14+ monocytes were isolated from peripheral blood mononuclear cells using CD14+ magnetic beads. Cell apoptosis was measured via Annexin V using flow cytometry. The gene expression profiling was analyzed via microarray (available in the NCBI GEO database; accession number GSE261765), and the candidate genes were validated using PCR. The results showed a higher number of peripheral CD14+ monocytes in patients with PsA than in the HCs. By analyzing the microarray data, identifying the differentially expressed genes, and conducting pathway enrichment analysis, we found that the apoptosis signaling pathway in CD14+ cells was significantly impaired in patients with PsA compared to the HCs. Among the candidate genes in the apoptotic signaling pathway, the relative expression level of cathepsin L was confirmed to be significantly lower in the PsAs than in the HCs. We concluded that the numbers of peripheral CD14+ monocytes increased, and their apoptosis activity was impaired in patients with PsA, which could lead to enhanced macrophage maturation and osteoclast activation. The resistance of apoptotic death in peripheral CD14+ monocytes may contribute to active joint inflammation in PsA. [ABSTRACT FROM AUTHOR]

Long-term Glucocorticoid (GC) use results in compromised bone strength and fractures, and several treatment recommendations have been developed to prevent fractures, but none have been validated in a real-world setting. This study aims to create a treatment decision tool and compares this tool to the treatment suggestions from the American College of Rheumatology (ACR), International Osteoporosis Foundation and European Calcified Tissue Society (IOF-ECTS), and GC-adjusted Fracture Risk Assessment Tool (GC-FRAX), above the intervention threshold. We utilized registry data gathered at Chang Gung Memorial Hospital at Kaohsiung, Taiwan, between September 2014 and April 2021. This research is a single-center, observational, and case-controlled study. We recruited participants using prednisone for at least 2.5 mg/day or the equivalent dose for over 3 months, excluding those younger than 40, those with malignancies, or those currently undergoing anti-osteoporosis therapy. The primary endpoint was new fragility fractures within 3 years, including morphometric vertebral fractures detected at baseline and with a follow-up thoracic–lumbar spine X-ray. Participants were randomly allocated into derivation and validation sets. We developed the Steroid-Associated Fracture Evaluation (SAFE) tool in the derivation cohort by assessing the weights of exploratory variables via logistic regression. Prediction performance was compared in the validation set by the receiver operating characteristic (ROC) curve, the area under the curve (AUC), and sensitivity and specificity. A total of 424 treatment-naïve subjects were enrolled, and 83 (19.6%) experienced new fractures within 3 years. The final formula of the SAFE tool includes osteoporosis (1 point), an accumulated GC dose ≥ 750 mg within 6 months (or equivalent prednisolone of ≥4.5 mg/day for 6 months) (1 point), a BMI ≥ 23.5 (1 point), previous fractures (1 point), and elderliness of ≥70 years (2 points). In the validation set, a treatment decision based on the SAFE ≥ 2 points demonstrated an AUC of 0.65, with a sensitivity/specificity/accuracy of 75.9/54.0/58.9, with an ACR of 0.56 (100.0/11.0/31.0), IOF-ECTS 0.61 (75.9/46.0/52.7), and GC-FRAX 0.62 (82.8/42.0/51.2). Among current GIOP recommendations, the SAFE score serves as an appropriate treatment decision tool with increased accuracy and specificity. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a major risk factor for osteoporosis/osteoporotic fractures. We aimed to elucidate the role of treatment choices among osteoporosis/osteoporotic fractures. Methodology: We utilized the Chang‐Gung Research Database to assess the risks of osteoporosis/osteoporotic fractures among independently treated RA patients, using retrospective time‐to‐event outcomes analysis. Results: A total of 3509 RA patients with a mean of 63.1 ± 8.6 years were analyzed. Among all, 1300 RA patients (37%) were diagnosed with newly diagnosed osteoporosis. The crude incidence of newly diagnosed osteoporosis was the highest among those treated with other conventional disease‐modifying anti‐rheumatic drugs (cDMARDs; 74.1 events/1000‐PYs, 95%CI 66.0–82.3), followed by those with a non‐treatment period (68 events/1000‐PYs, 95%CI 63.1–72.9), methotrxate (MTX) monotherapy (60.7 events/1000‐PYs, 95%CI 41.2–80.3), MTX plus other cDMARDs (51.9 events/1000‐PYs, 95%CI 43.4–60.3), and abatacept/rituximab (48.6 events/1000‐PYs, 95%CI 14.9–82.3). The lowest crude incidence was found in patients treated with anti‐TNFi biologics (40.4 events/1000‐PYs, 95%CI 28.6–52.2) and other biologic disease‐modifying anti‐rheumatic drugs (bDMARDs; 40.1 events/1000‐PYs, 95%CI 8.0–72.1). A total of 270 patients (20.8%) suffered from an incident fracture during follow‐ups. The crude incidence of fracture was the highest among those treated with abatacept/rituximab (49.0 events/1000‐PYs, 95%CI 6.0–91.9), followed by those with non‐treatment periods (24.3 events/1000‐PYs, 95%CI 19.3–29.4), other cDMARDs (24.2 events/1000‐PYs, 95%CI 18.1–30.2), anti‐TNFi biologics (20.2 events/1000‐PYs, 95%CI 8.8–31.6). Other bDMARDs (13.3 events/1000‐PYs, 95%CI 0–39.2), MTX mono (12.5 events/1000‐PYs, 95%CI 0.3–24.8), and MTX plus other cDMARDs (11.4 events/1000‐PYs, 95%CI 5.4–17.4) were low incidences. Conclusion: The treatment option has emerged as a critical determinant in the context of future osteoporosis and osteoporotic fracture risks among RA. These findings offer a valuable resource for clinicians, empowering them to tailor bespoke treatment strategies for RA patients, thereby mitigating the potential for future osteoporosis and fractures. [ABSTRACT FROM AUTHOR]

