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Many advanced learning tools have been recently developed; however, demand for interactive environments that can enhance learning performance in a blended setting is growing. This study designed an interactive approach by integrating a learning tool, interactive sessions, and a variety of interaction types, and the effects of the types of interactions on learning performance were evaluated. Specifically, the WeChat-based app Rain Classroom was used to enhance learning. Rain Classroom has learner-learner, learner-teacher, and learner-content interaction sessions before, during, and after class; the method was denoted the Rain Classroom interactive approach. Analysis of covariance results revealed that the experimental group using Rain Classroom significantly outperformed the control group participating in conventional learning. A Pearson correlation analysis was conducted on Rain Classroom system log data, and learner interaction features, namely self-practice tests, Danmu discussion, and the instant response system (IRS), were positively related with learning performance; however, attendance was unrelated. Multiple regression analysis was conducted to determine which Rain Classroom interaction types predict learning performance; all interaction types predicted learning performance, but learner-content interactions had the greatest effect. Teachers could refer to the proposed Rain Classroom-based interactive approach when developing methods to improve student learning performance in a digital interactive environment.

Purpose: This study explores the achievements and process of a group of Chinese primary school teachers learning from a research-based school-university collaborative project. Design/Approach/Methods: We used qualitative methods to construct our research design, collecting data through participatory observations of weekly meetings, teacher interviews, and participants' reflective journals. Both thematic analysis and discursive analysis were employed as strategies to scrutinize the data. Findings: We categorize teachers' learning into five achievements--outcome, processual, democratic, catalytic, and dialogic achievement. A further examination highlights seven successive learning actions composing an implicit mechanism to facilitate these achievements: questioning, analyzing, modeling, examining, implementing, reflecting, and consolidating. Originality/Value: Through this longitudinal study, we more comprehensively record details about teachers' learning as they conduct their own research. Although school-university heterogeneous collaboration has potential conflicts, teachers can improve their problem-solving and knowledge creation and sharing abilities, promoting a sense of professional accomplishment. These findings also suggest the need to reconsider the authentic process of teacher research, a task equally significant for international educators.

Electromigration (EM) has been a pivotal reliability challenge for interconnects, but there are only few studies on EM in Cu–Cu joints. In this work, accelerated EM tests for the Cu–Cu joints were conducted at three temperatures (150 °C, 179 °C, and 208 °C) and the temperature-dependent failures were discussed. The polarity effect of the grain growth behaviors at the bonding interfaces was observed at the opposite electron flows, which may be attributed to the difference in EM-build-up stress conditions and the divergence in atomic fluxes. Moreover, the activation energy (Ea) extrapolated from the three EM temperatures was derived as 0.9 eV. As compared to the solder joints with same dimensions, the Cu–Cu joints possess more than ten times of time-to-failures (TTFs) under the same EM condition.

Abstract NO previous studies have examined the simultaneous effects of obstructive sleep apnea (OSA), hypertension, and the SNP rs68430822 on stroke. We aimed to explore whether these elements together, play a role as risk factors for stroke. Data was obtained from the Taiwan Biobank and the National Health Insurance database. We used logistic regression analysis to investigate the effect of OSA and hypertension as a risk factor for stroke in different genotypes. We found that OSA and hypertension was associated with stroke in those with the rs6843082 genotype. People with OSA and hypertension together with the rs6843082 genotype (GA + AA) showed a statistically significant difference as a risk for stroke (OR,2.57; 95% CI,1.53 to 4.33). However, there was no statistically significant difference in those people with OSA but without hypertension (OR, 0.53; 95% CI,0.13 to 2.25). After further stratification by combination of OSA and hypertension, those with genotype rs6843082 (GG) had higher risk odds than those with OSA and those with hypertension alone (OR,5.46, 95% CI,3.46 to 8.60). Individuals with genotype rs6843082(GA + AA), OSA and hypertension together had the highest risk for stroke (OR,6.25, 95% CI,3.63 to 10.76) and those with OSA and no hypertension (OR,0.57, 95% CI,0.14 to 2.36) had no significant risk. Our findings showed that people with genotype rs6843082 (GG), with or without hypertension had OSA as a risk factor for stroke. For individuals with the genotype rs6843082 (GA + AA), those with hypertension, OSA is a risk factor for stroke, and for those without hypertension, OSA is not associated with stroke.

