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Background: The presence of single-node metastasis (Ns) sometimes could be encountered in patients with oral squamous cell carcinoma (OSCC). The survival outcome for different Ns should be worthy of discussion. Methods: Patients diagnosed with OSCC at the National Taiwan University Hospital between January 2007 and December 2018 were reviewed. All patients with Ns were classified into two groups: with and without extranodal extension (ENE). Results: We analyzed 311 OSCC patients with Ns: 77 (24.76%) with and 234 (75.24%) without ENE. Lymph node (LN) >3 cm was the only significant factor associated with ENE (odds ratio 17.21, p < 0.001). The 5-year, disease-free survival of N1/N2A and N3B patients was 60.5% and 49.4%, respectively (p = 0.04), and the 5-year overall survival was 63.1% and 33.6%, respectively (p = 0.0001). Four fifths of Ns patients with LN >3 cm were upgraded to N3B category as ENE+. Postoperative radiotherapy (PORT) could provide significant benefit in regional control for Ns patients with (p = 0.03) and without (p = 0.0004) other adverse features. After multivariant Cox analysis, ENE+ was a modest and significant risk factor for disease-free (p = 0.08) and overall survival (p = 0.001). By contrast, the LN>3cm and N2A category were not significant risk factors for disease-free and overall survival. Conclusions: For OSCC patients with Ns, the survival outcome between N3B category and N1/N2A category was significantly different. After ENE+ upgrades (>80%), there were fewer N2A patients, and these patients became more comparable to N1 patients. PORT could significantly improve regional control for Ns patients. [ABSTRACT FROM AUTHOR]

Bamboo has recently become a key material in green engineering. However, measuring its transverse elastic modulus (ET) is difficult due to the inherent structural properties of bamboo culm. In this study, two micromechanical analytical models, the Chamis model and Reuss model, and a finite element (FE) inverse numerical method were used to calculate the elastic modulus perpendicular to the bamboo grain by using a specially designed strip-reinforced polymer specimen. A bamboo veneer microtensile test was used to verify these approaches. The effect of the specimen geometry on measurement accuracy was also determined. This novel approach was also used to determine the ET of two bamboo species. The Chamis model had the best performance because its assumptions regarding the fiber section geometry were consistent with the actual specimen; the Reuss model had the worst results. The result of the FE method was slightly distorted due to the high sensitivity of parameters. A parametric study revealed that the micromechanics and FE descriptions of the modulus of the resin–fiber combination differed. The fiber volume fraction affected the prediction accuracy, but not the width or spacing of the bamboo strips. The strain and stress distribution of composite repeating units were studied. The results of ET measurements for the two bamboo species were reasonable. In conclusion, a novel, verified, simple, and accurate method was developed for determining the ET of bamboo. [ABSTRACT FROM AUTHOR]

Untangling causal links and feedbacks among biodiversity, ecosystem functioning, and environmental factors is challenging due to their complex and context-dependent interactions (e.g., a nutrient-dependent relationship between diversity and biomass). Consequently, studies that only consider separable, unidirectional effects can produce divergent conclusions and equivocal ecological implications. To address this complexity, we use empirical dynamic modeling to assemble causal networks for 19 natural aquatic ecosystems (N24◦~N58◦) and quantified strengths of feedbacks among phytoplankton diversity, phytoplankton biomass, and environmental factors. Through a cross-system comparison, we identify macroecological patterns; in more diverse, oligotrophic ecosystems, biodiversity effects are more important than environmental effects (nutrients and temperature) as drivers of biomass. Furthermore, feedback strengths vary with productivity. In warm, productive systems, strong nitrate-mediated feedbacks usually prevail, whereas there are strong, phosphate-mediated feedbacks in cold, less productive systems. Our findings, based on recovered feedbacks, highlight the importance of a network view in future ecosystem management. Disentangling causal interactions among biodiversity, ecosystem functioning and environmental factors is key to understanding how ecosystems respond to changing environment. This study presents a global scale analysis quantifying causal interactions and feedbacks among phytoplankton diversity, biomass and nutrients along environmental gradients of aquatic ecosystems. [ABSTRACT FROM AUTHOR]