Background: To evaluate the factors to predict subclinical inflammation of wrist joints in patients with RA who are in clinical remission or low disease activity. Methods: Gray scale and power Doppler ultrasound were performed on the dorsal radio-lunate of both wrists. The presence of synovitis, comorbidities, and use of disease modifying anti-rheumatic drugs were recorded. A Multivariable forward logistical regression model was used to identify factors associated with subclinical inflammation. Results: There were 1248 patients (1010 females, 238 males; mean age: 60.0 ± 10.5 years). 57.4% of patients in complete remission and low disease activity had sonographic inflammation. Multivariable forward logistic regression analysis indicated that male sex, smoking are positively associated with inflammation and that age, alcohol consumption, and use of methotrexate, glucocorticoid, or a biological therapy are negatively associated with inflammation. Use of biological agents decreased the risk of inflammation by 40.9%. Conclusions: There was evidence of subclinical inflammation in most patients who were in low or no disease activity, those with biological therapy had lower risk of subclinical inflammation. [ABSTRACT FROM AUTHOR]

Although prevention is better than treatment, after a knee injury occurs, the adjustment of the movement technique back to the posture before the injury and the restoration of accuracy is very important for professional and amateur players. This study aimed to compare the differences in lower limb mechanics during the golf downswing between those with and without a history of knee joint injury. A total of 20 professional golfers with single-digit handicaps were recruited for this study, 10 of whom had a knee injury history (KIH+), while another 10 players were without a knee injury history (KIH−). From the 3D analysis, selected kinematic and kinetic parameters during the downswing were analyzed using an independent samples t-test with a significance level of α = 0.05. During the downswing, individuals with KIH+ exhibited a smaller hip flexion angle, smaller ankle abduction angle, and larger ankle adduction/abduction range of motion (ROM). Moreover, there was no significant difference found in the knee joint moment. Athletes with a history of knee injury can adjust the motion angles of their hip and ankle joints (e.g., by avoiding excessive forward leaning of the trunk and maintaining stable foot posture without inward or outward rotation) to minimize the impact of changes in their movement patterns resulting from the injury. [ABSTRACT FROM AUTHOR]

A female 17‐year‐old diagnosed with seronegative spondyloarthritis (SpA) following the first jab of the BioNTech162b2 (BNT162b2) vaccine presented with recurrent swelling and painful knee accompanied by posterior heel tenderness over the past 1.5 months. Laboratory investigations revealed elevated serum erythrocyte sedimentation rate and C‐reactive protein. Synovial aspiration yielded level 3 crystal‐free, aseptic and inflammatory effusion. She tested positive for the human leukocyte antigen‐B27 and was diagnosed with peripheral SpA. She received daily celecoxib (400 mg), methylprednisolone (8 mg), and sulfasalazine (2 g), but the effect was limited. Nonetheless, her symptoms improved significantly with weekly subcutaneous etanercept administration (50 mg). Four weeks later, her arthritis was completely resolved. To our knowledge, this is the first case report of newly diagnosed seronegative peripheral SpA in an autoimmunity‐disease‐free individual following messenger RNA BNT coronavirus disease 2019 vaccination. [ABSTRACT FROM AUTHOR]

Neuropsychiatric systemic lupus erythematous (NPSLE) encompasses various psychiatric and neurological manifestations that develop in patients with systemic lupus erythematous (SLE), secondary to the involvement of the central nervous system (CNS). Although neuropsychiatric manifestations are commonly described in NPSLE, catatonia has been less frequently reported in patients with SLE. The roles of benzodiazepines (BZDs), immunosuppression, therapeutic plasma exchange (TPE), and electroconvulsive therapy (ECT) have all been reported in the management of catatonia. Furthermore, another research reported that catatonic symptoms associated with NPSLE were considerably improved by TPE. We, herein, report a case of catatonia in a patient with newly diagnosed NPSLE who exhibited a favorable prognosis through the early initiation of systemic immunosuppressants and TPE. Furthermore, we have reviewed the literature on the role of medication and plasmapheresis (PP), or TPE, in the treatment of catatonia that is associated with SLE. [ABSTRACT FROM AUTHOR]

This study aimed to develop the Computational Thinking Test for Elementary School Students (CTT-ES) to assess young children's CT competencies in non-programming contexts and also examine the relationship between CT competencies and CT dispositions. A survey including a pool of CTT-ES candidate items and the Computational Thinking Scale (CTS) was administered to 631 elementary school students. Rasch model of the Item Response Theory and the discrimination analysis of the Classical Testing Theory were conducted for item analyses. Pearson's correlation analyses and hierarchical multiple regression analyses were used to examine the relationships between CTT-ES and CTS scores. The results showed that the final CTT-ES including 16 items had a good fitness, discrimination, and reliability to evaluate elementary students' domain-general CT competencies. The convergent validity of CTT-ES was confirmed by its significant correlations with the CTS scores. The significant regression model not only showed students' CT competencies can be predicted by their CT dispositions but also supported The Developmental Model of CT. This study provided a valid and reliable tool for assessing young children's CT abilities. It also furthered our understanding about the developmental orders of CT abilities and contributed to the theoretical construction of CT. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore how students interacted with guidance to conduct a scientific inquiry in a physics simulation by using the eye-tracking techniques. The participants were 51 7th graders, and an eye-tracking system was used to record their visual behaviors and log data while they were using the simulation. As for data analysis, we first checked each participant's log data to examine whether they completed the requirement of the guidance, and then checked the correctness of her/his answer to the inquiry task. The participants were thus divided into two groups (correct vs. wrong), and the patterns of their visual behaviors were examined by a set of eye-movement indices, normalized heat maps and lag sequential analyses. The results indicate that both spatial distributions and temporal sequences of the participants' visual attention were associated with their performances on the inquiry task. Regarding the spatial distribution, the correct group tended to allocate more visual attention to the regions presenting the target phenomenon than the wrong group. Concerning the temporal sequence, the correct group tended to make more visual transitions among the content of the guidance, the relevant control panels and the target phenomena than the wrong group. [ABSTRACT FROM AUTHOR]