Abstract Taste, a pivotal sense modality, plays a fundamental role in discerning flavors and evaluating the potential harm of food, thereby contributing to human survival, physical and mental health. Patients with tongue cancer may experience a loss of taste following extensive surgical resection with flap reconstruction. Here, we designed a gustatory interface that enables the non-invasive detection of tongue electrical activities for a comprehensive operative assessment. Moreover, it decodes gustatory information from the reconstructed tongue without taste buds. Our gustatory interface facilitates the recording and analysis of electrical activities on the tongue, yielding an electrical mapping across the entire tongue surface, which delineates the safe margin for surgical management and assesses flap viability for postoperative structure monitoring and prompt intervention. Furthermore, the gustatory interface helps patients discern tastes with an accuracy of 97.8%. Our invention offers a promising approach to clinical assessment and management and holds potential for improving the quality of life for individuals with tongue cancer.

Abstract Background Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies have emerged as promising therapeutic options for the treatment of chronic migraine. However, treatment response varies considerably among individuals, suggesting a potential role for genetic factors. This study aimed to identify genetic variants affecting the efficacy of anti-CGRP monoclonal antibody therapy in chronic migraine among the Han Chinese population in Taiwan to enhance treatment precision and to understand the genetic architecture of migraine. Methods We conducted a quantitative trait locus (QTL) association study in patients with chronic migraines from a tertiary medical center in Taiwan using the Taiwan Precision Medicine Array Chip. The patients received fremanezumab or galcanezumab for at least 12 weeks. Treatment efficacy was assessed based on the improvement rate in monthly migraine days. Genetic variants were identified, and their associations with treatment efficacy were examined through quantitative trait loci analysis, linkage disequilibrium studies, and functional annotations using the Gene Ontology database. Results Six single nucleotide polymorphisms (SNPs) relative variants were significantly associated with anti-CGRP therapy response (p

Cu–Cu joints with various interfacial microstructures were fabricated, by applying different annealing conditions to the joints to trigger different amounts of recrystallization and grain growth at the bonding interfaces. Three distinct interfaces were obtained, including planar, zig-zag, and recrystallized. The joints with the recrystallized interfaces possessed superior pull strength exceeding 50 MPa, whereas for the planar-interface joints it was only 15 MPa. Moreover, after 1000 cycles of thermal cycling tests (TCTs), the resistance increase for the recrystallized joints was as low as 3.95%, which outperformed the planar-interface joints (16.67%) and zig-zag-interface joints (9.69%). Thermal stress induced fractures were prone to happening at the planar-type interfaces, while the recrystallized interfaces exhibited excellent resistance to thermal fatigue. This study offers understandings on the thermal and mechanical reliabilities for the Cu–Cu joints with various types of the bonding interfaces, fabricated intentionally by tailoring the bonding parameters. We highlight the influence of the bonding interfacial microstructures on the bonding strengths and TCT reliabilities.

Mobile technologies are widely used in education, both as standalone tools and in conjunction with other applications. The WeChat-based app Rain Classroom is one such application. Rain Classroom includes learning activities not only during class but also before and after class. Previous research has suggested strong demand for WeChat-based apps that can facilitate learning. However, relevant studies have not empirically evaluated the effect of Rain Classroom on English learning performance. This study examined the effects of using Rain Classroom for English learning. A total of 152 students were divided into control and experimental groups, each with 76 students. The experimental group had significantly better English reading, writing and listening scores than the control group did. The effects of the perceived features of Rain Classroom and learner satisfaction on learning performance were also investigated. Both factors had a significant positive influence on learning performance. The Rain Classroom has been proven to be an effective English learning tool. On the basis of the study findings, relevant implications are offered.

Abstract Background The ethmoid sinus (ES) is a three-dimensional (3D) complex structure, a clear understanding of the ES anatomy is helpful to plan intranasal surgery. However, most prior studies use 2D measurements, which may not accurately depict the 3D structure. The current study measured the gender differences in ES morphology based on 3D reconstruction of computed tomography (CT) images. Methods The 3D models were reconstructed using CT images. Twenty-one males and 15 females were enrolled in the study. The ES dimensions, including width, height and aspect ratio (AR) of each cutting-plane section, were measured at 10% increments along with the anteroposterior axis of the ES. The gender differences in the above parameters were further evaluated by an independent t-test. Results The width of the ES for males is 12.0 ± 2.1 mm, which was significantly greater than that in females (10.0 ± 2.1 mm). The average height for males is 18.4 ± 3.5 mm, and 18.2 ± 3.4 mm for females. The AR of female (male) is around 0.56 (0.63) for the anterior ES and 0.66 (0.75) for the posterior. There are significant differences between genders in the parameters of width and AR (p