Wood has important engineering applications. However, some important parameters required in numerical simulations or engineering calculations, including the true longitudinal bending elasticity EL and shear modulus GLT and GLR, remain difficult to measure accurately. According to Timoshenko's beam theory, the total deflection of a beam under conventional center loading is affected by both bending moment and shear force. Therefore, E calculated from the total deflection is an apparent value. In addition, the measurement of G is difficult, and previously used methods may be insufficient. This study proposed a method that can measure E and G directly and accurately using a strain gauge and dial gauge simultaneously under a fixed span/depth ratio. The measured E and G values were compared with those obtained indirectly by adjusting the span/depth ratio and those measured using a four-point loading test. As a result, this method could be used to measure E and G accurately for wood in a standard bending test with standard specimens with span/depth ratio equal to 14. Other factors such as local indentation caused by the loading point, regression deviation caused by a change in span range, and influence of the selection of strain levels were also discussed. [ABSTRACT FROM AUTHOR]

Specifically, following McCracken et al.[5], Yang et al.[1] used correlation difference (X cross-map Y - Y cross-map X) as the definition of CCM causation (Fig. Author contributions C.-W.C., S.B.M., and C.-H.H. conceived the research idea; C.-W.C. designed the models and analyzed data; C.-W.C., S.B.M., and C.-H.H. wrote the manuscript. The correct definition of causation under CCM is improvement of cross-mapping skill with increasing time series length (i.e., convergence). In summary, the probability of detecting spurious causation in paired short white noise was very low; this was opposite to conclusions of Yang et al.[1] based on the incorrect definition of CCM. [Extracted from the article]

In this study, BaTi1-mZrmO3-4.5 mol.% Gd2O3-2.0 mol.% SiO2 ceramics with different Zr/Ti ratios and MgO contents were prepared via solid-state reaction. The MgO addition decreased the densification temperatures of the ceramics and increased the second phase Ba2GdZrO5.5 content. The temperature coefficient of capacitance curves of the ceramics had an almost linear variation with temperature, with negative temperature coefficients. With the increase of the Zr4+/Ti4+ ratio and MgO content, the temperature coefficient of capacitance rotated counter clockwise due to the lower Tm temperature, and a smaller tan δ and a higher electrical resistance were obtained at room temperature. The Zr4+ ion replacement and MgO addition reduced the Ti Ti ′ concentrations, and therefore, lessened the hopping conduction between Ti4+ and Ti3+ ions, while excess MgO produced V O ∙ ∙ and had an opposing effect. Additionally, larger amounts of MgO led to smaller grain sizes, and thus, more insulating grain boundaries. The change in the dielectric constant with the bias field, a typical nonlinear dielectric behavior, decreased with increasing MgO content and Zr4+/Ti4+ ratio. For BaTi0.70Zr0.30O3 ceramics with additives of 6 mol.% MgO, 4.5 mol.% Gd2O3, and 2 mol.% SiO2, the dielectric constant changed by a minimum value of 0.37% under a bias of 2.5 kV/mm. [ABSTRACT FROM AUTHOR]

A 10-bit 300 MS/s pipeline ADC utilizing time-domain MDAC is presented. The time-domain MDAC using only current sources and comparators to execute both signal subtraction and amplification is proposed to realize an opamp-less power-efficient structure without calibration. At the conversion rate of 300 MS/s with Nyquist input frequency, the ADC simulated in 40-nm CMOS exhibits an ENOB of 9.38 and 7.96 bits without and with device noise, respectively. It dissipates 19 mW at 1.2 V supply, where one-third of the power is consumed by the low-noise comparator. The noise analysis of the proposed time-domain MDAC is addressed. The active area of the ADC is 0.1 mm2. [ABSTRACT FROM AUTHOR]