A prior study developed the Computational Thinking Scale (CTS) for assessing individuals' computational thinking dispositions in five dimensions: decomposition, abstraction, algorithmic thinking, evaluation, and generalization. This study proposed the Developmental Model of Computational Thinking through validating the structural relationships among the five factors of the CTS. To examine the model, a questionnaire including the CTS was administered to 472 middle school students. A confirmatory factor analysis was used to confirm the construct of the measurements, and a PLS-SEM analysis was used to validate the structural relationships among the factors. The results confirmed that the 19-item CTS has good item reliability, internal consistency, and construct reliability for measuring computational thinking (CT). In the Developmental Model of CT, decomposition and abstraction significantly predict all other three CT dispositions, suggesting that they are the two fundamental factors required for CT development. Moreover, a significant linear prediction path was shown starting from algorithmic thinking, evaluation, until generalization. Thus, a multi-level model was confirmed for the conceptual framework of CT. This model suggests a possible sequence for CT development which may provide a guideline for the teaching objectives of CT for different learning stages in different school levels. Decomposition and abstraction are especially suggested to be emphasized in school curricula before teaching algorithmic thinking or algorithm designs. [ABSTRACT FROM AUTHOR]

Objective: To determine the risk and time trends of heart failure (HF) leading to hospitalization in individuals newly diagnosed as having polymyositis/dermatomyositis (PM/DM) relative to non‐PM/DM controls at the general population level. Methods: A retrospective cohort study was conducted using data from a nationwide insurance database in Taiwan. Patients with incident PM/DM and without a history of HF were selected between 2000 and 2013. Unmatched and propensity score–matched cohorts were established separately. A multivariable Cox proportional hazards regression model was used to estimate the adjusted hazard ratio (HR) for the risk of HF in the unmatched cohort. In the propensity score–matched cohort, general population controls were selected and matched at a 1:1 ratio to the patients with PM/DM based on propensity scores, which accounted for the confounding factors of age, sex, index date (year) of first diagnosis, comorbidities, and medication usage. The cumulative incidence of HF was estimated using the Kaplan‐Meier method. A stratified Cox proportional hazards model was used to calculate the HR for the risk of HF events at different follow‐up time points among patients with PM/DM compared with non‐PM/DM controls in the propensity score–matched cohort. Results: In the unmatched cohort, the study assessed 2,025 patients with PM/DM and 196,109 general population controls. Results of multivariable Cox regression analysis, adjusted for age, sex, comorbidities, and medication usage, revealed a greater risk of HF leading to hospitalization in the PM/DM group than in the control group (adjusted HR 3.29, 95% confidence interval [95% CI] 2.60–4.18). After matching based on propensity score, a total of 1,997 pairs of PM/DM patients and general population controls were identified. In this propensity score–matched cohort, the cumulative incidence of HF in patients with PM/DM at 3 years, 5 years, and 10 years was 3.3%, 4.4%, and 7.4%, respectively. The absolute difference in HF risk in the PM/DM group compared with the control group was 1.8% at 3 years, 2.1% at 5 years, and 3.0% at 10 years. Compared with general population controls, patients with PM/DM exhibited an augmented risk of HF (HR 2.06, 95% CI 1.36–3.12). Analyses stratified according to follow‐up time point revealed that the increased risk of HF persisted for up to 10 years after the PM/DM diagnosis. Conclusion: These results indicate that the risk of HF leading to hospitalization was increased in patients with PM/DM throughout the study period, supporting the need for greater vigilance in the monitoring of patients with PM/DM for the development of this potentially lethal complication. [ABSTRACT FROM AUTHOR]

Objective: To compare changes in bone mineral density (BMD) in rheumatoid arthritis (RA) patients receiving three-year conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD), tumor necrosis factor-α inhibitors (TNFi), and abatacept. Methods: Patients with RA were recruited from September 2014 to February 2021. Dual-energy X-ray absorptiometry was used to measure BMD at the femoral neck (FN), total hip (TH), and lumbar spine (L1-4) at enrollment and three years later. Changes in the BMD of each regimen group were analyzed. Multiple ordinary least squares regression was used with the dependent variables to develop a model to predict the change in BMD. Results: A total of 752 participants were enrolled and 485 completed the three-year follow-up period. Of these, 375 (Group I), 84 (Group II), and 26 (Group III) participants received csDMARDs, TNFi, and abatacept therapy, respectively. Considering both type of therapy and completion of the follow-up period, participants were divided into groups A (csDMARDs, n = 104), B (TNFi, n = 52), and C (abatacept, n = 26). Compared to baseline, BMD decreased significantly at FN (p = 0.003) and L1-4 (p = 0.002) in Group A and at L1-4 (p = 0.005) in Group B, but remained stable at all sites in Group C. In terms of regression-adjusted percent change in BMD, there was a significant difference seen at all measured sites between group C compared to both groups A and B (+0.8%, -2.7%, -1.8% at FN; +0.5%, -1.1%, -1.0% at TH; +0.8%, -2.0%, -3.5% at L1-4, respectively; all p < 0.05). Anti-osteoporosis therapy had a BMD-preserving effect in RA. Conclusion: Compared with csDMARDs and TNFi, abatacept may have a better BMD-preserving effect in RA. Anti-osteoporosis therapy can prevent systemic bone loss irrespective of RA therapy. [ABSTRACT FROM AUTHOR]