Introduction: Epithelial-mesenchymal transition (EMT) of retinal pigment epithelial (RPE) cells is related to the pathogenesis of various retinopathies including age-related macular degeneration (AMD). Oxidative stress is the major factor that induces degeneration of RPE cells associated with the etiology of AMD. Objectives: Sodium iodate (NaIO3) generates intracellular reactive oxygen species (ROS) and is widely used to establish a model of AMD due to the selective induction of retinal degeneration. This study was performed to clarify the effects of multiple NaIO3-stimulated signaling pathways on EMT in RPE cells. Methods: The EMT characteristics in NaIO3-treated human ARPE-19 cells and RPE cells of the mouse eyes were analyzed. Multiple oxidative stress-induced modulators were investigated and the effects of pre-treatment with Ca2+ chelator, extracellular signal-related kinase (ERK) inhibitor, or epidermal growth factor receptor (EGFR) inhibitor on NaIO3-induced EMT were determined. The efficacy of post-treatment with ERK inhibitor on the regulation of NaIO3-induced signaling pathways was dissected and its role in retinal thickness and morphology was evaluated by using histological cross-sections and spectral domain optical coherence tomography. Results: We found that NaIO3 induced EMT in ARPE-19 cells and in RPE cells of the mouse eyes. The intracellular ROS, Ca2+, endoplasmic reticulum (ER) stress marker, phospho-ERK, and phospho-EGFR were increased in NaIO3-stimulated cells. Our results showed that pre-treatment with Ca2+ chelator, ERK inhibitor, or EGFR inhibitor decreased NaIO3-induced EMT, interestingly, the inhibition of ERK displayed the most prominent effect. Furthermore, post-treatment with FR180204, a specific ERK inhibitor, reduced intracellular ROS and Ca2+ levels, downregulated phospho-EGFR and ER stress marker, attenuated EMT of RPE cells, and prevented structural disorder of the retina induced by NaIO3. Conclusions: ERK is a crucial regulator of multiple NaIO3-induced signaling pathways that coordinate EMT program in RPE cells. Inhibition of ERK may be a potential therapeutic strategy for the treatment of AMD.

CDK4/6 inhibitors combined with endocrine therapy prolonged survival in hormone receptor (HR)-positive and HER2-negative advanced breast cancer. We investigated whether CDK4/6 inhibitors enhance radiosensitivity and their underlying mechanisms of this subtype of breast cancer. In vitro and in vivo experiments were conducted using two HR-positive and HER2-negative breast cancer cell lines (MCF-7 and T-47D), CDK4/6 inhibitors (ribociclib and palbociclib) and radiotherapy (RT) to assess the biological functions and mechanisms. The radiation-enhancing effect was assessed using clonogenic assays; γH2AX and 53BP1 levels were assessed by immunofluorescence to evaluate DNA damage. The levels of phospho (p)-ERK, c-Myc, and DNA-double strand break (DSB)-related molecules, p-DNA-PKcs, Rad51, and p-ATM, were assessed by western blotting. We used an NF-κB p65 transcription factor assay kit to evaluate NF-κB activity. We evaluated the antitumor effect of the combination of RT and ribociclib through the MCF-7 orthotopic xenograft model. The synergistic effects of combining RT with ribociclib and palbociclib pretreatment were demonstrated by clonogenic assay. CDK4/6 inhibitors synergistically increased the numbers of RT-induced γH2AX and 53BP1, downregulated the expression of p-DNA-PKcs, Rad51 and p-ATM activated by RT, and reduced RT-triggering p-ERK expression, NF-κB activation, and its down-streaming gene, c-Myc. Combined ribociclib and RT reduced the growth of MCF-7 cell xenograft tumors, and downregulated the immunohistochemical expression of p-ERK, p-NF-κB p65, and c-Myc compared to that in the control group. Combining CDK4/6 inhibitors enhanced radiosensitivity of HR-positive and HER2-negative breast cancer cells at least by reducing DNA-DSB repair and weakening the activation of ERK and NF-κB signaling by RT.