"Real-world" data on the nationwide epidemiology and treatment patterns of multiple sclerosis (MS) is very scarce in Asia. This study is aim to evaluate the 10-years trends in epidemiology and treatment patterns of MS with Taiwan's National Health Insurance Database (NHIRD). Patients aged 20 years or older and were newly diagnosed with MS between 2007 and 2016 were identified. The crude incidences of MS were presented annually and stratified by sex and age. Baseline characteristics and treatment patterns, particularly disease-modifying drugs (DMDs), were also analyzed. This study included 555 MS patients (mean age was 36.9 and 74.4% were female). The crude incidence rate of MS decreased slightly from 0.43 per 100,000 persons in 2007 to 0.24 per 100,000 persons in 2015. The female to male ratios remained mainly between 2 to 3. Approximately 80% of MS patients received initial DMDs, with interferon β-1a as the dominant one. Furthermore, 37.5% of MS patients received subsequent DMDs, with fingolimod being the most frequently used. The median times from diagnosis to initial and to subsequent DMDs were 77 and 1239 days, respectively. This nationwide study provides up-to-date and sophisticated estimates of MS epidemiology and treatment pattern in "real-world" setting in Taiwan. [ABSTRACT FROM AUTHOR]

Our study aimed to investigate the incidence, risk factors and time to occurrence of malignancy in patients with dermatomyositis (DM) and polymyositis (PM). The electronic medical records of 1100 patients with DM and 1164 patients with PM were studied between January 2001 and May 2019. Malignancies after myositis were diagnosed in 61 (5.55%) patients with DM and 38 (3.26%) patients with PM. The cumulative incidence of malignancies in patients with DM were significantly higher than patients with PM (hazard ratio = 1.78, log-rank p = 0.004). Patients with DM had a greater risk of developing malignancy than those with PM at 40–59 years old (p = 0.01). Most malignancies occurred within 1 year after the initial diagnosis of DM (n = 35; 57.38%). Nasopharyngeal cancer (NPC) was the most common type of malignancy in patients with DM (22.95%), followed by lung, and breast cancers. In patients with PM, colorectal, lung and hepatic malignancies were the top three types of malignancy. The risk factors for malignancy included old age (≥ 45 years old) and low serum levels of creatine phosphokinase (CPK) for patients with DM and male sex and low serum levels of CPK for patients with PM. Low serum levels of CPK in patients with myositis with malignancy represented a low degree of muscle destruction/inflammation, which might be attributed to activation of the PD-L1 pathway by tumor cells, thus inducing T-cell dysfunction mediating immune responses in myofibers. A treatment and follow-up algorithm should explore the occurrence of malignancy in different tissues and organs and suggested annual follow-ups for at least 5.5 years to cover the 80% cumulative incidence of malignancy in patients with DM and PM. [ABSTRACT FROM AUTHOR]

Consumer attitudes and behaviors are fundamentally dynamic processes; thus, understanding consumer dynamics is crucial for truly understanding consumer behaviors and for firms to formulate appropriate actions. Recent history in empirical marketing research has enjoyed increasingly richer consumer data as the result of technology and firms' conscious data collection efforts. Richer data, in turn, have propelled the development and application of quantitative methods in modeling consumer dynamics, and have contributed to the understanding of complex dynamic behaviors across many domains. In this paper, we discuss the sources of consumer dynamics and how our understanding in this area has improved over the past four decades. Accordingly, we discuss several commonly used empirical methods for conducting dynamics research. Finally, as the data evolution continues into new forms and new environments, we identify cutting-edge trends and domains, and offer directions for advancing the understanding of consumer dynamics in these emerging areas. [ABSTRACT FROM AUTHOR]