Neutrophils are the primary immune cells in innate immunity, which are related to various inflammatory diseases. Astragalus mongholicus Bunge is a Chinese medicinal herb used to treat various oxidative stress-related inflammatory diseases. However, there are limited studies that elucidate the effects of Astragalus mongholicus Bunge in human neutrophils. In this study, we used isolated human neutrophils activated by various stimulants to investigate the anti-inflammatory effects of Astragalus mongholicus Bunge water extract (AWE). Cell-free assays were used to examine free radicals scavenging capabilities on superoxide anion, reactive oxygen species (ROS), and nitrogen-centered radicals. Imiquimod (IMQ) induced psoriasis-like skin inflammation mouse model was used for investigating anti-psoriatic effects. We found that AWE inhibited superoxide anion production, ROS generation, and elastase release in human neutrophils, which exhibiting a direct anti-neutrophil effect. Moreover, AWE exerted a ROS scavenging ability in the 2,2'-Azobis (2-amidinopropane) dihydrochloride assay, but not superoxide anion in the xanthine/xanthine oxidase assay, suggesting that AWE exhibited anti-oxidation and anti-inflammatory capabilities by both scavenging ROS and by directly inhibiting neutrophil activation. AWE also reduced CD11b expression and adhesion to endothelial cells in activated human neutrophils. Meanwhile, in mice with psoriasis-like skin inflammation, administration of topical AWE reduced both the affected area and the severity index score. It inhibited neutrophil infiltration, myeloperoxidase release, ROS-induced damage, and skin proliferation. In summary, AWE exhibited direct anti-inflammatory effects by inhibiting neutrophil activation and anti-psoriatic effects in mice with IMQ-induced psoriasis-like skin inflammation. Therefore, AWE could potentially be a pharmaceutical Chinese herbal medicine to inhibit neutrophilic inflammation for anti-psoriasis. [ABSTRACT FROM AUTHOR]

Objectives: To explore the risk factors for fragility fractures in rheumatoid arthritis (RA) patients using a 3-year longitudinal, observational cohort study. Methods: This RA registry study included consecutive RA patients in the outpatient clinic of Chang Gung Memorial Hospital since September 1, 2014. The demographics, clinical characteristics, lifestyle, evidence of previous fracture, risk factors according to the Fracture Risk Assessment Tool (FRAX®), and the FRAX score of each participant were recorded. The participants were categorized into the new incident fracture (group A) and no incident fracture (group B) groups based on evidence or absence of new incident fractures and propensity score matching (age and gender, 1:2). Results: Overall, 477 participants completed the 3-year observation period. After matching, 103 and 206 participants were allocated to groups A and B, respectively. The non-adjusted model revealed, presented as hazard ratio (HR) (95% confidence interval [CI]), that the presence of co-morbidity (1.80 [1.17–2.78], p = 0.008), Health Assessment Questionnaire Disability Index (1.35 [1.07–1.69], p = 0.010), lower baseline hip bone mineral density (0.11 [0.02–0.48], p = 0.004), longer disease duration (1.02 [1.00–1.04], p = 0.026), higher FRAX score of major fracture (1.03 [1.02–1.04], p<0.001) or hip fracture (1.03 [1.02–1.04], p<0.001), and previous fracture history (2.65 [1.79–3.94], p<0.001) were associated with new incident fracture. After adjustment, it was disclosed that a previous fracture is an independent risk factor for fragility fractures in RA patients (2.17 [1.20–3.90], p = 0.010). Conclusions: In addition to aging and disease-related factors, previous fracture history is the most important risk factor for fragility fractures in RA patients. [ABSTRACT FROM AUTHOR]

Computational thinking has received tremendous attention from computer science educators and educational researchers in the last decade. However, most prior literature defines computational thinking as thinking outcomes rather than thinking processes. Based on Selby and Woodland's framework, this study developed and validated the Computational Thinking Scale (CTS) to assess all students' thought processes of computational thinking for both general and specific problem-solving contexts in five dimensions: abstraction, decomposition, algorithmic thinking, evaluation and generalization. A survey including 25 candidate items for CTS as well as demographic variables was administered to 388 junior high school students in Taiwan. An explorative factor analysis using the principal axis method with the oblimin rotation was used to validate the scale. Finally, 19 items were extracted successfully under the designed five dimensions, with a total explained variance of 64.03% and an overall reliability of 0.91. Results of the demographic comparisons showed that boys had a greater disposition than girls in decomposition thinking when solving problems using computer programming. In addition, programming learning experience, especially self-directed learning and after-school learning, had significant positive effects on all dimensions of CTS. Several future studies are suggested using this tool. [ABSTRACT FROM AUTHOR]

Objective: Metformin has been linked to anti-proliferative and anti-inflammatory mechanisms. In this study, we aimed to examine the long-term impact of metformin on mortality and organ damage in patients with autoimmune diseases and type 2 diabetes mellitus (T2DM). Methods: We conducted a cohort study using the National Health Insurance Research Database in Taiwan between 1997 and 2013. Based on metformin and other anti-diabetic agent prescriptions, we categorized all patients with autoimmune diseases into either the metformin group (metformin administration for at least 28 days) or the non-metformin group. The primary outcomes were all-cause mortality and annual admission rate, while the secondary outcome was target organ damage. We followed patients from the index date to the date on which the event of interest occurred, death, or the end of this study. Results: Our cohort study included 3,359 subjects for analysis. During a mean follow up of 5.2 ± 3.8 years, the event rate of all-cause mortality was 228 (33.6%) in the metformin group and 125 (36.9%) in the non-metformin group. The risk of both all-cause mortality and annual number of admissions for autoimmune diseases was significantly lower in the metformin group than in the non-metformin group [hazard ratio (HR) 0.77; 95% CI 0.62–0.96 and risk ratio (RR) 0.81; 95% CI 0.73–0.90, respectively]. Conclusion: Metformin may add benefits beyond T2DM control with regard to reducing all-cause mortality and admission rate, as well as minimizing end-organ injury in lungs and kidneys among patients with autoimmune diseases. [ABSTRACT FROM AUTHOR]