Objective To investigate the clinical effect of transsegmental shunt surgery in the treatment of syringomyelia due to trauma and infection in perspective of cerebrospinal fluid dynamics. Methods A total of 17 syringomyelia patients admitted to the Syringomyelia Department in Zhengzhou Central Hospital from July 2019 to June 2021 were collected, all patients underwent trans-segmental shunt surgery for syringomyelia. The clinical features, electromyography and imaging features of patients before and after operation were analyzed. The Chicago Chiari outcome scale (CCOS) and Japanese Orthopaedic Association (JOA) score improvement index were used to evaluate the clinical prognosis of patients. Pearson method was used to analyze the correlation between the JOA score improvement index, CCOS score and the difference of peak velocity of cerebrospinal fluid. Results After transsegmental shunt, the clinical symptoms of 14 cases were significantly improved, and 3 cases did not improve. The JOA score was significantly higher after surgery than before surgery (17.65±1.80 vs 8.94±2.36, t=11.609, P＜0.01). Limb numbness, dissociative sensory disorder, gait disorder, dizziness, lower limb weakness, ataxia, sensory nerve conduction, motor nerve conduction, maximum diameter of cavity and peak cerebrospinal fluid flow in the foramen magnum and the midbrain aquaquet during systolic and diastolic periods were significantly improved after surgery (P＜0.05). JOA score improvement index and CCOS score were significantly correlated with the difference of cerebrospinal fluid peak velocity (P＜0.05). Conclusion For patients with syringomyelia caused by trauma or infection, trans-segmental shunt of syringomyelia can improve the cerebrospinal fluid dynamics of patients with syringomyelia to a certain extent, promote the reduction of syringomyelia and improve the clinical symptoms of patients.

Abstract Introduction Eight-week glecaprevir/pibrentasvir (GLE/PIB) is indicated for treatment-naïve (TN) patients with chronic hepatitis C (CHC), with or without compensated cirrhosis. Given that the Taiwanese government is committed to eliminating hepatitis C virus (HCV) by 2025, this study aimed to measure real-world evidence for TN patients using 8-week GLE/PIB in the Taiwan HCV Registry (TACR). Methods The data of patients with CHC treated with 8-week GLE/PIB were retrieved from TACR, a nationwide registry program organized by the Taiwan Association for the Study of the Liver (TASL). Treatment efficacy, defined as a sustained virologic response at posttreatment week 12 (SVR12), was assessed in the modified intention-to-treat (mITT) population, which excluded patients who were lost to follow-up or lacked SVR12 data. The safety profile of the ITT population was assessed. Results A total of 7246 (6897 without cirrhosis; 349 with cirrhosis) patients received at least one dose of GLE/PIB (ITT), 7204 of whom had SVR12 data available (mITT). The overall SVR12 rate was 98.9% (7122/7204) among all patients, 98.9% (6780/6856) and 98.3% (342/348) among patients without and with cirrhosis, respectively. For the selected subgroups, which included patients with genotype 3 infection, diabetes, chronic kidney disease, people who injected drugs, and those with human immunodeficiency virus coinfection, the SVR12 rates were 95.1% (272/286), 98.9% (1084/1096), 99.0% (1171/1183), 97.4% (566/581), and 96.1% (248/258), respectively. Overall, 14.1% (1021/7246) of the patients experienced adverse events (AEs). Twenty-two patients (0.3%) experienced serious AEs, and 15 events (0.2%) resulted in permanent drug discontinuation. Only one event was considered treatment drug related. Conclusion Eight-week GLE/PIB therapy was effective and well tolerated in all TN patients, regardless of cirrhosis status.

Introduction: Syphilis, an ancient sexually transmitted disease, is recognized as a systemic infection disease manifesting with diverse symptoms and variations. Secondary syphilis characterized by systemic symptoms resulted from hematogenous and lymphatic dissemination of the infection, may include manifestations such as hepatitis and nephrotic syndrome. However, the simultaneous occurrence of hepatitis and nephrotic syndrome in secondary syphilis is rare. Case Presentation: A young man presented with fatigue, abnormal liver function tests, and hyperbilirubinemia and had history of men who have sex with men (MSM). Serological tests confirmed the diagnosis of secondary syphilis, and kidney biopsy indicated membranous nephritis. After antibiotic treatment, the patient experienced resolution of proteinuria, and liver enzyme levels returned to normal. Conclusion: Syphilis should be considered in the differential diagnosis of simultaneous liver and kidney dysfunction, particularly in patients engaging in high-risk sexual behavior. This case highlights the importance of considering syphilis in young patients with MSM and presenting with unexplained nephrotic syndrome and liver abnormalities.