Background: Electrical cortical stimulation is shown effective in treating patients with drug-resistant epilepsy. We demonstrated how detailed procedures of pre- and intra-operative planning of cortical stimulation implantation may influence the results of seizure reduction rate. Methods: To confirm the precision of subdural grids covering the epileptogenic foci in the eloquent regions, pre- and intra-operative video-electroencephalography (VEEG) were performed in patients with drug-resistant epilepsy during a 4-day 24-h monitoring. The localization of the grid was determined via 3D reconstruction imaging of subdural electrodes co-registered onto the patient's cortex. A final quadripolar lead in cyclic stimulation mode was then placed and secured on the target cortex area. Post-operative 3D CT ensured the accurate location of stimulation lead without any misplacement. Bipolar cyclic stimulation and post-implantation VEEG were performed for 7 days. Patients were discharged and followed up regularly for parameters adjustment and recording of seizure outcomes. Results: Eight patients received chronic cortical stimulation implantations between February 2003 and December 2017. The mean age of these patients was 21.1 years old and the average post-operative follow-up was 77.3 months. Comparisons of their seizure frequency at baseline and during the postoperative period revealed a mean reduction in seizures of 60.4% at the first year and 65.6% at the second year. Conclusions: Pre-surgical planning enhanced the accuracy of electrode placement and led to a favorable seizure reduction rate. Our report confirms that electrical cortical stimulation with detailed implantation procedures is safe and effective for patients with drug-resistant epilepsy originating from eloquent cortex. [ABSTRACT FROM AUTHOR]

Background: The incidence of cefepime-induced neurotoxicity (CIN) has been previously underestimated, and there have only been sporadic reports from critical neurological settings. The present study aimed to investigate the potential factors associated with disease development, electroencephalography (EEG) sub-classification, and outcome measures.Methods: The 10-year medical records of patients who underwent EEG between 2007 and 2016 at a tertiary medical center in Taiwan, and developed encephalopathy after cefepime therapy were retrospectively reviewed. Age- and sex-matched controls were included for further analysis. Demographic data, the occurrence of clinical seizures, non-convulsive status epilepticus (NCSE), use of antiepileptic drugs (AEDs), receiving maintenance or urgent hemodialysis, EEG findings, and functional outcomes were analyzed. The Chi-square test and a logistic regression model were applied to survey significant prognostic factors relating to mortality.Results: A total of 42 CIN patients were identified, including 25 patients from wards and 17 from intensive care units; their mean age was 75.8 ± 11.8 years. Twenty-one patients (50%) had chronic kidney disease, and 18 (43%) had acute kidney injury. Among these patients, 32 (76%) received appropriate cefepime dose adjustment. Three patients had a normal renal function at the time of CIN onset. The logistic regression model suggested that maintenance hemodialysis and longer duration of cefepime use were independently associated with the development of CIN, with odds ratios of 3.8 and 1.2, respectively. NCSE was frequently noted in the CIN patients (64%). Generalized periodic discharge with or without triphasic morphology was the most common EEG pattern (38%), followed by generalized rhythmic delta activity and generalized spike-and-waves. AEDs were administered to 86% of the patients. A total of 17 patients (40%) did not survive to hospital discharge. Adequate cefepime dose adjustment and early cefepime discontinuation led to a better prognosis.Conclusions: CIN was associated with high mortality and morbidity rates. Neurotoxic symptoms could still occur when the cefepime dose was adjusted, or in patients with normal renal function. Patients with maintenance hemodialysis or a longer duration of cefepime therapy tended to develop CIN. Early recognition of abnormal EEG findings allowed for the withdrawal of the offending agent, resulting in clinical improvements and a better prognosis at discharge. [ABSTRACT FROM AUTHOR]

Objective: Toxic leukoencephalopathy is a rare but critical neurological disorder in heroin abusers. Our aim is to compare the clinical manifestations, brain MRIs and prognoses of heroin-induced leukoencephalopathy by different intake routes.Methods: We present two patients with toxic leukoencephalopathy caused by intravenous (IV) injection of heroin and 48 additional cases from systematic reviews of the literature published between 1994 and 2018.Results: Among the 50 heroin abusers who developed leukoencephalopathy, inhalation was the most popular route (60%), followed by IV injection (30%) and snorting (10%). Mental changes, mutism and urine/fecal incontinence were the major symptoms in patients who IV injected heroin, while cerebellar ataxia and dysarthria were more common among those who inhaled heroin. Delayed-onset encephalopathy uniquely occurred in those who IV injected heroin, whereas progressive encephalopathy was more commonly observed in those who inhaled heroin. Clinical improvement was observed in 60% of patients, the overall mortality rate was 12%, and higher mortality was observed in patients who used the inhalation route (16.7%). The hallmarks on the MRIs of those who inhaled heroin were posterior to anterior involvement of the cerebral white matter and lesions in the posterior limbs of the internal capsules, cerebellum and brainstem. In contrast, those who IV injected heroin had more frequent lesions in the subcortical U fibers and the genu of the internal capsules.Conclusion: These data could help physicians make an early diagnosis and predict prognosis and suggest that prompt antioxidative or symptomatic treatments might reduce the long-term consequences and mortality of heroin-induced leukoencephalopathy. [ABSTRACT FROM AUTHOR]