Although a modality effect indicating better learning from an animation with spoken learning guidance than from an animation with written learning guidance has often been found in research on learning from animation, the effect has hardly been investigated for learning from computer simulation. This study examined the interaction effects between the multimedia types of animation and computer simulation, and the presentation modes of written and spoken learning guidance. Based on cognitive load theory and the specific characteristics of the multimedia types it was hypothesized that a modality effect would be replicated in the animation condition and a reverse modality effect would be found in the simulation condition. Results partially supported the hypotheses, indicating that participants learned more from animation when it was accompanied with spoken text, and from a simulation when it was accompanied with written text. However, no effect was found for cognitive load. Based on the results, spoken text is recommended to be used to guide learners in animations assisted learning environments, and written text is recommended to be used to guide learners in simulations assisted learning environments. Practitioner NotesWhat is already known about this topic Animation and computer simulation have been widely used in different learning fields.Modality effect means that students learn more from graphical representations when they are accompanied with spoken text instead of written text.The modality effect has been verified in different learning environments.What this paper adds Examined the interaction effects between the multimedia types of animation and computer simulation, and the presentation modes of written and spoken text in a learning guide.Provided recommendations for designing the leaning guide of animation and simulation based on cognitive load theory.Implications for practice and/or policy Modality effect was verified in animation, and thus, spoken text is more suitable for learning from animation.Reversed modality effect was found in simulation condition, and thus, written text is more suitable for learning from simulation. [ABSTRACT FROM AUTHOR]

Background. Hormonal changes had been found in menopausal women. Muscle and bone mass decline after menopause and with aging, increasing the risk for sarcopenia and osteoporosis in later life. Only a few studies suggest that menopausal hormonal changes have an effect on the decline in muscle mass. Objectives. This study aimed at evaluating the risk of muscle mass loss in menopausal women. Materials and Methods. Menopausal women from routine physical health examination were eligible for this study. Muscle mass was determined using dual-energy X-ray absorptiometry at baseline and 1 year later. All of the patients underwent the assessments for liver and kidney function, diabetes, and hypertension, and associated comorbidities were recorded. Results. A total of 172 patients were enrolled. 70 patients had muscle loss at 1 year, and the other 102 did not had loss. The mean age was 70.26 ± 9.93 years at the muscle loss group, while 69.25 ± 10.50 at the nonprogress group (p = 0.531). The mean body mass index was 22.96 ± 1.91 kg/m2 at the muscle loss group, while 23.33 ± 3.71 kg/m2 at the nonprogress group (p = 0.433). The baseline trunk limb fat mass ratio was 1.01 ± 0.20 in the muscle loss group and 1.12 ± 0.26 in the no muscle loss (p = 0.004). Using muscle mass loss as the outcome, logistical regression analysis showed that a baseline trunk limb mass ratio could predict muscle loss, and a higher baseline trunk limb mass ratio was associated with less muscle loss, while a lower trunk limb mass ratio was associated with increased muscle mass loss (p = 0.01). Conclusion. This is the first study to investigate the risk of muscle mass loss in menopausal women. Menopausal women with higher central fat had less muscle mass loss, while lower central fat was a risk factor for muscle mass loss. Chronic kidney disease was also a risk factor for muscle mass loss in menopausal women in this study. [ABSTRACT FROM AUTHOR]

Objectives To investigate changes in BMD in RA patients receiving 3-year biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) or conventional synthetic DMARD (csDMARD). Methods Patients with RA were recruited from September 2014 until March 2019. Clinical characteristics, BMD and evidence of fragility fractures at enrolment were documented. Participants were treated according to the National Institute for Health and Care Excellence (NICE) guidelines over a 3-year observation period. Repeated BMD was measured at the end of the study period. Participants were grouped into those receiving b/tsDMARD or csDMARD and by propensity score matching (1:2). Results A total of 388 participants completed the 3-year follow-up. After propensity score matching, 92 and 184 participants were allocated to the b/tsDMARD (Group I) and csDMARD (Group II), respectively. After 3 years, BMD remained stable at the femoral neck (FN), hip (total) (TH) and lumbar vertebra (L1-4) (P  =0.09, 0.15, 0.87) in Group I. However, BMD decreased significantly in Group II (P =0.045, <0.001, 0.004) at corresponding sites. Participants receiving combined b/tsDMARD and anti-osteoporosis therapy experienced a greater BMD preserving effect than other subgroups. Conclusion Long-term b/tsDMARDs therapy had protective effects on bone loss for patients with RA. Patients receiving concomitant anti-osteoporosis therapy and b/tsDMARDs therapy experienced the greatest BMD preserving effect. [ABSTRACT FROM AUTHOR]

The aim of this study was, first, to validate the instruments of Technological Pedagogical Content Knowledge-Games (TPACK-Games) and the Game-based-learning Teaching Belief Scale (GTBS). Second, a series of analyses were conducted to examine differences and relationships among the factors of the TPACK-Games and GTBS, in terms of different school levels. A total of 384 junior high school and elementary school teachers were recruited to complete the surveys. The study found that the TPACK-Games and GTBS surveys were valid and reliable instruments. Further, in comparison with teachers in junior high school, elementary school teachers tended to have higher self-efficacy in game pedagogical knowledge (GPK) and game pedagogical content knowledge (GPCK). They also demonstrated stronger beliefs, confidence and motivation to use games in their classes. Teachers' GPK was the most influential factor in predicting their GPCK, and GPCK further positively predicted their beliefs, confidence and motivation in using games in class. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to develop an algorithm to identify high-risk populations of fragility fractures in Taiwan.Materials and Methods: A total of 16,539 postmenopausal women and men (age ≥ 50 years) were identified from the Taiwan Osteoporosis Survey database. Using the Taiwan FRAX® tool, the 10-year probability of major osteoporotic fracture (MOF) and hip fracture (HF) and the individual intervention threshold (IIT) of each participant were calculated. Subjects with either a probability above the IIT or those with MOF ≥ 20% or HF ≥ 9% were included as group A. Subjects with a bone mineral density (BMD) T-score at femoral neck based on healthy subjects of ≤ - 2.5 were included in group B. We tested several cutoff points for MOF and HF so that the number of patients in group A and group B were similar. A novel country-specific hybrid intervention threshold along with an algorithm was generated to identify high fracture risk individuals.Results: 3173 (19.2%) and 3129 (18.9%) participants were categorized to groups A and B, respectively. Participants in group B had a significantly lower BMD (p < 0.001), but clinical characteristics, especially the 10-year probability of MOF (p < 0.001) or HF (p < 0.001), were significantly worse in group A. We found the algorithm generated from the hybrid intervention threshold is practical.Conclusion: The strategy of generating an algorithm for fracture prevention by novel hybrid intervention threshold is more efficient as it identifies patients with a higher risk of fragility fracture and could be a template for other country-specific policies. [ABSTRACT FROM AUTHOR]