BackgroundDementia poses a growing global mental health impact, with variations in prevalence by gender, possibly influenced by reproductive factors. Ectopic pregnancy (EP), known for its association with cardiovascular diseases and depression, which are also predictors of dementia, prompted an exploration of their interplay.MethodsUsing Taiwan’s National Health Insurance Research Database, this nationwide cohort study examined 53,096 individuals to investigate the link between EP and dementia. Covariates included age, insured premiums, comorbidity by Charlson Comorbidity Index revised by excluding dementia, level of care, and residence. Surgical approaches, number of EP episodes, and dementia subtypes were considered in outcomes analysis using Cox regression.ResultsAmong 13,274 women diagnosed with EP, 791 developed dementia over a 15-year follow-up, particularly vascular dementia. Adjusting for the covariates, the adjusted sub-distribution Hazard Ratio (asHR) with competing risks was 1.644 (95% CI, 1.394–2.053; p < 0.001). For patients with more than one episode, it was even higher (asHR=1.670 [95% CI, 1.419–2.092; p < 0.001]). Post-ectopic depression, prevalent in 62.2% within four weeks, was associated with a greater dementia risk compared to those without (asHR=1.702 [95% CI, 1.444-2.125; p

Temporomandibular joint osteoarthritis (TMJ-OA) is usually caused by increased friction at the joint interface, excessive release of inflammatory factors and catabolic enzymes, and free radical accumulation, which can lead to accelerated degradation and damage of cartilage. In this study, we develop a biological metabolism-inspired injectable hydrogel crosslinking by hydrazide modified hyaluronic acid (HA-HYD), aldehyde modified hyaluronic acid (HA-ALD), and ε-polylysine coated catalase-mimic nanozyme (mesoporous manganese cobalt oxide). Herein, this nanozyme-reinforced hydrogel with outstanding and durable reactive oxygen species (ROS) depletion capability and biocompatibility can alleviate the oxidative stress microenvironment, improve cell viability and proliferation, as well as up-regulate chondrogenic related gene expression and cartilage matrix formation of chondrocytes in vitro. Intra-articular administration of this engineered hydrogel can effectively scavenge endogenous over-expressed ROS to ameliorate the harsh microenvironment in the cavity of TMJ-OA. The nanozyme-reinforced hydrogel reduced proinflammatory cytokines (TNF-α, IL-1β, and IL-6) and enhance anti-inflammatory cytokines (IL-10) expression, induced polarization of synovial macrophages towards M2 phenotype, alleviated structural damage to the cartilage and subchondral bone of the condyle, thus reducing cartilage matrix destruction and protect cartilage in osteoarthritis. In summary, the bioinspired nanozyme-reinforced hydrogels might be used as a promising ROS scavenger for treatment of TMJ-OA.

ObjectivePsilocybin-assisted therapy has shown promising efficacy on clinical depressive symptoms. However, diverse psychological support or psychotherapy was performed with psilocybin treatment. This study aimed to explore the association of psychological protocols with the efficacy of psilocybin-assisted therapy for depressive symptoms.MethodFive major databases were systemic searched for clinical trials addressing psilocybin-assisted therapy for patients with clinical depressive symptoms. A Bayesian random-effects meta-analysis and meta-regression were performed. The effect size was mean difference (with 95% credible interval) measured by 17-Item Hamilton Depression Rating Scale.ResultsThere were 10 eligible studies including 515 adult patients with clinically diagnosed depression. The psychological protocols could be categorized into four types: (i) manualized directive psychotherapy(k=1); (ii) manualized nondirective psychological support(k=3), (iii) non-manualized nondirective psychological support(k=5); and (iv) non-manualized supportive psychotherapy(k=1). The pooled standard mean difference of psilocybin-assisted therapy was 10.08 (5.03-14.70).ConclusionCompared with manualized nondirective psychological support, the other three psychological approaches did not differ significantly. The improvement of depressive symptoms was not associated with the psychological protocols in adult patients receiving psilocybin-assisted therapy.Systemic review registrationOpen Science Framework: identifier (osf.io/3YUDV).

Resistive random‐access memory (RRAM) is considered the next‐generation nonvolatile memory owing to its simplicity, low power consumption, and high storage density. Resistive switching (RS) occurs in a wide range of materials among the transition metal oxides. Herein, an epitaxial ternary metal oxide layer, LaCoOx (LCO), grown on Nb‐doped SrTiO3 substrates, is utilized as an RRAM device. When voltage is applied, it exhibits excellent RS behavior. More than 900 cycles are obtained, and the retention time reaches up to 104 s. To investigate the RS behavior, high‐resolution transmission electron microscopy and atomic‐scale scanning transmission electron microscopy are used to observe the structural evolution and oxygen ion migration in LCO. The structure exhibits a perovskite–brownmillerite topotactic phase transformation from LaCoO2.5 or LaCoO2.67 to the LaCoO3 conductive regions. The reversible transition between the low‐resistance states and high‐resistance states enables the RS mechanism. Additionally, the valence states are confirmed using high‐resolution X‐ray photoelectron spectroscopy. This study not only illustrates the oxygen‐ion migration mechanism of LCO but also demonstrates its suitability for RRAM applications.