Ecological theory suggests that large-scale patterns such as community stability can be influenced by changes in interspecific interactions that arise from the behavioural and/or physiological responses of individual species varying over time. Although this theory has experimental support, evidence from natural ecosystems is lacking owing to the challenges of tracking rapid changes in interspecific interactions (known to occur on timescales much shorter than a generation time) and then identifying the effect of such changes on large-scale community dynamics. Here, using tools for analysing nonlinear time series and a 12-year-long dataset of fortnightly collected observations on a natural marine fish community in Maizuru Bay, Japan, we show that short-term changes in interaction networks influence overall community dynamics. Among the 15 dominant species, we identify 14 interspecific interactions to construct a dynamic interaction network. We show that the strengths, and even types, of interactions change with time; we also develop a time-varying stability measure based on local Lyapunov stability for attractor dynamics in non-equilibrium nonlinear systems. We use this dynamic stability measure to examine the link between the time-varying interaction network and community stability. We find seasonal patterns in dynamic stability for this fish community that broadly support expectations of current ecological theory. Specifically, the dominance of weak interactions and higher species diversity during summer months are associated with higher dynamic stability and smaller population fluctuations. We suggest that interspecific interactions, community network structure and community stability are dynamic properties, and that linking fluctuating interaction networks to community-level dynamic properties is key to understanding the maintenance of ecological communities in nature. [ABSTRACT FROM AUTHOR]

B Correction to b : I Nature Communications i https://doi.org/10.1038/s41467-022-28761-3, published online 03 March 2022 The original version of this Article contained an error in the Acknowledgements, which incorrectly read: "Data for Lake Võrtsjärv were provided by Estonian Environment Agency and by the Centre for Limnology at Estonian University of Life Sciences funded by the Estonian Research Council grants PRG 1167 and PRG709, and by the European Union's Horizon 2020 research and innovation programme under grant agreement No. 95196." The correct version replaces this sentence with "Data for Lake Võrtsjärv were provided by Estonian Environment Agency and by the Centre for Limnology at Estonian University of Life Sciences funded by the Estonian Research Council grants PRG 1167 and PRG709. [Extracted from the article]

Investigation of the causes of vestibular symptoms in patients with chronic otitis media (COM) faces frustration, mainly because the bithermal caloric test using tap water is generally contraindicated in perforated ears. This study utilized audiometry, ocular vestibular-evoked myogenic potential (oVEMP) test, and cervical VEMP (cVEMP) test to evaluate inner ear deficits after COM. A total of 85 COM patients (117 ears) underwent otoscopy, image study, audiometry, oVEMP test, and cVEMP test. Mean bone-conducted (BC) hearing threshold ≤25 dB was observed in 74 ears, 26-40 dB in 30 ears, and >40 dB in 13 ears. Restated, abnormal BC hearing threshold was identified in 43 ears (37 %). Percentages of abnormal cVEMP test, oVEMP test, and BC hearing threshold in 117 COM ears were 65, 62, and 37 %, respectively, exhibiting a significantly declining sequence in inner ear function. Furthermore, cVEMP/oVEMP test results were significantly correlated with BC hearing threshold, whereas no correlation existed between the cVEMP and oVEMP test results. In conclusion, the sequence of inner ear deficits after COM runs from the saccule/utricle to the cochlea and semicircular canals. Restated, in addition to BC hearing test, the cVEMP/oVEMP test may serve as a supplementary tool for early detection of inner ear involvement in COM patients. [ABSTRACT FROM AUTHOR]