In the field of science education, laboratory learning environment has gained renewed interest in the recent decade. This study aimed to investigate the relationships among students' conceptions of science laboratory learning, perceptions of the science laboratory learning environment, and their academic self-efficacy in science learning by adopting the structural equation modeling (SEM) technique. A total of 513 senior high school students (262 females) in Taiwan were invited to participate in this survey study. Three instruments were adapted and implemented to investigate the aim of the study (i.e. the conceptions of science laboratory learning questionnaire, the science laboratory environment inventory, and the academic self-efficacy in science learning questionnaire). The results indicated that the students' conceptions of science laboratory learning made a significant contribution to their perceptions of the science laboratory environment, which consequently fostered their science learning self-efficacy. More specifically, students with conceptions of science laboratory learning as reviewing their prior learning profiles tended to highlight the "student cohesiveness," "integration," and "material environment" aspects of the laboratory environment. Moreover, students who held personal ideas of science laboratory learning as acquiring manipulative skills tended to perceive actual science laboratory environments as much more open-ended and to attain advanced academic science learning self-efficacy. In addition, those students who viewed laboratory learning as achieving in-depth understanding, and who perceived that laboratory activities are guided by clear rules, were prone to express a stronger sense of academic self-efficacy. Based on the results, practical implications and suggestions for future research are discussed. [ABSTRACT FROM AUTHOR]

Background: We investigated the association of anti-osteoporosis medication with mortality risk in older adults with hip fractures and evaluated the influence of medication adherence on mortality.Methods: We conducted a population-based cohort study and identified a total of 13,123 patients aged 65 years or older with hip fracture from the Taiwan National Health Insurance Database during the period 2001-2010. Individuals with (n = 2092) and without (n = 2092) receiving anti-osteoporosis medication were matched using propensity score matching (1:1 ratio). The 1-, 3- and 5-year survival rates after the index fracture were compared between patients with and without treatment. In the treated group, survival rate was compared between those with good and non-adherence. Good adherence was defined as the medication possession ratio of ≥80% and non-adherence as a ratio < 80%.Results: The 1-, 3- and 5-year mortality rates were significantly lower in the treated vs. the non-treated group (all p < 0.0001). In the treated group, the estimated 1-, 3- and 5-year survival rates were higher in those with good adherence than in those with non-adherence (all p < 0.0001). Regarding all-cause mortality, the adjusted hazard ratio in the treated vs. the non-treated group was 0.63 (95% confidence interval 0.58-0.68, p < 0.0001). The good adherence subgroup showed a significantly lower mortality risk than that in the non-adherence subgroup (hazard ratio 0.41, 95% confidence interval 0.32-0.51, p < 0.0001).Conclusions: The 1-, 3- and 5-year survival rates were significantly higher in patients receiving anti-osteoporosis medication than in the untreated group. All-cause mortality rates were lower in patients with good adherence to anti-osteoporosis medication. [ABSTRACT FROM AUTHOR]

This study was to investigate the role of students' game self-efficacy in their game performance as well as in their visual behavior distributions and transfer patterns during their gameplay. A total of 48 university students were recruited for participating in a gameplaying task while wearing with an ASL Mobile Eye eye-tracker. After the gameplay, each participant was asked to report their self-efficacy of the gameplay. Based on the self-reported game self-efficacy (GSE) score, the participants were divided into the higher and lower GSE groups. Independent t tests were used to compare their game performances and eye-tracking indices for each area of interest. A lag sequential analysis was used to profile the visual transfer pattern for each group. The results showed that the higher GSE group had better performances than the lower GSE group. During the gameplay, the higher GSE students tended to pay more attention to the critical information for a successful play. In addition, the lag sequential analyses revealed different visual transfer patterns for the two GSE groups. The higher GSE group tended to show a critical-factor-centralized visual-trasfer pattern which demonstrated more planning and monitoring gameplaying strategies; while the lower GSE students, probably lacking the self-confidence of gameplaying, tended to pay more attention to the remaining time for the game.This study may provide suggestions for future game-based leraning system designs. [ABSTRACT FROM AUTHOR]

This cross-sectional research was conducted to probe how 626 Taiwanese children's conceptions of learning differ by age and gender via drawing. Participants were from the kindergarten, the first grade, and the third grade. A coding scheme categorizing the people, learning domain, and place in the drawings was developed. Chi-square tests were then performed to examine the associations among the children's three grade levels, gender, and three categories: people, learning domain, and place. The findings showed that the kindergarteners tended to draw more family members as well as family and outdoor scenes, while the third graders tended to draw more school figures as well as classroom and school outdoor scenes. The first graders drew more peers than the third graders did. The kindergarteners drew significantly more social, informal, and playful activities than the other two groups did. The place for literacy learning switched from school (kindergarteners and first graders) to home (third graders). No gender difference was identified. This study provides insight into developing curricula that smooth children's transition from kindergarten to elementary school. [ABSTRACT FROM AUTHOR]