Introduction Postoperative ileus (POI) is a postoperative complication that can cause lingering recovery after colorectal resection and a heavy healthcare system burden. Acupuncture aims to prevent postoperative complications, reduce the duration of POI, help recovery and shorten hospital stays. We hypothesise that preoperative electroacupuncture (EA) can promote POI recovery under the enhanced recovery after surgery protocol after laparoscopic surgery in patients with POI.Methods and analysis This is a multicentre, randomised, sham-controlled trial. A total of 80 patients will be enrolled and randomly assigned to the EA or sham electroacupuncture (SA) group. The eligible patients will receive EA or SA for one session per day with treatment frequency starting on preoperative day 1 for four consecutive days. The primary outcome is the time to first defecation. The secondary outcomes include the time to first flatus, length of postoperative hospital stay, time to tolerability of semiliquid and solid food, postoperative nausea, vomiting, pain and extent of abdominal distention, time to first ambulation, preoperative anxiety, 30-day readmission rate, the usage of anaesthetics and analgesics during operation, length of postanaesthesia care unit stay. A mechanistic study by single-cell RNA sequencing in which postintervention normal intestinal tissue samples will be collected. The results of this study will provide evidence of the effects of acupuncture on POI and promote good clinical decision to millions of patients globally every year.Ethics and dissemination This study has been approved by the ethical application of Beijing University of Chinese Medicine (2022BZYLL0401), Beijing Friendship Hospital Affiliated to Capital Medical University(2022-P2-368-02), Cancer Hospital Chinese Academy of Medical Science (23/175-3917), Huanxing Cancer Hospital (2023-002-02). The results will be published in a medical journal. In addition, we plan to present them at scientific conferences.Trial registration number ChiCTR2300077633.

Abstract Optimization of experimental materials synthesis and characterization through active learning methods has been growing over the last decade, with examples ranging from measurements of diffraction on combinatorial alloys at synchrotrons, to searches through chemical space with automated synthesis robots for perovskites. In virtually all cases, the target property of interest for optimization is defined a priori with the ability to shift the trajectory of the optimization based on human-identified findings during the experiment is lacking. Thus, to highlight the best of both human operators and AI-driven experiments, here we present the development of a human–AI collaborated experimental workflow, via a Bayesian optimized active recommender system (BOARS), to shape targets on the fly with human real-time feedback. Here, the human guidance overpowers AI at early iteration when prior knowledge (uncertainty) is minimal (higher), while the AI overpowers the human during later iterations to accelerate the process with the human-assessed goal. We showcase examples of this framework applied to pre-acquired piezoresponse force spectroscopy of a ferroelectric thin film, and in real-time on an atomic force microscope, with human assessment to find symmetric hysteresis loops. It is found that such features appear more affected by subsurface defects than the local domain structure. This work shows the utility of human–AI approaches for curiosity driven exploration of systems across experimental domains.

Abstract The increase in intense tropical cyclone (TC) activity across the western North Pacific (WNP) has often been attributed to a warming ocean. However, it is essential to recognize that the tropical WNP region already boasts high temperatures, and a marginal increase in oceanic warmth due to global warming does not exert a significant impact on the potential for TCs to intensify. Here we report that the weakened vertical wind shear is the primary driver behind the escalating trend in TC intensity within the summer monsoon trough of the tropical WNP, while local ocean surface and subsurface thermodynamic factors play a minor role. Through observational diagnoses and numerical simulations, we establish that this weakening of the vertical wind shear is very likely due to the increase in temperature of the Tibetan Plateau. With further warming of the Tibetan Plateau under the Representative Concentration Pathway 4.5 scenario, the projected TCs will likely become stronger.