A highly sensitive detection of breast cancer marker, carbohydrate antigen 15-3 (CA 15-3) by carbon nanotube (CNT) based immuno-polymerase chain reaction was reported. The study was aimed to develop a precise and sensitive method to diagnose breast cancer and its recurrence. The hydrofluoric acid (HF) treated silicon wafer layered with bundled CNT was used as the substrate. The surface was treated with HNO/HSO to graft carboxyl groups on the tips of CNT. Subsequently, polyoxyethylene bis-amine was grafted to conjugate anti human CA 15-3 antibodies. Water contact angle measurement, scanning electron microscope, Fourier transform infrared spectrometer, Raman spectrometer and sodium dodecyl sulfate polyacrylamide gel electrophoresis were employed to confirm the surface modification. The captured antibodies on the CNT were used to capture the target antigen CA 15-3 and the biotinylated secondary antibodies were subsequently bound with the target antigen. A bi-functional streptavidin was used to link biotinylated DNA to the biotinylated detection antibodies. The biotinylated target DNA was amplified by PCR, and then analyzed by agarose gel electrophoresis. The lower limit of detection of CA 15-3 by the proposed immuno-PCR system was 0.001 U/mL, which is extremely sensitive than the other bioanalytical techniques. [ABSTRACT FROM AUTHOR]

Boron-doped, single (∼54 nm) or double (∼21 + 54 nm) Si1−xGex layers were epitaxially grown on 300-mm-diameter p−-Si(100) device wafers with 20 nm technology node design features, by ultrahigh vacuum chemical vapor deposition. The Si1−xGex/Si wafers were annealed in the temperature range of 950–1050 °C for 60 s to investigate the effect of annealing on possible changes of Ge content and Si stress near the Si1−xGex/Si interface. High spectral resolution, micro-Raman spectroscopy was used as a nondestructive characterization technique with five excitation wavelengths of 363.8, 441.6, 457.9, 488.0, and 514.5 nm. Ge diffusion and generation of compressive stress at the Si1−xGex/Si interface were measured on all annealed wafers. Ge diffusion and the accumulation of compressive Si stress after annealing showed significantly different behaviors between single- and double-layer Si1−xGex/Si wafers. Raman characterization results were compared with secondary ion mass spectroscopy and high-resolution x-ray diffraction results. [ABSTRACT FROM PUBLISHER]

Since this paper was first published, the publisher has been informed of an additional contributing author, Chun-Wei Chang. No other changes have been made to the text. [ABSTRACT FROM AUTHOR]

The article discusses a study which further investigates the phytochemical aspects of Annulohypoxylon ilanense. The study subjects the n-BuOH-soluble fraction of the fungus to solvent partitioning and chromatographic separation to afford 25 pure substances. It also determines the structures of the isolated compounds found in the fungus by extensive analysis of their spectroscopic data as well as by comparison with literature reports.

Cerebral cavernous malformation (CCM) is a vascular malformation characterized by clustered enlarged capillary-like channels in the central nervous system. The genes harboring variants in patients with CCM include CCM1/Krev interaction trapped-1, CCM2/MGC4607, and CCM3/programmed cell death protein 10. We aimed to identify pathogenic variants in an ethnic Chinese population in Taiwan. We recruited 95 patients with multiple CCMs or a single lesion with a relevant family history. Sanger sequencing was performed for 41 patients. Variants were identified using sequence alignment tools, and the clinical significance of these variants was determined using American College of Medical Genetics and Genomics standards and guidelines. Several pathogenic variants were found in six patients, including three unrelated patients and three affected members of one family. Two novel pathogenic variants leading to early truncation comprised a deletion variant in exon 18 of CCM1 (c.1846delA; p.Glu617LysfsTer44) and an insertion variant in exon 4 of CCM2 (c.401_402insGCCC; p.Ile136AlafsTer4). One novel pathogenic splice site variant was c.485 + 1G > C at the beginning of intron 8 of CCM1. In this study, we identified novel variants related to CCM in an ethnically Chinese population in Taiwan. [ABSTRACT FROM AUTHOR]