This study, first of all, aimed to develop a new survey to assess Taiwanese teachers' perceived self-efficacy in STEM knowledge. Second, it aimed to probe any differences in teachers' perceived self-efficacy in STEM knowledge regarding their gender and teaching subjects. Last, we examined the structural relations among teachers' perceived self-efficacy in STEM knowledge and their attitudes toward STEM education. The participants were 220 high school teachers in Taiwan. The 30-item instrument consisted of six factors: scientific inquiry, technology use, engineering design, mathematical thinking, and synthesized knowledge of STEM, as well as attitudes toward STEM education. The results showed that the proposed instrument was valid and reliable. In addition, male teachers outperformed female teachers in each dimension of the survey. Last, teachers' self-efficacy in synthesized knowledge of STEM had two mediating effects. One was in the relationship between self-efficacy in engineering design and attitudes toward STEM education. The other was in the relationship between self-efficacy in Mathematical Thinking and Attitudes toward STEM education. [ABSTRACT FROM AUTHOR]

Aims: Osteoporosis is one of the consequences of aging, and it remains underdiagnosed and undertreated; this study aimed to present the characteristics and prevalence of osteoporosis in elderly men by conducting a nationwide survey in Taiwan. Methods: The participants were enrolled between 2008 and 2011, and bone mineral density (BMD) was measured via dual‐energy X‐ray absorptiometry for the hip (total), lumbar spine (L1‐4), and femoral neck (FN). Patients with rheumatoid arthritis, female patients, and those using steroids were excluded. Osteoporosis was defined as a T‐score at the FN of ≤−2.5. Results: This study included 3734 men of mean age 70.0 ± 9.3 years, accounting for the prevalence of osteoporosis at 9.7%. Participants with osteoporosis had a significantly older age, lower body weight, shorter height and more previous fractures than those without osteoporosis. The mean BMD at FN was 0.534 ± 0.056 and 0.791 ± 0.115 (g/cm2) in participants with and without osteoporosis, respectively (P < 0.001). The FN and hip (total) BMD showed a significant negative correlation with age (r = −0.234, P < 0.001) and (r = −0.003, P < 0.001), respectively, but not at L1‐4 (r = 0.00, P = 0.540). A history of fracture is the most important risk factor associated with male osteoporosis (odds ratio, 2.50; 95% CI, 1.49‐4.21; P = 0.006). Conclusions: The associated factors for male osteoporosis are aging, lower body weight, and a history of fracture; the BMDs at FN and hip (total), but not L1‐4, are inversely correlated with age. We recommend that BMD at the proximal femur be the preferred site to evaluate osteoporosis for elderly male subjects. [ABSTRACT FROM AUTHOR]

Objectives HCQ, which is known to decrease SLE activity, may have a protective effect on survival, but this has not been proven in Asia. This study aimed to determine whether HCQ treatment is associated with increased survival in patients with SLE. Methods We designed this prospective SLE cohort study using data from the Taiwan National Health Insurance Research Database. The participants were divided into HCQ and control groups according to whether HCQ was prescribed during the first year after an SLE diagnosis. The primary outcome was mortality 1 year after inclusion. In the subgroup analysis, these participants were divided based on medication possession ratio (MPR) in the first year into non-users, MPR <40%, 40% ⩽ MPR < 80% and MPR ⩾80% subgroups to explore the relationship between survival and HCQ adherence. Results A total of 12 443 patients were eligible for the analysis. After propensity score matching, we included 2287 patients in each group. During a mean follow-up of 7.6 years, there were 169 events in the HCQ group (7.4%) and 248 events in the control group (10.8%). The risk of mortality in the HCQ group was lower than that in the control group (hazard ratio = 0.68; 95% CI: 0.56, 0.82). The subgroup analysis revealed that the survival protective effect was associated with HCQ adherence. Conclusion Patients with SLE who received HCQ had lower mortality rates due to any cause than those who did not. The survival benefit could be augmented by HCQ adherence. [ABSTRACT FROM AUTHOR]

The target of treatment for rheumatoid arthritis (RA) is to keep low disease activity or remission. Tocilizumab can fully inhibit interleukin-6 and C reactive protein (CRP) production. The goal of the study is to search whether tocilizumab treatment compared with adalimumab treatment had the similar effect on sonography and inflammatory parameters in patients with RA. We compared ultrasound scores and inflammatory parameters between patients with RA receiving tocilizumab therapy and those receiving adalimumab therapy. Power Doppler (PD) ultrasound and grayscale synovial hypertrophy on bilateral radiocarpal joints were performed. Inflammatory mediators and ultrasound scores were compared by independent t-test between the adalimumab and tocilizumab groups. 65 patients with RA (32 tocilizumab and 33 adalimumab) were included. Between the two groups, there were no significant differences in age, gender, rheumatoid factors and anticyclic citrullinated peptide antibody. Following biological therapy, the ultrasound score was 2.33 in the tocilizumab group and 2.08 in the adalimumab group (p=0.570), while the erythrocyte sedimentation rate, CRP and Disease Activity Score in 28 joints (DAS28) were lower in the tocilizumab group. So ultrasound scores between the two groups were not significantly different, but the laboratory parameters and DAS28 were lower in the tocilizumab group than in the adalimumab group. Hence, to assess disease activity cannot be based only on clinical evaluations, so we suggest PD ultrasound to be used for all patients on tocilizumab therapy and reflect the true disease activity in these patients. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effect of low-dose glucocorticoids (LDGs) on disease activity, bone density, and fractures in patients with rheumatoid arthritis (RA). This was an interim analysis of the RA Registry. Demographic data and clinical characteristics, including fracture risk assessment tool, were collected. 25(OH) Vitamin D, bone mineral density (BMD), and intact parathyroid hormone were measured at enrollment. The study group were those who took LDGs (2.5-7.5 mg/day prednisolone or equivalent dose), and the others were included as the control group. A total of 425 participants were enrolled, including 85 (20%) in the control group and 340 (80%) in the study group. The demographics and clinical characteristics were comparable between the two groups. Compared with the control group, the LDGs group had a significantly lower vertebral BMD (L 1-4) (g/cm2), (0.854 vs 0.896, p=0.046), significantly higher rate of previous fractures (103 (30.3%) vs 13 (15.3%), p=0.006), higher 10-year probability of major fractures (14 (15.5) vs 8 (8.6), p<0.0001), and higher 10-year probability of hip fractures (4.4 (8.4) vs 2 (3.9), p<0.0001). Disease activity appeared to be similar in the patients with RA regardless of whether or not they received LDG treatment. However, the patients with RA who received LDG treatment had a lower BMD at the spine (L1-4) and a higher rate of previous fractures that was associated with a significantly higher 10-year probability of fractures than those who did not receive LDG treatment. [ABSTRACT FROM AUTHOR]