The strong multipath and long delay extensions can lead to large errors in the timing offset estimation and carrier frequency offset estimation of the Orthogonal Frequency Division Multiplexing (OFDM) underwater communication system, resulting in significant performance degradation. Therefore, this paper proposes a robust time-frequency synchronization method for OFDM systems. First, a new preamble based on Constant Amplitude Zero Autocorrelation (CAZAC) sequence is designed, and a new signal timing offset estimation method is developed based on the time domain characteristics of the preamble. Secondly, a two-stage frequency offset estimation (CFO) method is designed in the time domain followed by the frequency domain, which achieves a wide range of high-accuracy frequency offset estimation. Finally, an adaptive threshold signal first-arrival path detection method is proposed to achieve reliable detection of the position of the signal first-arrival path under complex multipath channels. The simulation, pool, and lake experiment results are provided to verify the reliability and effectiveness of this method. Compared with the traditional methods, the proposed method can more accurately obtain the signal timing position and estimate the CFO in complex multipath channels, and at the same time greatly expand the estimation range of the CFO.

Melanoma is rare in Taiwan. Asian melanoma is distinct from Western melanoma because acral and mucosal melanoma accounts for the majority of melanoma cases, leading to distinct tumor behaviors and genetic profiling. With consideration of the clinical guidelines in Western countries, Taiwanese experts developed a local clinical practice consensus guideline. This consensus includes diagnosis, staging, and surgical and systemic treatment, based only on clinical evidence, local epidemiology, and available resources evaluated by experts in Taiwan. This consensus emphasizes the importance of surgical management, particularly for sentinel lymph node biopsies. In addition, molecular testing for BRAF is mandatory for patients before systemic treatment. Furthermore, immunotherapy and targeted therapy are prioritized for systemic treatment. This consensus aimed to assist clinicians in Taiwan in diagnosing and treating patients according to available evidence.

Abstract Extracellular vesicles (EVs) have gained increasing recognition as significant regulators of intercellular communication in various physiological and pathological processes. These vesicles play a pivotal role in cancer progression by facilitating the transfer of diverse cargoes, including lipids, proteins, and nucleic acids. Regulated cell death (RCD), the orderly and autonomous death of cells, is controlled by a variety of biomacromolecules and, in turn, influences various biological processes and cancer progression. Recent studies have demonstrated that EV cargoes regulate diverse oncogenes and tumor suppressors to mediate different nonapoptotic forms of RCD, notably ferroptosis, pyroptosis, and necroptosis. Nevertheless, comprehensive exploration of EV-mediated nonapoptotic RCD forms in the context of cancer has not been performed. This review summarizes the progress regarding the biological functions and underlying mechanisms of EVs in mediating nonapoptotic RCD by delivery of cargoes to regulate tumor progression. Additionally, the review delves into the potential clinical applications of EV-mediated cell death and its significance in the areas of cancer diagnosis and therapy.

Abstract Long non-coding RNAs (lncRNAs) have been shown to play crucial roles in response to aging processes. However, how lncRNAs regulate postharvest senescence of Sparassis latifolia (S. latifolia) with oriented polypropylene (OPP) film packing during cold storage remains unclear. In this study, we performed RNA-seq using the fruiting bodies of S. latifolia stored at 4 ℃ for 0, 8, 16 and 24 days after harvest, and profiled the lncRNA and mRNA transcriptome, respectively. In total, 1003 putative lncRNAs were identified, and there were 495, 483 and 162 differentially expressed (DE) lncRNAs, and 3680, 3941 and 1870 differentially expressed mRNAs after 8, 16 and 24 days of storage, respectively, compared to 0 day of storage. Target genes of differentially expressed lncRNAs were found to significantly associate with carbon and energy metabolism, response to abiotic stimulus, amino acid biosynthesis and metabolism, and protein synthesis and transcription. In addition, DE-lncRNA-mRNA co-expression networks in response to aging stress were also constructed. Taken together, these results confirm the regulatory role of lncRNAs in postharvest senescence of S. latifolia and will facilitate for improving preservation method.

Background The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments (EDs). However, scientific evidence regarding the association between home-based healthcare services and ED uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for ED visits among patients receiving publicly-funded homecare services.Methods The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and ED visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned ED utilizations.Results Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio [OR] = 1.33, 95% CI = 1.05 to 1.70), male caregiver (OR = 0.18, 95% CI = 0.05 to 0.66), duration of introducing homecare services (OR = 0.97, 95% CI = 0.95 to 1.00), working experience of dedicated nurses (OR = 0.89, 95% CI = 0.79 to 0.99) and number of ED utilizations within previous past year before enrollment (OR = 1.54, 95% CI = 1.14 to 2.10) as significant determinants for unplanned ED visits.Conclusion The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent ED visits among patients receiving homecare services.

Objective The present study is to analyze the effects of the coronavirus disease 2019 (COVID 2019) outbreak and the subsequent lockdown on the outcomes of spinal metastasis patients. Methods The study was a retrospective analysis of data from a prospective cohort study. All patients underwent surgical intervention for spinal metastases between January 2019 and December 2021 and had at least 3 months of postoperative follow-up. The primary outcome was overall mortality during the 4 different stages (pre-COVID-19 era, COVID-19 pandemic except in Taiwan, national lockdown, lifting of the lockdown). The secondary outcomes were the oncological severity scores, medical/surgical accessibility, and patient functional outcome during the 4 periods as well as survival/mortality. Results A total of 233 patients were included. The overall mortality rate was 41.20%. During the Taiwan lockdown, more patients received palliative surgery than other surgical methods, and no total en bloc spondylectomy was performed. The time from surgeon visit to operation was approximately doubled after the COVID-19 outbreak in Taiwan (75.97, 86.63, 168.79, and 166.91 hours in the 4 periods, respectively). The estimated survival probability was highest after the national lockdown was lifted and lowest during the lockdown. In the multivariate analysis, increased risk of mortality was observed with delay of surgery, with emergency surgery having a higher risk with delays above 33 hours, urgent surgery (below 59 and above 111 hours), and elective surgery (above 332 hours). Conclusion The COVID-19 pandemic and related policies have altered daily clinical practice and negatively impacted the survival of patients with spinal metastases.

Abstract Heatmap‐based regression (HBR) methods have dominated for a long time in the face alignment field while these methods need complex design and post‐processing. In this study, the authors propose an end‐to‐end and simple enough coordinate‐based regression (CBR) method called Dynamic Deformable Transformer (DDT) for face alignment. Unlike general pre‐defined landmark queries, DDT uses Dynamic Landmark Queries (DLQs) to query landmarks' classes and coordinates together. Besides, DDT adopts a deformable attention mechanism rather than a regular attention mechanism which has a faster convergence speed and lower computational complexity. Experiment results on three mainstream datasets 300W, WFLW, and COFW demonstrate DDT exceeds the state‐of‐the‐art CBR methods by a large margin and is comparable to the current state‐of‐the‐art HBR methods with much less computational complexity.

Cyanate, a toxic product from the chemical oxidation treatment of highly toxic cyanide, can be converted to harmless ammonia and carbon dioxide by cyanase (EC 4.2.1.104). Cyanase from Thermomyces lanuginosus was entrapped in biomimetic silica to improve stability and reusability. After entrapment, the enzyme’s activity increased by two-fold, and the residual activity after 30-min of incubation at 60 °C also increased by two-fold, compared to the free enzyme. After being stored at room temperature for 28 days, the entrapped cyanase retained 79% of the initial activity, while the free form retained 61%. The immobilized cyanase was successfully applied to cyanate detoxification; the co-entrapment of carbonic anhydrase from Sulfurihydrogenibium azorense decreased the amount of bicarbonate necessary for cyanate detoxification by 50%. The cyanate degradation retained 53% of the initial value after the co-entrapped cyanate and carbonic anhydrase were reused five times.

This longitudinal study examines the use of a mandatory learning module in an initial teacher education (ITE) programme that aims to develop the practical knowledge of pre-service teachers (PSTs) in a Chinese Normal university. Guided by formative interventions, data were collected from videotaped discussion meetings, teaching activities, and reflective journals of PSTs. The data were then analysed from the theoretical perspectives of expansive learning and the components of teachers' practical knowledge. The results identified the intervention trajectory as three consecutive cycles and the intervention outcomes as different development trends among knowledge components in PSTs' practical knowledge. This study contributes to the methodology of formative intervention and its empirical utility, and therefore has global implications for ITE transformation by regarding teacher practical knowledge as a complex knowledge system with evolutionary dynamics.

Concept mapping (CM) is widely used in educational settings as a teaching/learning or assessment tool. We conducted a bibliometric analysis and systematic review to provide an updated review on CM research in computer-supported learning environments. A total of 356 selected studies published from 1990 to 2020 were analyzed from the Web of Science database. The findings revealed an increasing and continuous focus on CM research. The leading journal for publishing CM research was "Computers & Education," and the United States was the country with the most published studies. The most frequently used keywords were categorized into four clusters to represent the four main themes of CM research. Subsequent analysis showed that the most applied learning subject was environmental science or natural science; traditional computers/devices were the most used devices/hardware; higher education students were the most used samples; quantitative methods were the most used research methods; computers as mindtools were the most adopted learning strategy; and concept mapping assessment was the most used measurement tool in the CM research. These findings reveal the trends of CM research and provide future research directions and applications of practical education for researchers and educators.