Background. Apheresis treatment includes plasmapheresis (PP) and plasma exchange (PE), and these terms are commonly used interchangeably. Nevertheless, the two procedures are carried out differently. The aims of this study were to investigate the mortality rate of patients who underwent therapeutic apheresis and compare the mortality rate between PP and PE. Methods. We conducted a medical chart review retrospective study. All identified subjects (n=436) were over 20 years old with at least one ICD-9-CM intervention code plasmapheresis or plasma exchange and at least one diagnosis code with rheumatic disease. All of them were hospitalized to Chang Gung Memorial Hospital between 1st of January, 2000, and 31st of December, 2014. Results. 436 nonoverlapping patients had never received PE and/or PP before 1 Jan, 2000. Among all the patients, 350 received PE, 63 received PP, and 23 received both therapies. Female patients accounted for 85.09% of patients. The overall mortality rate was 4.65% in the PE subgroup, 4.76% with combination therapy, and 13.46% in the PP subgroup. There were 374 patients diagnosed as SLE, which is the majority of overall patients who received PE and/or PE. In multivariate analysis, PE was the sole independent factor predictor of survival in SLE subgroup patients (p=0.02, exp(B)=0.314, 95% CI 0.12–0.81). Conclusions. We showed that both PP and PE were used in treating a variety of autoimmune disorders. Plasmapheresis was preferentially carried out in patients with peripheral neuropathy. In 374 lupus patients treated with either PE or PP, PE is superior to PP in reducing in-hospital mortality. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop and validate an online contextualized test for assessing students’ understanding of epistemic knowledge of science. In addition, how students’ understanding of epistemic knowledge of science interacts with learner factors, including time spent on science learning, interest, self-efficacy, and gender, was also explored. The participants were 489 senior high school students (244 males and 245 females) from eight different schools in Taiwan. Based on the result of an extensive literature review, we first identified six factors of epistemic knowledge of science, such as status of scientific knowledge, the nature of scientific enterprise, measurement in science, and so on. An online test was then created for assessing students’ understanding of the epistemic knowledge of science. Also, a learner-factor survey was developed by adopting previous PISA survey items to measure the abovementioned learner factors. The results of this study show that; (1) by factor analysis, the six factors of epistemic knowledge of science could be grouped into two dimensions which reflect the nature of scientific knowledge and knowing in science, respectively; (2) there was a gender difference in the participants’ understanding of the epistemic knowledge of science; and (3) students’ interest in science learning and the time spent on science learning were positively correlated to their understanding of the epistemic knowledge of science. [ABSTRACT FROM AUTHOR]

Objectives. The quantification of synovitis is of great significance for follow-up in patients with rheumatoid arthritis (RA). This study aimed to validate the use of power Doppler ultrasonography (PDUS) for evaluating synovial vascularity and synovial hypertrophy for synovitis in patients with rheumatoid arthritis treated with adalimumab. Materials and Methods. The synovial disease activity and vascularity of RA on both wrists (radio-carpal joint) were assessed using GS and PDUS to derive the composite US scores based on abnormal counts and severity. The relationship between each measure was determined. Results. The 71 patients who received adalimumab therapy had significantly decreased DAS28, ESR, and CRP. After one month, PD score decreased and then remained low for 12 months. Synovial hypertrophy did not change until 3–6 months after, when it started to improve (p=0.017). By multivariate analysis, sex, age, BMI, and DAS28 did not lead to any difference between synovial hypertrophy and PDUS changes (p=0.498). Discussion. Composite US markers of synovial hypertrophy correlate significantly to the DAS28 score and ESR/CRP in adult RA. The time needed for synovial hypertrophy to decrease may be up to 3–6 months after adalimumab therapy. Switching to biological therapy before 3–6 months is inappropriate and ineffective. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the effect of early anti-tumor necrosis factor (TNF) therapy in patients with severe rheumatoid arthritis (RA) on the subsequent risk of total knee replacement (TKR) surgery.Methods: This retrospective observational study included a hospital-based cohort of 200 patients diagnosed with severe RA who received treatment with anti-TNF therapy between 2003 and 2014. Clinical parameters including age, sex, body mass index, and the time from the diagnosis of RA to the initiation of anti-TNF therapy were analyzed.Results: Of the 200 enrolled patients, 84 underwent an early intervention (≤3 years from the diagnosis of RA to the initiation of anti-TNF therapy), and 116 underwent a late intervention(>3 years from the diagnosis of RA to the initiation of anti-TNF therapy). Five (6.0%) patients in the early intervention group underwent TKR compared to 31 (26.7%) in the late intervention group (p = 0.023). After adjusting for confounding factors, the late intervention group still had a significantly higher risk of TKR (p = 0.004; odds ratio, 5.572; 95% confidence interval, 1.933-16.062). Those receiving treatment including methotrexate had a lower risk of TKR (p = 0.004; odds ratio, 0.287; 95% confidence interval, 0.122-0.672).Conclusions: Delayed initiation of anti-TNF therapy in the treatment of severe RA was associated with an increased risk of TKR surgery. Adding methotrexate treatment decreased the risk of future TKR. [ABSTRACT FROM AUTHOR]